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The Three Week Well Check Up

Your baby should be alert and respond to noise. They should be watching  bright lights but the vision is not clear yet. That is why they cross their eyes a lot. Get a picture of the crossed eyes .. they are cute! It’s normal unless the eyes are continuously crossed. They have a reflex grin in their sleep but not "smiling" back at you. The first development you should watch for is not rolling over, which they may accidentally do occasionally. They do not role over every day until over 2 months old. The first development is smiling back when they see your smiling face and start to coo at you. Then their vision is crystal clear and this occurs between 1 & 2 months old.

They should be eating often.  Feed them as often as they want to eat…. Breast or bottle.  Babies have small stomachs and cannot hold but a limited amount.  If they are hungrier that day, they first eat the same volume more often.  Then when their stomachs grows bigger, they eat a larger volume less often.

        Example: _____4oz .............4oz .............4oz .............4oz

        ____________4oz...... 4oz...... 4oz .....4oz..... 4oz..... 4oz

        ____________6oz.............. 6oz............. 6oz............. 6oz

 So when they hit a growth spurt, they will eat often so feed them! The babies do not over eat, but you can force them to eat more than they need. As soon as they seem satisfied, stop. You are not over feeding if    the baby is sucking it down. Fat babies do not grow into obese adults.  No correlation! You may start Rice cereal when they need it.....when the 4 oz  bottle does not satisfy them 4 hours and they are hungry 1 or 2 hours   later, start cereal in that bottle that they are not satisfied with. Add enough spoonfuls of rice baby cereal to the bottle of formula until it is a “thick slush”. Then cut a larger hole in the nipple &/or cross cut it. You can use an infant feeder too. Adjust the hole size so that the slush is coming out at the correct speed. They do not use a spoon well until 3-4 months old …. but if you would like to use a spoon, go for it.  Definitely use a spoon by 5-6 months old. The purpose of the cereal is to give them a satisfied feeling. It does not make them sleep through the night any sooner.  The cereal is not needed for growth.  So wait until they need it. You also may give juice for constipation.   Stick with apple, pear or prune. No citric acid juice; no wheat, barley,  or mixed cereal, and no vegetables or meats till 6 months old (this is  important for many reasons, please wait.)  You can use the adult juice and water it down strength.  Dilute the baby juice to strength. Start with 1 or 2 oz and increase as needed to loosen the stools.

Advantages of breast feeding.  If you are not successful at breast feeding, don't have a melt down.

If they are breast fed, they also may feed frequently, for the same reason above, plus the frequent feedings cause the breast supply of milk to increase as the baby’s demands increase.  You can strictly breast feed until 6 months old. You do not have to give them extra water when you are breast feeding (or bottle feeding either).  If you have to go back to work later, you can keep the baby acquainted with a bottle by pumping breast milk out and let others feed it to them. Or if unable to get more milk out, you can give a bottle of formula once a day in the evenings and that one bottle a day will not turn them off to the breast. Then they will take a bottle later from the sitter.

After one week of age, they should be gaining 1 once a day so you can plot their weight and height on the curves supplied from my web site or ask the doctor for one.  You can take them out for walks and they can travel in cars or planes.  It does not hurt their ears to fly generally till 4 years old.  Keep sleeping them on their backs until they can role over both ways.  Rotate their sleeping position so that they spend equal time on both sides of their heads.  If they sleep on one side all the time the skull will misshapen.  Let us know if the baby keeps their head turned to one side all the time.  If  they are congested or if they prefer, you can sleep them in a carrier or in the swing all night.  It does not hurt their back.    Keep them on their back with no blankets or pillows near their face.  Also there is less crib death if no smoking in the house (and less illnesses too).  There are less illnesses and better development if the parent stays home with the child and not put them in daycare.

The cord should be off but we have seen them go 2 months before falling off.  Don’t be alarmed if it has not come off yet.  Keep cleaning it with alcohol sparingly and infrequently.  The only sign of trouble with the cord is if it gets infected, there will be a 2 inch area of redness around the cord. (See photograph at the web site.)   We will not know if there is a hernia (outy) until 2 months old. You should not cover the umbilical area  with tape or binder because a hernia will go away later almost all the time without treatment.  Clean the face with mild baby soap.  I recommend using no-tears baby shampoo.  Baby acne starts now and worse  by 1 month old.  Clean the face and leave it dry.  Lotions and oil will clog more pores and cause more trouble.  Wash your breast area with mild soapy water to decrease your body oils and bacteria if you are breast  feeding.  Watch out for your makeup and after-shave when you put the baby against your cheek.  If there is going to be cradle cap, there may be flakiness across the eyebrows.  Cradle cap will be burnt orange scales on the scalp after 2 months of age.  This first month there is just dry skin on the scalp.  You may put oil on the scalp and you can put lotion on the body.  Leave the face alone.  I do not recommend wipes  for cleaning their bottoms, hands or face. Use water and paper.  Then put Vaseline or A&D on the bottom.  If it is a girl, they have mucus coming out of their bottoms for weeks and sometimes it's bloody. That’s OK.   Spread the small labia so that you can see the entrance of the vagina, cleanse with just water and paper, leave some of the white mucus there, and put a wall of Vaseline between the labia to repel stool away and  keep the labia from getting stuck together. This is a common problem in girls and you need to do this for 2 years; or we have to break open the adhesions which bleeds and is painful. It is common but no one mentions it. Spread them several times every day. Boys have  the same problem. If they are circumcised, gently pull the skin back to the ridge of the glans every day and put Vaseline to keep it from getting stuck to the head. If they are not circed, push the skin back to see the  tip of the head in the opening of the foreskin, but you do not have to  pull it all the way back. We just do not want the tip to scar down to a pin point opening.

Be sure you have gotten the second PKU. We will not do the second Hep. B shot now but would rather wait till later.  If there  are illness symptoms, call for an appointment. If they run fever in the  first 2 months, then bring them in immediately to the clinic or Cook's ER if after hours.   We want to see them soon in the next 2 hours if the infant is less than 2 months of age. Fever is 100 or more under the arm.  It is 101 in the rectum. The ear thermometers are terrible and I do not recommend them.  We use them in the office just to give a ballpark number but if they are borderline, it is not accurate.  

If there is blockage of the tear duct, you will see constant tearing and matting up of the eye.   See my web page for instructions for that.  If you see the center pupil become gray or white or different from the other pupil, call the office right away.  There are no treatments for colds and congestion until much older. You can suction the nose and sleep them with the head elevated sitting up in a seat. Vaporizers and humidifiers can help some but some it makes them worse so watch it.

All babies have "colic" in the evenings for 2 hours up to 2 months of age.  Usually you can pacify them with a pacifier, hold them and rock them, put them in the swing or vibrating chair.  If they are screaming for 2 hours in the evenings, call for some colic medication that works.  The gas medicine from the stores does not usually work.  Most of the time we will try to talk you out of using medication, but if it is bad then call.  There is an anti-cramp medication that can help these cramps.  It is not the gas and that is why the Milacon does not help.

Most medications will be fine with breast feeding but check with us if there is any questions about medications with breast feeding.  Do not take Ibuprofen in the first month because it will cause the Jaundice to be worse than it appears.  After 1 month you can take Ibuprofen.

 The baby’s next visit is at 2 months old. Call this week for that appointment.  There may be a wait for the next available appointment so call early.   We still do checkups and vaccinations in spite of colds or illnesses.  That's an old wise tale we stopped long ago, so come in for their checkups if they are well or sick.

Dr. Knapp