How Our Practice Is Organized 

For newborn care at Hackensack University Medical Center and The Valley Hospital, we practice as a group. One of us will see both you and your child daily. We all hope to get to know you and let you get to know us. In our office you may select the doctor of your choice and they will be considered your child's primary care giver. However, please understand that if an appointment with that doctor is not possible, we are in full agreement on general medical care to your child and have complete confidence in each other's clinical expertise. We see patients by appointment only. For well child visits, please request your primary physician and we will do our best to accommodate you. If your child is ill, please call in the morning so that if the child needs to be seen we can try to find time with the doctor of your choice.

Calls to the Office
Please feel free to call if you have any questions. Please call between 10:00AM and 4:00PM with ordinary problems or questions. Call any time if you have an emergency. We have a staff of excellent nurses who will be able to answer most of your questions. If for any reason the nurse is unable to help you, she will either speak to the doctor and get back to you or have the doctor speak to you. If you wish to speak to a physician, please ask and they will  call you back at their earliest convenience. Unless it is an emergency, a physician will not leave a patient to take a phone call. When you call, we find that the following suggestions will be helpful.

Give the age of your child
1. If your child is ill, please take a rectal temperature (or oral temperature in an older child) before calling. Feeling the skin is inadequate and can be misleading. If you do not know how to take a rectal temperature, our nurses will be happy to teach you.
2. Have a pencil, paper, and your pharmacy's phone number handy to record any instructions that might be given.
3. Please refrain from using your telephone until your call has been returned, especially in case of an emergency.
4. If you will be leaving home before the call might be returned, please inform us of the times you will be available or leave a cell phone number.

Suggested Reading
Some excellent books that deal with child development and problems of early childhood: Infants and Mothers by T. Berry Brazelton, M.D., The Magic Years by Selma H. Fraiberg, Your Baby and Child by Penelope Leach, What to Expect the First Year by Eisenberg, Murkoff, Hathaway and Caring for Your Baby and Young Child Birth to Age 5 by Steven Shelov.


Equipment
The following should be obtained ahead of time and be stored in a safe place, out of the reach of children.
1. Thermometer (rectal): Familiarize yourself with its use. If broken, get another one right away. Always take the temperature before you call the doctor. Glass thermometers should not be used!
2. Vaporizer: An ultrasonic nebulizer is the most effective and quietest. A cool mist is adequate. A hot mist vaporizer heats up the room and may make fever control more difficult. Use a good 8 hours type with an automatic cut-off. Use only distilled water and be sure to follow all cleaning instructions that came with the machine.

3. Nasal Aspirator:  May be obtained for use in nasal obstruction associated with a cold.
4. Salt Water (Saline) Nose Drops:  Dissolve ¼ teaspoon of table salt in 8 ounces of warm water or saline drops may be purchased at your pharmacy.  Place 3-5 drops in each nostril before feeding and at bedtime.
5. Tylenol (Acetaminophen) Drops may be used for a fever.  Aspirin should never be given to a child.
6. Pediacare or Sudafed:  Available without prescription.  Use for colds and coughs in children over 4 years of age.
7. Mortin:  Children’s (Ibuprofen):  To be used for fevers over 101°F.  5 ml for 24 pounds of body weight every 6-8 hours in children over 6 months of age.
8. Benadryl:  For allergic symptoms of nasal congestion, itchy eyes or skin rash and be sure to follow all cleaning instructions that came with the machine. 

Vomiting and Diarrhea

Occasional vomiting and loose stools are seen with colds. The child with bad diarrhea and/or vomiting should be treated as follows:
A. First 24 hours: Give only clear liquids such as Pedialyte liquid, Pedialyte freezer pops, half strength Gatorade or flat Cola. Do not give orange juice. It is best to only give small but frequent feeds.
B. Second 24 hours: Continue clear liquids. Offer solid foods such as jello, applesauce, room temperature yogurt, bananas, rice and boiled carrots.
C. Third 24 hours: With gradual improvement, slowly begin to give his/her regular diet.

Vomiting which continues for 12-24 hours while giving clear liquids should be brought to our attention. Remember, the younger the child, the sooner he should be seen by a doctor. 

CARE OF THE UMBILICAL CORD
Apply rubbing alcohol three times a day with a "cotton swab" directly to the cord base, lifting the dry cord to expose the base. It is not uncommon to notice some slight bleeding before the cord drops off or in the first few days after separation. Call the office if you should notice any foul odor or increased swelling and redness from the umbilical cord.

The application of alcohol to the umbilical cord is not currently felt to be required, however as many parents still prefer to use it, we support this if it is your desire.  Thereafter, the belly button should be cleaned with soap and water at each bath. If there is still wetness or a discharge 48 hours after the cord has come off please call our office, as the baby may need to be seen.

CARE OF THE CIRCUMCISION AND GENITALIA
The circumcision will ordinarily be healing by the time you leave the hospital. Vaseline should be applied with each diaper change while the skin is raw to prevent sticking to the diaper. A small amount of bleeding may occur due to irritation from the diaper and is no cause for alarm unless it persists or increases. A yellow film may develop on the head of the penis and is normal.


Some female infants will have a mucousy or slightly bloody discharge from the vagina soon after birth. This is due to withdrawal of maternal hormones after birth and is no cause for concern.

COLIC AND GAS
Many children will develop some stomach distress associated with feedings when 10-14 days old. Either during or shortly after feedings they will scream, drawing their legs up and pass gas. This is often alarming to parents who mistakenly blame the formula or breast feeding. In these infants the feeding causes cramps. If mild, the baby will interpret this as hunger pains causing frequent feeding. If severe, the baby will feel the urge to move its bowels and strain, pushing out more gas. There is no effective treatment and you will not spoil the infant by carrying and comforting him or her. You may wish to discuss this with one of our nurses but colic is NEVER an emergency and calls concerning it should be restricted to regular hours. The baby generally outgrows it by four months. 

BOWEL MOVEMENTS
Breast fed babies will usually have more frequent and more watery bowel movements than formula fed babies, sometimes with each feeding. However, some babies will have less frequent bowel movements. Do not be alarmed if the baby does not have a bowel movement every day. There is wide variation between normal babies. Some breast fed babies have only one bowel movement every 5-7 days. A baby is constipated only if the stools are very hard. Straining before stooling is normal and part of the baby's process of learning to use its body. If your infant's bowel movements are very hard, you may add one teaspoon of dark Karo syrup to each bottle of formula or one tablespoon of dark Karo syrup to 2 ounces of water once to twice a day. Karo syrup may be purchased in the grocery store. 

BREAST FEEDING
Technique
The infant should be hungry, dry and neither too warm or cold. The only exception is if your tap water comes from a personal well.  In this case sterilization or the use of bottled (non-fluoride) water is recommended. His/Her position should be a comfortable, semi-sitting one. The mother should also be comfortable and at ease. Before and after nursing, cleanse the nipples with water. Alternate the starting breast with each feeding to stimulate equal milk production.


Usually 10-12 minutes will serve to empty each breast, depending on how vigorously the baby nurses. It is important for the nursing mother to eat an adequate, well balanced diet, relatively high in protein, fluids, vitamins and minerals. Her fluid intake should be at least 1-1/2 quarts per day. Adequate rest is essential, and proper exercise is also important to foster a feeling of well-being. If any medication is prescribed for you, inform the doctor that you are nursing. Most medications are secreted to some degree in the breast milk. It is generally recommended that mothers continue prenatal vitamins while nursing. In addition, Tri-Vi-Sol, a vitamin supplement is recommended for all nursing babies

Supplementary Feedings
After the milk supply is well established, substitute bottles can be given. This has the advantage of allowing the mother to enjoy greater freedom of activity, familiarizes the baby with sucking from the bottle, and allows the father to participate in feeding the baby


BOTTLE FEEDING
Sterilization is no longer necessary with modern refrigeration, packaging and regulated water supplies.  In this case, sterilization or the use of bottled (non-fluoride) water is recommended.  Formula is available in concentrated liquid form, powdered or ready to feed. If you are using a can, clean top before opening. If using the concentrated form, pour half the required amount directly into the bottle, dilute with an equal amount of warm water, shake, and feed the baby. Unused diluted formula should be discarded. Cover the remaining undiluted formula with plastic wrap or foil and store in original container in the refrigerator. Powdered formula should be mixed based on the instructions on the label. It may be stored in the refrigerator for 24 hours. If you are using "ready to feed," do not dilute with water. If you want to carry a bottle in your diaper bag, use single use ready to feed bottles. Never microwave formula. 

Bottle and Nipple Care
Wash in hot water or dishwasher. Rinse before using. No sterilization is necessary.

SCHEDULES
Feeding schedules should not be too strict and a "self-regulated" schedule is the best plan. The emptying time of a baby's stomach usually varies from one to four hours. Thus, there is considerable variation in any one infant. Irregularity in the intervals between feedings and in amounts consumed can be expected in the first few weeks, but over 90% of infants will have established a definite "self-regulated" schedule by the end of the first month. After the baby has established a schedule, single feedings or an entire day's schedule may be changed to fit into family activities and to avoid conflict with mealtimes and bedtimes.

It is important to point out that your baby may cry for reasons other than hunger and he/she does not require feeding each time he/she cries. A wet diaper, colic, feeling cold, a desire to be held, etc., may be the cause of the distress and parents should avoid offering frequent small feedings to pacify the baby. Babies who stop crying when picked up or do not stop crying when offered food usually are not hungry and another source of distress should be looked for.

WATER
After six months of age, small amounts of water may be offered between meals, particularly in hot weather, but is not usually necessary. Plain tap water will do. Juice should never be given in a bottle. Nutritionally, it is 100% sugar and is also bad for the child's teeth. Bottled water with fluoride should not be used since it may cause the baby's fluoride intake to exceed recommendations.


ACCIDENT PREVENTION
Parents must be constantly alert to the dangers that surround their children. From infancy through childhood, accidents take more lives than any other cause of death. Most of the over 12,000 childhood accidental deaths each year are preventable. It is essential that you begin guarding against accidents from your first day home beginning with an approved car seat for his/her first ride home from the hospital. Walkers cause a great number of injuries and should be avoided.

If your child eats something which may be harmful, call Poison Control Center at (212) POISONS or 1-800-962-1253. Follow all directions given and call the doctor if advised to do so.

IMMUNIZATIONS
Beginning at birth, your baby should be given all the benefit immunizations can provide. These "shots" represent one of the most important advancements in pediatric care and have served to reduce once dreaded childhood diseases to a minimum. Poliomyelitis, tetanus (lockjaw), whooping cough (pertussis), diphtheria, measles, mumps, rubella (German measles), chicken pox, meningitis (HIB, meningococcus and pneumococcus) and Hepatitis B are preventable diseases with proper vaccination. Hepatitis A and Rotovirus have recently been added to the recommended vaccine list. Yearly Flu vaccines are recommended for all children over 6 months of age and for all family members and contacts of infants less than 6 months of age during flu season.  None of the vaccines we use have Thimerisol.

Directions After a DaPT Injection


Despite recent publicity, serious side effects are quite rare and the benefits of immunization far outweigh the risks. Even the mild symptoms of irritability, fever, or a local reaction (swelling, pain, inflammation) on the evening of the injection are uncommon with the new acellular pertussis vaccine which we use exclusively. Infants may have Tylenol Drops (Acetaminophen) prior to a noticeable reaction and it may be repeated every 4 hours. See chart below for appropriate dosage. Most infants will be fine by morning. About one week after the DaPT injection, you may notice a knot in the muscle. This is normal and will go away.

Directions After an MMR Vaccine Injection
Most children have no reaction at all, but up to 15% may have fever above 101° and a mild transient rash for 3-4 days starting 5-7 days after injection. Infants experiencing a reaction are not contagious. Give Tylenol for any fever.


Directions After other Immunizations
Polio, HIB, (Hemophilus Influenza B), pneumococcal and Hepatitis immunizations usually cause little or no reactions. Varicella immunization may cause a low grade fever and localized swelling at the site of injection which can be treated with Tylenol and cold compress. 8-21 days after the Varicella vaccine, 5% of children may develop a skin rash consisting of 5 or fewer pox.

SKIN CARE

Diapers and Diaper Rash
Irritation in the diaper area is usually caused by urinary ammonia. To control this, leave the diaper off as much as possible, change diapers frequently, dry well, and use protective ointments as necessary (i.e., A&D Ointment, Desitin, zinc oxide, Balmex, Diaprex, Vaseline, etc.). If it becomes a serious problem, consult with us during routine office hours. Disposable diapers are better for the baby’s skin than cloth diapers. However, the type of diaper used is a personal choice.


Newborn skin is very sensitive and pre-moistened wipes may cause rashes. Water and cotton washcloths are preferred. If wipes are used, please make sure the skin is dry before putting on a new diaper.


Bathing
The baby should not be immersed in water until the umbilical cord drops off and the belly button is healed. Prior to this, sponge bathing will suffice. A washcloth with a pure, mild soap (Dove, Ivory, baby soap i.e.: J&J Head to Toe) should be used to clean all areas including the face, being careful to keep soap from the eyes, ears and nose. The head only needs to be washed once or twice a week. Dry and flaky skin is normal in the newborn period. An acne-type rash is also common in the first couple of months and is due to withdrawal from maternal hormones. It needs no special care.


Cradle Cap
This condition may be caused by either too little or too much natural scalp oils. First REDUCE the frequency the head is washed. Comb or brush the scale out daily and moisturize child's scalp with baby oil daily, drying off until not greasy.

CLOTHING
Dress the baby the way you dress yourself - do not overdress. Cotton is the best material. Wool and synthetic fibers are frequently irritating and should be avoided. Always wash clothing and bedding before using. 

Fresh Air and Room Temperature


Fresh air is desirable, but there should be no direct draft on the baby. The room temperature should be comfortably cool, 65-70 F.

Do not swaddle or wrap the baby too tightly unless directed to do so by your doctor. It is important that he/she be allowed free movement. Babies may become restless if they are too warm. If the hands and feet feel cold to your touch, it does not mean that he/she is cold. If the body is warm, he/she is comfortable and all right. If a baby is perspiring, he/she is too warmly dressed. Being overheated and then chilled is more harmful than too few clothes.

SLEEP
Bedroom
In the initial few weeks after you get your baby home, it may be more convenient to have the baby in your bedroom, especially if you are breast feeding. However, it is usually best to establish your baby in his/her own room, or at least in a room other than your bedroom, as soon as possible. Not only will the baby rest better, but the parents will not be disturbed by the infant's innocent noises.


Bedding
In the initial newborn period, a cradle or a bassinette may be used as long as it permits the baby some freedom of movement. The crib should be well made, free of lead based paint, and have a firm mattress. Some older cribs do not conform with current safety guidelines and care should be used if you have a "hand-me-down." Pillows, comforters and blankets are not recommended. Bumpers to protect the baby from side rails and ends may be used when the baby is small,  but are not necessary and are potential suffocation risks in very young infants.  Never use plastic bags anywhere on the baby's bed.


Sleeping Position
The American Academy of Pediatrics recommends that infants be placed on their back to sleep to reduce the incidence of SIDS (sudden infant death syndrome). It is also natural for baby to suck their thumbs or fingers when falling asleep. Do not worry about this nor attempt to stop it. Pacifiers, if kept clean, are a suitable substitute for fingers and thumbs during the first year of life. Sucking is one of the ways that a baby gets pleasure and it is a natural instinct.


Period of Sleep
Each baby will differ in the amount of sleep required. Generally speaking, the newborn patterns are quite irregular, but as they grow older, a more consistent pattern will be established. If the baby has long wakeful periods during the night, it may be helpful to keep him/her awake during more convenient hours, thus making him/her more sleepy at night.


Good Sleeping Habits
Sometimes parents will put the baby to bed with a bottle. This practice may lead to complete dependence on the bottle or parent before going to sleep. Once established, this pattern can be very difficult to break in later months. Babies should NEVER be placed lying down with a bottle. This can lead to cavities and may increase the likelihood of ear infections.

ILLNESSES
The Stuffy Nose
A clear nose will help infants breathe and feed easier. To clean the nose, use salt water (saline) nose drops and suction using a nasal aspirator. Place 3-5 drops in each nostril and then gently suck out the mucous with the syringe. Do this 3-4 times daily, particularly before feedings.

A cool mist vaporizer with distilled water alone at night will help keep your child's nose clear while sleeping. An ultrasonic vaporizer is best.

Nose drops are rarely needed in children old enough to blow their noses.  Oral cold medications and decongestants may be used in children over the age of 4 years, but their effectiveness is questionable.  Sinus rinses and Neti pots are effective and safe in older cooperative children.

Chest Colds
This is a cold in which mucous drips down the throat causing discomfort and results in a chest "rattle." This "rattle" is not a danger sign. Treatment is the same as with any cold unless the child appears to be having difficulty breathing or is not drinking and urinating.


Fever
A temperature above 100.5°F rectally or orally is considered fever. The following is a recommended guide to treatment.


Infants less than 2 months: with temperatures above 100.5°F consult a doctor immediately. Do not treat yourself! Infants over 2 months of age: fever is a normal response to infection and aids the immune response. Temperatures over 100.5°F may be treated with Tylenol. Fevers tend to rise in late afternoon and evenings.

Children tolerate high temperatures better than adults. Except in the child known to have convulsions, no harm will result from transient temperatures up to 105°F. If the temperature exceeds 104°F, you may wish to sponge or bathe your child with room temperature water for 15-20 minutes until the temperature is reduced. Afterwards, keep the child lightly dressed and in a cool room. See chart below (Medical Dosages) for Tylenol/acetominophen and Motrin/Advil/ibuprofen dosages (over 6 months only).

If your child's temperature exceeds 101 °F and is over 6 months, you may use Children's Motrin (ibuprofen) in addition to Tylenol. As long as the doses of the Motrin are six hours apart, it does not matter how close the Tylenol is to the Motrin.

MEDICAL DOSAGES


Weight (lbs)
6- 1112-1718-2324-3536-4748-5960-7172-95
Tylenol Drops/Suspension (Acetaminophen) (160 mg/5ml) dosage in ml 
1.252.53.755.0



Children’s Motrin/Advil Suspension (Ibuprofen) every 6-8 hours (100 mg/5ml) dosage in ml 
----3.7557.51012.515
Motrin/Advil Drops (Ibuprofen) every 6-8 hours (50 mg/1.25ml) dosage in ml 
----1.8752.53.7556.257.5
Benadryl
12.5mg/5ml 
----57.5




Tylenol >2 months of age; Motrin>6 months of age

Note: 1cc=1ml 5cc=1teaspoon
Always use the measuring device (dropper/syringe/cup) that came with the product. 

Remember, alcohol or cold water baths are neither safe nor comfortable. Should your child continue to run fever longer than 48 hours or other symptoms alarm you, a doctor should be consulted. Frequently, your child may be constipated during the illness. This should cause no concern and enemas are unnecessary. 

Antibiotics:   There is No Cure for a Cold


Colds are caused by viruses, and antibiotics do not work against viruses. A cold may last for 10-14 days regardless of the medication you give. The most important thing you can do for your child is to keep him/her comfortable by following the steps described above.

VISITORS AND OUTINGS
When you first come home from the hospital, visitors should be limited to family members and a few close friends. This allows the mother, father, and baby to adjust to their new lives. Unannounced drop-ins and prolonged visits should be discouraged until everyone has sufficiently recuperated from the "big event" to enjoy visitors without becoming overtired. Young infants (less than eight weeks) should be kept away from anyone with an illness or fever. All visitors and family should wash their hands prior to touching the infant.

The baby may be taken out at any time in reasonable weather. Always use an approved infant car seat in the rear facing position when traveling, including the ride home from the hospital. It is recommended that whenever possible, the car seat should be in the center of the rear seat.


SHOES
Shoes protect the feet from foreign objects. They do not lend support or help the baby walk. Sneakers and low top shoes suffice. A baby will outgrow shoes very rapidly; therefore, do not buy expensive, long wearing ones. You should realize that lasting damage to the feet can result from continuing to use shoes that have been outgrown just because "they have so much wear left in them."


DEVELOPMENTAL SCREENING
MODIFIED CHECKLIST FOR AUTISM IN TODDLERS (M-CHAT)
We have instituted a developmental screening for our 1, 2 and 3 year old patients.  This screening is the “M-CHAT” screening recommended by the American Academy of Pediatrics.  These questions are for SCREENING PURPOSES ONLY.  They in no way imply a delay in your child.  We ask that you print out the questionnaire, answer the questions by putting an “X” through your answer and bring it with you for your checkup (see Forms Tab).  Your doctor will check your answers and discuss with you.

We, here at Pediatric Specialties are constantly instituting new and current diagnostic tools in order to provide your children the best medical care possible.

Thank you.

Patient Information