Newborn Care Frequently Asked Questions
By Michael Schoenwetter, M.D. and Loraine Stern, M.D.

The most frequently asked questions in my practice from parents of newborns are discussed in detail in the newborn care video. These topics include jaundice, congestion, skin disorders and many others.

One topic not discussed in the video is medication usage by nursing mothers. A breast-feeding mother should not take any medication unless discussed with her physician. Although most are safe, a great resource to answer questions regarding medicines and breast-feeding is LACTMED.

I practice in Southern California so I get a lot of questions regarding sun exposure. A newborn's skin is very sensitive and can burn easily. When outside with a newborn, direct sun should be avoided and the baby should wear appropriate clothing to cover his/her skin, including hats. Remember, babies can get sunburn in the shade. It is okay to apply a small amount of sunscreen to an infant if sun exposure is unavoidable.

Since the "Back to Sleep" campaign was initiated - putting a baby on its back to sleep - the incidence of Sudden Infant Death Syndrome (SIDS) has dramatically decreased. Due to this recommendation, we have seen an increase in head shape asymmetry, as prolonged pressure on the same spot on the newborn's head can result in shape change. Occipital flattening, where the back of the head flattens, and plagiocephaly, when the side of the head flattens, are now frequent issues. Make sure your baby can easily turn its head in both directions and also give the baby tummy time when not sleeping. If you feel that your newborn always lays its head on one side or its head shape is flattening, you need to see your pediatrician. Intervention, which might include physical therapy, repositioning the head, or a specialized helmet, can help the majority of head asymmetry, especially if acted on early.

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Fever
A common concern for parents is when their baby runs a fever. I have addressed some important information below:

In a baby under 3 months, any temperature over 100.4 is a fever. Because small infants cannot fight infection as well as older infants and children, you should call your pediatrician immediately. For older infants and children, a temperature of 101 or above is considered a fever. Body temperature can be raised by playing in the hot sun or by overdressing. Unless your child is acting sick, wait a few minutes and repeat the temperature after cooling off. Again, a newborn should go to the pediatrician immediately when having a 100.4 temperature.

What's True about Fevers
Fever is a part of the body's natural response to invasion by germs. The reason to lower fever is for your child's comfort, so that drinking fluids is easier.

What's Not True
Treating fever does not interfere with the body's ability to fight infection.

Call your pediatrician immediately or go to the emergency room if:

• Your child has a weak cry

• Is abnormally quiet with a vacant stare

• Is difficult to arouse

• Is grunting or moaning

• The fever is associated with a rash

• Your child was recently exposed at to a serious infection, such as meningitis.

Again, if your newborn runs any fever, call your pediatrician immediately.

Should You Have Your Baby Sleep With You

Although the American Academy of Pediatrics and other newborn organizations do not recommend co-sleeping, many parents still find it convenient and loving to have their newborn in bed with them. Breast feeding your newborn is easier if you don't have to get up, for example.

The safer way to have your newborn with you is to use a co-sleeper that attaches to your bed. Then you will only need to roll over and take the baby out. There are also sleepers that contain baby in a safe space between parents.

If you fall asleep while nursing your newborn, be sure the baby cannot fall off the bed, get tangled in the blankets or bury his or her face in or under a pillow. Remember that you may be exhausted and it is important to make sure your newborn is in a safe sleeping environment.

We hope these frequently asked questions are helpful and please check back as we will be adding more new information regarding newborn care.

Insurance for Newborn

Medical insurance can be a very confusing topic for new parents. In most states, the newborn is automatically under the mother's medical insurance when born. With some insurance plans, the parent does have a responsibility to add the newborn to their policy if they want the coverage to continue. This is a step that is sometimes forgotten and can cause problems at the doctor's office, billing issues and even lapses in medical coverage for the newborn.

Usually, which doctor you choose is based on the type of medical insurance you possess. Remember, just because the doctor is in your plan or takes your insurance carrier does not always mean that everything that is done at the doctor's office is a covered benefit. There might be certain exclusions or limitations of your particular policy. I find in my practice that well child care benefits, including vaccine coverage, are the most common areas of coverage where families do not completely understand what is covered and what is not.

I strongly recommend reading your insurance policy from cover to cover and understanding exactly what your benefits are. This will avoid confusion at the doctor's office and prepare you for medical expenses you are likely to incur.

Post-partum Depression in Fathers

A study published in the Journal of American Medical Assn. found that over 10% of men experienced depression at some point between the first trimester and one year after birth. This is double the rate for men in general.

In the past, post-partum depression has been viewed as a disorder of motherhood and how the father was affected has been largely overlooked. The more contemporary father has different stressors than fathers of the past, as the number of women joining the workforce has significantly increased. This has changed expectations on the father to increase household responsibilities.

Marital problems, financial issues and an ill or colicky baby can increase the risk of depression. Also, sleep deprivation plays a large role. Even healthy men and women will start to show signs of depression after one month of inadequate sleep. Paternal depression can be harder to recognize. A woman will most likely be sad and withdrawn while a man might become more angry, irritable or detached.

Be sure to consult with your doctor if you suspect depression in either the mother or father.

Chord Blood: To Bank or Not To Bank

If you are pregnant you have probably received solicitations from for profit companies offering to arrange to save your baby's cord blood. It may be touted as "biological insurance." I recently received an email from a former patient who moved away. (Grand patients are one of the blessings of a long career.) She wanted to know whether she should opt to bank her new born's cord blood. She was confused because she couldn't find any consensus among  authorities. The reason she could not find a consensus is that as of now there is none.

Should you do it?
Cord blood contains stem cells, that can be transplanted to treat blood, metabolic, immunologic or malignant disorders. They are not useful for a vast array of medical conditions yet although in the future that will probably change. As of now, the disorders for which stem cells are useful are a few specific conditions. If a child develops leukemia, for example, his or her own cells are not useful because those are already programmed to turn into leukemia; those of a matched sibling without leukemia might be.

There are various studies around the country examining the usefulness of cord blood stem cells in other conditions. For example, the Medical College of Georgia is studying whether infusions of stem cells can help children with cerebral palsy.. As more and more of these are reported to be successful, cord blood will be more desirable.

Saving cord blood for possible future use is a highly individual decision. If your family has a history of certain genetically transmitted diseases or malignancies, talk with your pediatrician and/or a genetic counselor. Seek information from a specialist treating the disease that runs in your family. If you are not at high risk, the choice is not clear. The chance of needing these cells with no risk factors is estimated anywhere from 1 in 5,000 to 1 in 100,000. Not zero but not high.

There is an initial cost and a yearly maintenance fee, which is not inconsiderable. What we should have is a national cord blood bank similar to the traditional blood bank but that is not generally available yet. There are only a handful of not-for-profit cord blood banks. One is one through the National Institutes of Health for families with a close relative that has a possibly treatable condition. The American Academy of Pediatrics (AAP.org) has a detailed section for parents with a list of questions and answers (Healthy Children.org/cord blood banking).

If you want to save your new born's cord blood you must prepare for it before your due date so the delivery room is set up to capture it. Several weeks before give the information to your obstetrician and to the hospital where you will deliver. If there is a life threatening emergency for you or your baby around your delivery the procedure may fall by the wayside. If you have a good amount of disposable income and want to do it without a medical reason, fine. But if it is a sacrifice and you do not have a medical history that makes it advisable, think twice.

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