DIET
Nothing should be fed to your child except breast milk, formula, or water, until 4 months of age. We do not feed infants anything else since other foods may cause allergies if fed too early. We believe that children inherit the chance, or gene, to get allergies, then some trigger causes the gene to turn on and look for something to become allergic to. Certain foods and exposure to high concentrations of dust, pollen and mold appear to be this trigger. The foods may not cause allergies to themselves but can turn on the immune system so that it becomes allergic to something else. Rice cereal may be fed at this age if you desire, as it probably does not induce allergies. Some physicians will start rice at 4 months, some at 2 months and for certain medical problems we will start it at less than 2 weeks. The only thing this may cause at this age is a little constipation, and that is unusual. If you wish to start rice cereal, you may feed it by spoon mixed with water, breast milk or formula, or you may put it in the milk. A teaspoon per bottle to a tablespoon per ounce may be mixed with the formula, but make sure to cut a slit in the nipple so it doesn't clog it. Do not feed rice-apple, rice-banana or oatmeal. No juices will be given until 4 months unless directed by the physician.
BREAST FED INFANTS: All infants should receive 200-400 micrograms of Vitamin D. Vitamin D is essentially for Calcium metabolism and bone strength. Infants who are Vitamin D deficient can get Rickets (severe weakness of the bones). Breast milk does not contain Vitamin D. 12 ounces of formula contains the minimum requirement of Vitamin D (200 micrograms). If you are supplementing with more than 12 ounces of formula per day, then no additional vitamins are necessary for the baby. If you are exclusively breast-feeding or giving less than 12 ounces of formula, the buy TRI-VI-SOL vitamins (over the counter) and give the amount recommended on the bottle for your infants age.
COMMON PROBLEMS & ILLNESSES
Colic may start at 5-8 weeks of age, and if you think your child has it, then please refer to your NEWBORN BOOKLET in the glossary section on how to diagnose and treat colic.
Your NEWBORN BOOKLET covered two areas that I would like to repeat, circumcision and the umbilical cord. An UNCIRCUMCISED foreskin will be adherent to the head of the penis at first. Usually only good cleansing is required and the foreskin will be retractable by 2 to 3 years of age. Occasionally the opening of the foreskin is tight or small and will require gentle traction at each bathing to GRADUALLY expand the opening so that the foreskin is retractable by several years of age. A whitish material about the head of the penis is normal and should be cleaned off. As your son learns how to bathe himself, teach him how to clean and retract the foreskin to its normal position to prevent swelling and tightening. On a CIRCUMCISED penis, the head of the penis should have a helmet shape with a lip around the rim. Occasionally the foreskin will grow over the head of the penis again or will adhere to the head of the penis. If this happens, then gently pull the foreskin off of the head of the penis a little each day. I will show you how to do this if you are unsure how. Occasionally you may also notice a whitish material under the adherent foreskin. This is normal and is just skin cells that are being shed off from the trapped skin. Notify the doctor that performed the circumcision or me immediately if the rim has not fallen off in 8 days, you notice an unusual swelling or redness, a foul odor or if the rim slips off onto the shaft of the penis.
The UMBILICAL CORD will usually fall off in about 7 to 21 days, the record is 6 months, I believe. When the cord falls off, there will still be greenish mucus where it fell off. This will last for 3 to 5 days and should be cleaned just like the cord was. A small amount of bleeding or oozing is also normal after the cord falls off, and this should disappear in 2 to 3 days and should not be more than a few drops. If the greenish ooze lasts more than 2 weeks, then there may be a remnant of the cord left, and you should call the doctor. We will cauterize this with a painless silver nitrate chemical stick in the office.
The most common question at this visit is about nasal congestion. Every baby has it, every new parent is worried about it, and every grandparent worries the parents needlessly about it. If this is not your first child and this baby seems to have it worse, then it might be because of the time of the year the babies were born. Nasal congestion is much worse in dry air (cold dry winter air or air conditioning drying out the air in the summer). Please refer to your newborn booklet if you have questions about this topic.
NEXT VISIT : 6-8 weeks of age for the 2 month check up and the first set of vaccines.
