Prenatal 3 Handouts Online

Prenatal 3: Preparing for Your Newborn
Health Engagement 10/20

Table of Contents: Prenatal 3 Handout Order
1. Enrolling Your Newborn Baby ……………………………………………………………………….. 3-6
2. Health Care Visit Schedule for Children-Newborn to 2 Years…………………………. 7-10
3. Breastfeeding Your Newborn: The First Weeks …………………………………………… 11-16
4. Newborn Circumcision………………………………………………………………………………….17-18
5. Car Safety Seats for Babies …………………………………………………………………………..19-20
6. Choosing Child Care ……………………………………………………………………………………. 21-22
Additional Resources
1. Reference- How to Care for Yourself and Your New Baby (Fourth Edition)..23-70
2. Newborn Care Center Visit Information…………………………………………………….71-72
3. Prenatal Flyer ………………………………………………………………………………............ 73-74
Resources for members that did not attend Prenatal 2 class

1. Community Resources for Expectant and New Mothers ……………………………75-76
2. How to Tell When You Are in Labor …………………………………………………………. 77-78
Appendix
1. Understanding “Baby Blues”, and Perinatal Mood and Anxiety Disorders (PMAD).79-82
ENROLLING YOUR NEWBORN BABY
• If your health care coverage is provided through
an employer group, please contact your
employer’s health benefits office immediately
regarding the birth of your newborn. Your
employer will provide instructions on how to
formally enroll your newborn into a Kaiser
Permanente plan. To prevent a lapse in
coverage, it is imperative your employer submit
an enrollment form for your newborn within 31
days of your child’s birth.
• If your health care coverage is provided
through the Federal Employees Health
Benefits Program (FEHBP), please complete
a Kaiser Permanente FEHB Change in Status
form (form 2809) and submit it to Kaiser
Permanente within 60 days of your child’s birth.
The form must be submitted to:
»» Kaiser Permanente
Employer Services Department
PO Box 6306
Please review the information below to ensure Rockville, MD 20849-6306
your newborn is properly enrolled in Kaiser FAX: (855) 414-2799
Permanente. This brochure also provides • If your health care coverage is provided
information concerning coverage for your through Kaiser Permanente Individual and
adopted newborns, or newborns for whom Families under family coverage (or subscriber
you maintain court-ordered legal custody plus dependents/subscriber plus 1), please
or guardianship. Additional information for submit a newborn enrollment form within 31
alternative care is also included. days of the birth of your baby. You can obtain
this form by calling the Kaiser Permanente
1. If you already have family coverage with Member Services Contact Center at (301)
Kaiser Permanente: 468-6000 in the Washington DC metropolitan
Babies born to a Kaiser Permanente subscriber area, (800) 777-7902 outside the Washington
or subscriber’s spouse with family coverage are DC metropolitan area, TTY (855) 632-8278,
covered for the first 31 days following birth. Monday through Friday, 7:30 a.m.-9 p.m.
Please take the following steps to enroll your • If your health care coverage is provided through
newborn beyond the 31 day coverage period a plan you bought on an Exchange in DC, MD
in order to ensure that your baby’s legal name or VA, please contact the following agencies to
is recorded on his or her Kaiser Permanente enroll your newborn:
member identification card:
»» DC Health Link Your employer will provide instructions on
dchealthlink.com how to formally enroll your newborn into a
(855) 532-5465 Kaiser Permanente plan. To prevent a lapse in
TTY/TDD: 711-1-532-5465 coverage and ensure the correct application of
premiums, it is imperative your employer submit
»» Maryland Health Connection
an enrollment form for your newborn within 31
marylandhealthconnection.gov
days of your child’s birth. Please note: If you fail
(855) 642-8572
to enroll your baby within 60 days of birth, you
TTY: (855) 642-8573
will have to wait until the next open enrollment
Fax: (855) 642-8574
period to add the baby to your coverage.
»» VA Health Insurance Marketplace
• If your health care coverage is provided
healthcare.gov
through the Federal Employees Health
(800) 318-2596
Benefits Program (FEHBP), please complete
TTY: (855) 889-4325
a Kaiser Permanente FEHB Change in Status
• If your health care coverage is provided through form (form 2809) and submit it to Kaiser
the state Medicaid agency in MD or VA, please Permanente within 60 days of your child’s birth.
contact your state Medicaid agency directly to The form must be submitted to:
enroll your newborn:
»» Kaiser Permanente
»» Cover Virginia Employer Services Department
coverva.org PO Box 6306
(855) 242-8282 Rockville, MD 20849-6306
FAX: (855) 414-2799
»» Maryland Medicaid
mmcp.dhmh.maryland.gov • If your health care coverage is provided through
(877) 463-3464 Kaiser Permanente Individual and Families,
please submit an enrollment form within 31
2. If you don’t have family (or subscriber plus days of your child’s birth. You can obtain
dependents/subscriber plus 1) coverage with this form by calling the Kaiser Permanente
Kaiser Permanente: Members Services Contact Center at (301)
468-6000 in the Washington DC metropolitan
You will need to pay an additional premium to
area or (800) 777-7902 outside the Washington
increase your coverage to include your newborn.
DC metropolitan area, TTY (855) 632-8278,
A baby born to a Kaiser Permanente subscriber
Monday through Friday, 7:30 a.m -9 p.m. To
with self-only or two-party coverage (without family
prevent a lapse in coverage and ensure the
coverage) will be covered for the first 31 days after
correct application of premiums, it is imperative
birth and may receive covered services during this
that you submit an enrollment form for your
period. However, please follow the steps listed
newborn within 31 days of your child’s birth.
below to ensure your baby is enrolled beyond
Please note: If you fail to enroll your baby within
the 31 days. Failure to enroll your child in a timely
60 days of birth, you will have to wait until the
manner will result in a loss of coverage for your
next open enrollment period to add the baby
child. Following these steps will also help ensure
to your coverage.
that your baby’s legal name is recorded on his or
her Kaiser Permanente member identification card. • If your health care coverage is provided through
a plan you purchased on an Exchange in
• If your health care coverage is provided through
DC, MD or VA, please contact the following
an employer group, please contact your
agencies to enroll your newborn:
employer’s health benefits office to increase
your coverage and enroll your newborn.
»» DC Health Link Program (“CHAP”), you may apply for coverage
dchealthlink.com for your newborn by submitting an account
(855) 532-5465 change form within 60 days of the child’s birth
TTY/TDD: 711-1-532-5465 to the following address to allow us determine
your eligibility for Kaiser Permanente’s
»» Maryland Health Connection
charitable premium subsidy and financial
marylandhealthconnection.gov
assistance for cost sharing amounts.
(855) 642-8572
TTY: (855) 642-8573 »» California Service Center
Fax: (855) 642-8574 Attn: CHC
P.O. Box 939095
»» VA Health Insurance Marketplace
San Diego, CA 92193-9095
healthcare.gov
Or fax toll free to: (858) 614-3344
(800) 318-2596
Questions: Call (800) 777-7902,TTY (855)
TTY: (855) 889-4325
632-8278.Monday through Friday, 7:30
• If your health care coverage is provided through a.m.-5:30 p.m., Eastern time.
the state Medicaid agency in MD or VA, please
You may also explore other health care coverage
contact your state Medicaid agency directly to
for the baby, such as Medicaid. If the newborn
enroll your newborn:
doesn’t qualify for other health care coverage,
»» Cover Virginia you should obtain a Kaiser Permanente Individual
coverva.org and Families enrollment form by calling the
(855) 242-8282 Kaiser Permanente MemberServices Contact
Center at (301) 468-6000 in the Washington DC
»» Maryland Medicaid
metropolitan area or (800) 777-7902 outside the
mmcp.dhmh.maryland.gov
Washington DC metropolitan area.
(877) 463-3464
If the proper enrollment notification is received 5. If the newborn baby is the grandchild of a
within the 31 days of your child’s birth, your baby’s Kaiser Permanente subscriber:
coverage will be effective retroactive to the date Any grandchildren of subscribers, including
of birth. If you fail to enroll your baby within 60 newborn babies of a subscriber’s dependent,
days of birth, you will have to wait until the next are generally not eligible for Kaiser Permanente
open enrollment period to add the baby to your enrollment. However, some employers make
coverage. eligibility decisions according to their own
criteria. Please contact the subscriber’s employer’s
3. If the newborn baby is the child of a Kaiser benefit office for questions regarding coverage
Permanente Medicare Plus member: for grandchildren.
Medicare does not cover your infant after
delivery. While Medicare covers certain costs of 6. Adoption, placement for adoption,
pregnancy and delivery for mothers enrolled in, court-ordered guardianship/legal custody,
Medicare does not cover newborns after delivery. foster care.
You must explore other insurance options for For newborns and children adopted/placed
the baby, such as employer group coverage, for adoption, for children for whom you gain
individual coverage, or Medicaid. guardianship/legal custody, and for children
placed in your home for foster care, you must
4. If the newborn baby is the child of a Kaiser submit an enrollment form according to your
Permanente member enrolled through the coverage as described above, within 31 days
Community Health Access Program (CHAP): of the date of your child’s adoption, placement
• If you are a member enrolled in Kaiser for adoption, or the date of the court-ordered
Permanente’s Community Health Access legal custody or guardianship/foster placement.
Coverage is effective as of the date of adoption, For more information
placement for adoption, or the date of the If you have any questions about your newborn
court-ordered legal custody or guardianship/ baby’s coverage, please contact the Member
foster placement, not the date of the child’s birth. Services Contact Center by calling (301)
Please note: if you fail to enroll your child within 468-6000 in the Washington DC metropolitan
60 days of the date of adoption, placement for area or (800) 777-7902 outside the Washington
adoption, or the date of the court-ordered legal DC metropolitan area.
custody or guardianship/foster placement, you
will have to wait until the next open enrollment
period to add the baby to your coverage.
REGIONAL HEALTH EDUCATION, HEALTH PROMOTION

0036-0139 3/18 Mid-Atlantic Permanente Medical Group. 2101 E. Jefferson St., Rockville, MD 20852
HEALTH CARE VISIT SCHEDULE
FOR CHILDREN - NEWBORN TO
2 YEARS
HEALTH NOTES
Your Kaiser Permanente pediatric and family practice doctors have

developed this schedule of health visits to help keep your child healthy.
During each visit, your child’s doctor will examine your child and talk
with you about growth and development and other health matters.
Call (703) 359-7878 or 1-800-777-7904 to schedule your child’s health

care visits. TTY (855) 632-8278.
Join us as a partner in your child’s health.

• Write down a list of questions before each visit. Express your opinions
and concerns.
• Be ready to talk about your child’s eating habits, development, and
safety issues.
• Keep track of when your child needs visits and tests.
• After each appointment, ask a member of your health care team for
an up-to-date printout of your child’s immunizations for your records.
You can also view your child’s health information online. Visit kp.org/
actforfamily.
For more information
The guidelines on the following pages are for information only. Your
Visit kp.org/children
child’s doctor may make changes based on your child’s health and
• Select Maryland/Virginia/ immunization history, and use a combination of vaccines when possible.
Washington D.C. to read
more about important topics
on your child’s health. Resources for vaccine information
Visit kp.org/actforfamily • Centers for Disease Control and Prevention
National Immunization Program
• View your child’s health
cdc.gov/nip
information online by signing
up for “Act as a Family • National Immunization Hotline
Member.” 1-800-232-2522 (English) or 1-800-232-0233 (Spanish)
• Immunization information automated service
1-800-232-7468
• American Academy of Pediatrics
aap.org
• Immunization Action Coalition
immunize.org
• Voices for Vaccines
voicesforvaccines.org
Health
Age Immunizations Screenings/procedures
visit
Newborn 3 • Hepatitis B (HBV) #1 • Growth and development
(in hospital) • Hepatitis B Immune • Safety
Globulin (HBVig), if needed • Newborn hearing
• Metabolic and jaundice screen, as needed
• Hip dysplasia (abnormal development of
the hip joint)
• Breastfeeding consult
• Congenital heart defect screening
3 - 5 days 3 • Growth and development
• Metabolic and jaundice screen, if needed
• Breastfeeding consult, if desired
2 weeks 3 • Growth and development
• Metabolic screen, if needed
• Hip dysplasia
• Breasfeeding consult, if desired
1 month 3 • Growth and development
health • Metabolic screen, if needed
assessment • Hip dysplasia
• Breastfeeding consult, if desired
2 months 3 • Diphtheria, Tetanus, and • Growth and development

health Acellular Pertussis (DTaP) #1 • Screening for hip dysplasia
assessment • Hepatitis B (HBV) #2 • Breastfeeding consult, if desired
• Inactivated Polio (IPV) #1
• H. Influenzae type b (Hib) #1
• Pneumococcal Conjugate
(PCV13) #1
• Rotavirus (ROTA) #1
health Acellular Pertussis (DTaP) #2 • Screen for hip dysplasia
assessment • Hepatitis B (HBV) #3
• H. Influenzae type b (Hib) #2
(PCV13) #2
• Rotavirus (ROTA) #2
health Acellular Pertussis (DTaP) #3 • Screen for hip dysplasia
assessment • Hepatitis B (HBV) #4 • Fluoride supplement, if needed
• Influenza (Flu) (Aug-Apr)
»» Two doses 4 weeks apart
(PCV13) #3
Health
visit
9 months 3 • Influenza (Flu) (Aug-Apr), if • Development screening - Ages and Stages
health needed • Growth and development
assessment »» Two doses 4 weeks apart • Blood test (CBC), if needed
Catch up on any shots that • Lead level, if needed
are behind schedule • Screen for hip dysplasia
• Fluoride supplement, if needed
• Hepatitis B surface antigen (HBsAg) and
Hepatitis B surface antibody (Anti-HBs),
if needed
12 months 3 • Hepatitis A (HAV) #1 • Growth and development
health • Influenza (Flu) (Aug-Apr), if • Nutrition
assessment needed • Lead level, if needed
»» Two doses 4 weeks apart • Blood test (CBC), if needed
• Measles, Mumps, and • Check teeth. Fluoride treatment, if
Rubella (MMR) #1 indicated
(PCV13) #4
• Varicella (VAR) – Chickenpox
#1
Catch up on any shots that
are behind schedule
RN Visit Acellular Pertussis (DTaP) #4 • Lead level, if needed
• H. Influenzae type b (Hib) #3 • Blood test (CBC), if needed
• Influenza (Flu) (Aug-Apr), if • Check teeth. Fluoride treatment, if
needed indicated
»» Two doses 4 weeks apart
are behind schedule
18 months 3 • Hepatitis A (HAV) #2 • Growth and development
health »» Must be 6 months after • Development screening - Ages and stages
assessment 1st dose • Autism screening (MCHAT) if indicated
• Influenza (Flu) (Aug-Apr), if • Blood test (CBC), if needed
needed • Check teeth. Fluoride treatment, if
»» Two doses 4 weeks apart indicated
Catch up on any shots that • Dietary/nutrition counseling
are behind schedule, DTaP
#4 and HIB #3 if not already
complete
24 months 3 • Influenza (Flu) (Aug-Apr), if • Growth and development
health needed • Lead level, if needed
assessment »» Two doses 4 weeks apart • Development screening - Ages and stages
Catch up on any shots that • Autism screening
are behind schedule • Body mass index (BMI)
• Blood test (CBC), if needed
• Check teeth. Fluoride treatment, if
indicated
Health
visit
30 months Talk • Influenza (Flu) (Aug-Apr), if • Growth and development
with needed • Nutrition
your »» Two doses 4 weeks apart • Lead level, if needed
health • Autism screening
care • Blood test (CBC), if needed
are behind schedule
team • Check teeth. Fluoride treatment, if
indicated
Yearly flu vaccine is recommended for all children six months to 17 years. This includes children with asthma,
heart disease, sickle cell disease, HIV, and diabetes. The flu vaccine is also recommended for parents and
caregivers of children under 6 months.
A Tuberculosis (TB) skin test can be done if you have a positive screening following questions about potential
exposures.
The information presented here is not intended to diagnose health problems or to take the place of professional medical care.
If you have persistent medical problems, or if you have further questions, please consult your doctor or member of your health
care team.
REGIONAL HEALTH EDUCATION & HEALTH PROMOTION

0003-4880 Revised/reprinted 2/17 Mid-Atlantic Permanente Medical Group. 2101 E. Jefferson St., Rockville, MD 20852
BREASTFEEDING YOUR NEWBORN:
THE FIRST WEEKS
Breastfeeding is natural, but learning how to breastfeed takes practice and patience. The information
in this Health Note will help you get started. If you would like more help or just have a breastfeeding
question, contact an International Board Certified Lactation Consultant (IBCLC) in Kaiser Permanente’s
Newborn Care Center. See phone numbers below on the left.
We’re here to help you reach your breastfeeding goals!

HEALTH NOTES
The basics
• Breastfeeding should start within the first hour of your baby’s life. Your
baby will be very alert for 1-2 hours after birth before getting sleepy for
4-6 hours.
• Use this alert time to bond. Hold your baby tummy-down and
skin-to-skin on your chest. Research shows that holding your baby like
this helps you bond and breastfeed well down the road. Refer to the
Kaiser Permanente Health Note Caring for your Newborn: Skin-to-skin
Contact for more info.
• Nurse your baby 8 to 12 times every 24 hours.
• A newborn may nurse every 1 ½ to 3 hours (from the start of one
feeding to the start of the next feeding), but don’t watch the clock too
Call Kaiser Permanente’s closely. Feed your baby when you see hunger cues (see first bullet in
Newborn Care Center to the section below).
contact a Certified Lactation • Nurse on one breast, then burp your baby and offer the other breast.
Consultant Switch which breast you start with at each feeding. You can put a safety
• In Northern Virginia: pin on your bra to help you remember which side to nurse first.
(703) 922-1469 • You should wake your baby up to eat if it has been more than three
• In Washington, DC and hours since the last feeding.
suburban Maryland: • Do not give your baby any formula or water unless your doctor tells you to.
(866) 264-4766
• In the Baltimore area: How to get a good latch
(410) 737-5464
A good latch is an important step to successful breastfeeding. Latching
Visit kp.org/maternity your baby is a learned skill. It may take your baby a few weeks to learn
how to latch, but it is worth it in the end. The better the latch, the more
Visit kp.org/health
milk the baby will get and the less likely you are to have nipple pain or
• Enter “breastfeeding” in the
breastfeeding problems. If you are not sure about how well your baby is
search box
feeding and latched on, seek help from an International Board Certified
Call Kaiser Permanente Lactation Consultant (IBCLC) in Kaiser Permanente’s Newborn Care Center.
Medical Advice See phone numbers on the left.
• Talk to your medical advice
The tips below will help you get a good latch:
nurse 24 hours a day, 7 days
• Tune in to your baby’s early hunger signs - also called “hunger cues.”
a week by calling (703)
Your baby may smack her lips, stick out her tongue, bring her hands to
359-7878 or (800) 777-7904
her mouth, suck on her fists, or just become more active. This is the best
TTY: (885) 632-8278.
time to nurse your baby. Crying is a late sign of hunger. Crying babies
Visit kp.org/womenshealth
• Read about breastfeeding in
the Health Encyclopedia.
have more trouble latching on to the breast. If How to latch your sleepy baby
your baby is crying, calm her down before trying
to latch. Nursing a sleepy baby is a challenge. Even if your
• Get into a comfortable position. Choose a baby is sleepy, he should nurse every 1 ½ to 3
comfy chair with back support and sit upright. hours, or 8-12 times per 24 hours. Try to wake
Using a footstool is often helpful. Have plenty of your baby up and make him alert before nursing.
pillows to support you and your baby. Align your Feed him in only a diaper so he does not get too
baby’s nose with your nipple. Gently massage cozy and sleepy. Tickle his skin if his sucking slows
your breast before starting. down. You can also change his diaper to wake him
• Squeeze your breast slightly to make a up, even if his diaper is not dirty. While nursing,
“breast sandwich.” Your thumb should be you can break suction and change sides often to
opposite your baby’s nose, and your fingers keep the baby awake. Refer to the Health Note
should be by your baby’s chin. Keep your fingers Breastfeeding Your Newborn: How to Wake Your
one inch behind the areola (the dark area around Sleepy Baby for more information.
your nipple).
• Stroke your baby’s upper lip with your nipple. How to tell if your baby is getting enough to eat
Wait for your baby to open her mouth wide like
a yawn. When this happens, quickly bring her to Once your milk comes in, look for these signs:
your breast to latch. Do not bring your breast to • You baby latches well.
your baby. Let her chin touch the breast first, and • You can hear your baby swallow after every few
then bring her mouth forward over the nipple. sucks.
She should get a good mouthful of your areola. • Your baby nurses 20-45 minutes each session.
• A good latch is when: • Your baby looks full after each feeding.
»» the baby’s chin is firmly into the breast, • Your baby has 6 wet diapers each day after the
»» the angle of your baby’s lips are wide over the first week.
areola, • Your baby’s stools (poop) no longer look black
»» lips are rolled out like a fish, and tarry. By the end of the first week, yellow
»» more of the lower areola is in the baby’s mouth stools come three times a day.
than the top, • By two weeks, your baby weighs as much as he
»» you don’t hear clicking or popping, did at birth.
»» you can tell your baby is swallowing
Once your milk comes in (3-6 days), nursing may
»» you feel pulling but not pinching,
feel different. It is okay if you:
»» your breasts feel softer after feeding, and
• feel brief discomfort for less than a minute at the
»» your baby is content after feeding.
start of the breastfeeding session,
• If your nipple hurts, break the seal of suction
• feel a pulling sensation at the nipple without a
and try latching again. It may take a few tries
sharp pain,
each nursing session to get the latch just right.
• feel that breasts are softer after feeding, or
• Use breast massage and gently squeeze your
• notice some breast fullness and dripping of milk
breast when the sucking slows down. Your baby
from the opposite breast while nursing.
will get more of the creamy hind milk and feel
fuller.
• Unless your baby is very sleepy, don‘t limit Positioning to breastfeed
the time on each breast. Let your baby break
off when she is finished feeding. Try burping your A good latch is key to good breastfeeding, but
baby. She might not need to burp, but it’s good finding a comfortable position is also important.
to try. Then latch her to the other breast. There are many ways to hold your baby while you
• Sometimes babies just suck at the breast for nurse. The cross-cradle and football holds are
comfort rather than feeding. You might notice good “beginner” holds for newborns. With any
longer pauses between sucks and a “quivery” position that you choose, be sure that your baby:
latch. Try compressing your breast or tickling • is supported at the level of your breast,
your baby to remind her to keep feeding. • is facing you. Unless you use the football hold,
you and your baby should be “tummy-to-
tummy.”
• has his ears, shoulder, and hips in a line, Common concerns
• has his head directly facing your breast with your
nipple opposite his nose, and Engorgement
• has his head lifted just a little in a “sniffing”
Engorgement is when your breasts feel firm
position to grasp your nipple far back in his
and full. This usually occurs when your mature
mouth. This helps to prevent sore nipples.
milk comes in (3-6 days after birth) or when you
Cross-cradle hold cut back on nursing. The best way to prevent
engorgement is to nurse often. Here are some
ways to relieve engorgement:
• Take a warm shower or put a warm cloth on your
breasts before feeding.
• Express milk by hand for a few minutes before
nursing.
• Put a cool compress on your breasts after
feeding. A bag of frozen peas in a washcloth
works well.
• Wear a bra with gentle support if it feels good.
Do not wear a very tight bra, which can make
engorgement worse.
• Take 200 mg of ibuprofen (Advil® or Motrin®)
In the cross-cradle hold, your baby’s tummy lies every 6 hours.
against yours. One hand is low on the baby’s head
to give control as you bring your baby to the Refer to the Kaiser Permanente Health Note
breast to latch. The other hand (on the same side Breastfeeding your Newborn: Preventing and
as the breast being used) supports the breast to Managing Engorgement for more information. If
help the baby form a good, deep latch onto the you can’t latch your baby on or express milk, you
areola. should contact an IBCLC at Kaiser Permanente.
Phone numbers are on the front of this Health
Football hold (clutch position) Note.
Sore or cracked nipples

There are many ways to keep your nipples from
getting sore. Try any of these tips:
• Make sure your latch is good. A good latch
means the baby is not just sucking your nipple.
His mouth should be around the areola, too.
Look at the tips on a good latch in this Health
Note.
• Use your finger to break the seal between your
baby’s mouth and your breast at the end of a
feeding.
• Express some breast milk with your hand and rub
In the football hold, you sit on a bed or sofa. Your it onto your nipple.
baby is tucked under your arm and lying along the • Let your nipples air dry after nursing.
side you will be feeding on. You can use pillows to • After your nipples dry, put lanolin cream on
help support the baby and your arms. The baby’s them.
head is in your hand (on the same side as the • You do not need to wash your breasts with soap.
breast being used), and the baby’s upper body • Change breast pads before they become damp.
is supported by your arm. With that hand you • Do not use breast pads with plastic liners.
can control the baby’s head to bring the baby’s
mouth in quickly for a good latch. Your other hand Refer to the Kaiser Permanente Health Note
reaches across to support your breast. Breastfeeding your Newborn: Preventing and
1 www.aap.org/breastfeeding/PolicyOnBreastfeeding.html Viewed 12/5/2011.

Managing Sore Nipples for more information. Talk to your doctor about the Early Start program
If you continue to have sore or cracked nipples, at Kaiser Permanente. Early Start is a confidential
contact an IBCLC from Kaiser Permanente’s program designed to support pregnant women who
Newborn Care Center (See phone numbers on the have issues with drug use, including alcohol and
front page of this Health Note.) tobacco. Early Start aims to help pregnant women
lower or quit their drug use to have healthy babies.
Foods and medicines to avoid when you are The Early Start Specialist can meet with women
breastfeeding in-person, by phone or by video consult. There is no
fee for this program.
Maintain your prenatal diet plus one healthy snack a
day. Visit choosemyplate.gov and search “checklist All babies should be seen in the pediatric office
calculator” to create a meal plan made just for between three and five days of life.
new moms. Breastfeeding will make you thirsty, so
drink plenty of fluids. In general, you may eat as As a breastfeeding mom, you are encouraged
you normally do while nursing, but there are a few to make a telephone or office appointment with
exceptions. a Kaiser Permanente IBCLC when you have any
questions or concerns about breastfeeding. If you
Alcohol - While you are nursing, avoid drinking are having breastfeeding trouble, call a Kaiser
alcohol for the first 3 months. After that time, an Permanente IBCLC promptly. Breastfeeding
occasional drink is okay. Wait 2 hours after drinking problems are easier to solve in the early stages.
before you nurse your baby. There is no fee for a breastfeeding consultation.
Caffeine - Try to reduce your intake of caffeine while
you are breastfeeding. A daily cup of coffee (6 oz.) is Resources
fine, but too much caffeine might cause your baby • Attend a New Mother’s Support Group. These are
to be fussy and not sleep well. Remember, some available in most hospitals.
sodas and teas have caffeine. • Find a local breastfeeding support group. Contact
La Leche League by visiting their website at
Cigarettes - You should not smoke cigarettes. lalecheleague.org.
Cigarettes harm your baby and reduce your milk • Visit the American Academy of Pediatrics website
supply. For a class to help you quit smoking, call the at aap.org
Health Education Department at 1-800-444-6696 • Download a breastfeeding app to keep track of
and leave a message. If you must smoke, be sure your feedings. Try “MammaBaby” or “MyMedela”
to smoke outside. Wear a cover over your clothing – both are free!
while you smoke and take it off before coming
indoors. Don’t forget to wash your hands before Books
touching your baby. • The Nursing Mother’s Companion 6th ed. by
Kathleen Huggins (2010)
Drugs and Medicine - Drugs such as amphetamines • The Womanly Art of Breastfeeding, from the La
(speed), cocaine, heroin, marijuana (pot) and Leche League (2010).
phencyclidine (PCP) pass into breast milk and should • The Ultimate Breastfeeding Book of Answers
be avoided. Revised and Updated: The most comprehensive
Acetaminophen (Tylenol®) and ibuprofen (Advil®, problem-solving guide to breastfeeding, by Jack
Motrin®) are safe to take while nursing. You should Newman, MD and Theresa Pittman (2006)
not take aspirin. Check with your doctor before
taking any other medicines. If you take medicine,
take it right after nursing. Keep taking your prenatal Your health and your ability to take care of your baby can be
seriously affected by violence or abuse. If you are hit, hurt,
vitamins, unless your doctor tells you not to. or threatened by a partner or spouse, there is help. Call the
National Domestic Violence Hotline at (800) 799-7233 (SAFE) or
visit thehotline.org.
Fact and fiction about breastfeeding
You may have heard a lot about breastfeeding from friends or family. With so much advice, it is hard to
know what is and is not true. The following chart should help clear up some common breastfeeding myths.
Fiction Fact
Small breasts can’t Your breasts make milk based on how much your baby nurses, not how big your
produce enough breasts are. The more often the baby suckles, the more milk you make. The fatty
milk. part of the breast does not make milk, so size does not matter.
Colostrum, or “first Colostrum, also called “liquid gold,” gives your newborn immunities to protect him
milk” is not helpful from illness and disease. These immunities do not exist in formula. Colostrum also
for your baby. helps your baby have his first bowel movement.
Infants do not need many calories for the first few days. Your “mature” milk will
come in just when your baby needs it.
Babies need water Everything your baby needs is in your breast milk. The American Academy of
and other food Pediatrics says the best food for babies for the first six months is only breast
– they won’t get milk. After six months, you should give your baby other food, but do not stop
enough if they are breastfeeding for at least the first year. After a year, you can breastfeed as much or
only breastfed. as little as you want.1
It hurts to Breastfeeding should not be painful. Sore or painful nipples are often caused
breastfeed. by a poor latch. Try some of the latch tips in this Health Note. If you still have
trouble, refer to the Kaiser Permanente Health Note Breastfeeding your newborn:
Preventing and managing sore nipples. You might feel discomfort in your
uterus, like period cramps. Breastfeeding tells your uterus to shrink back to its
pre-pregnancy size.
You will be You don’t have to be. Since breast milk is free, always warm, and always available,
tied down by it is often more convenient than formula. You can pump breast milk and have
breastfeeding. someone else feed the baby if you are away. Refer to the Kaiser Permanente Health
Note Breastfeeding your baby: Choosing and using a breast pump.
You can’t go to You can work or go to school while breastfeeding. You can pump breast milk while
work or school you are away and store it for other people to give to your baby. Your workplace is
and continue to required to give you time and space to pump. Check out the Kaiser Permanente
breastfeed. Health Notes Breastfeeding you Baby: Returning to Work or School and
Breastfeeding your Baby: Safe Storage of Breast milk for Full-term Babies.
Fathers get Babies need skin-to-skin contact, cuddling, caring, and other people. Dad or your
“cheated” out of partner can help in these activities and support you when you nurse. Refer to the
feeding the baby. Kaiser Permanente Health Note Breastfeeding: How partners can get involved.
You have to give Unlike when you are pregnant, you can eat almost anything when you breastfeed.
up many foods You are allowed to eat raw meats and fish. A little alcohol is okay after 3 months.
you like while Even coffee is okay if you do not have too much.
breastfeeding.
1 www.aap.org/breastfeeding/PolicyOnBreastfeeding.html Viewed 3/1/2016.

care team. Kaiser Permanente does not endorse any brand names. Similar products may be used. Adapted with permission from
copyrighted material of The Permanente Medical Group, Inc., Northern California.

NEWBORN CIRCUMCISION
Although about 58%1 of newborn boys are circumcised in the United States, the American Academy of
Pediatrics (AAP) has not found enough evidence to recommend that all infant boys be circumcised2. But,
in a Circumcision Policy Statement (2012) released by the AAP, they said that the benefits of newborn
circumcision outweigh the possible risks.2 For many new parents, whether or not to circumcise their sons
can be a hard decision. Some parents choose to have their sons circumcised for religious or cultural
reasons or to look the same as the other men in the family. Other parents choose not to have their sons
circumcised because of fear that their babies will experience pain or problems from the procedure.
HEALTH NOTES
Since circumcision is not medically necessary in most cases, parents should
choose the best option for them. This guide was developed to help you make
the decision.
What is circumcision?
A layer of skin called the foreskin covers the tip of the penis (glans).
Circumcision is an elective (voluntary and by choice) surgery which removes
the foreskin. Parents make the decision to have their sons circumcised; law or
the hospital does not require it.
Circumcision is generally safe and can be completed in a few minutes. Your

For more information health care provider often performs the circumcision soon after birth while
your baby is still in the hospital. In the Jewish faith, the surgery may also be
Visit kp.org/health performed by a Mohel, a person (sometimes a doctor) who is trained in ritual
• Enter newborn circumcision in circumcision.
the search box.
Call Kaiser Permanente Things to consider
Medical Advice
Possible medical benefits of circumcision include the following:
• Talk to your medical advice • Lower risk of urinary tract infections,2 however, urinary tract infections are not
nurse 24 hours a day, 7 days common among male infants. Some studies show a lower risk of sexually
a week by calling (703) transmitted infections.2
359-7878 or (800) 777-7904. • Lower risk of getting the Human Immunodeficiency Virus (HIV) for men in
TTY: (885) 632-8278. heterosexual relationships. For men who have sex with men, the results are
mixed.3
• Lower chance of developing cancer of the penis (however, this type of
cancer is rare in circumcised and uncircumcised males).
• Easier to keep the penis clean (boys who are not circumcised can be taught
to wash underneath the foreskin which can decrease their chances of
infections).
• Prevent infections of the foreskin.
• Prevent tight foreskin which cannot be pulled back (phimosis).
Some of the reasons that parents are against circumcision include the
following:
• General risks of surgery – infection, bleeding, and scarring (problems do not
generally happen and are normally minor).
• Fear that circumcision is painful (local should be taught to wash underneath the foreskin
anesthesia or creams may be used to reduce every day. Your health care professional will give
pain and stress). you more detailed instructions.
• Belief that circumcision leads to a decrease in
sexual pleasure (the effect of circumcision on If I choose to have my son circumcised, how
men’s sexual pleasure is not known). should I care for his penis?
If possible, make the decision before your baby Following circumcision, the tip of the penis may
is born. After delivery, you will probably be look red (raw) or yellowish. Often no treatment is
very tired which will make the decision more needed, though occasionally the recommendation
stressful. is to have the tip covered with a gauze bandage
coated with petroleum jelly (vaseline). In some
If you decide to circumcise your son, it is safest cases, there may still be a small amount of foreskin
during the newborn period. The risks of surgery that can be retracted. Continue to retract and wash
increase after this period. the foreskin to keep it from re-sticking.
Most healthy infant boys can be circumcised. If You should gently clean the penis by pouring warm
you have a family history of bleeding problems mild soapy water over it when the baby is soiled
or if your son was very premature or has medical or at bath time. Some pediatricians recommend
problems, talk to your health care professional. using just warm water, without soap, to clean your
newborn’s penis. If a gauze bandage is present,
Frequently asked questions it should be replaced and coated with vaseline at
each diaper change. Your health care professional
Is circumcision a medically-covered benefit? will tell you how long you need to do this.
Kaiser Permanente currently provides coverage Rarely, doctors may use a plastic ring instead of a
for newborn circumcision. Circumcision after the gauze bandage. If a plastic ring is present, it will
newborn period without a medical reason is not fall off by itself within a week.
covered. Sometimes, older males have medical
problems that make circumcision necessary such It takes about seven to 10 days for a circumcision
as repeated urinary tract infections or a very tight to heal.
foreskin that interferes with urination.
When to call medical advice
If I choose not to have my son circumcised, how
should I care for his penis? Call Medical Advice for the following:
• bright red bleeding on the penis or constant
The foreskin does not need to be retracted or dark red blood in the diaper,
pulled back for cleaning during the first year of • any sign of infection – fever more than 100.4º F
life. When your child is one to two years of age, rectally, pus, swelling, or constant crying,
the foreskin can be retracted partially and cleaned • no urination within 12 hours after the
once a week by rinsing the inside fold of the circumcision, or
foreskin with warm water and soap. Later, when • plastic ring has not fallen off by 14 days after the
the foreskin can be pulled back completely, boys circumcision.
1. cdc.gov/nchs/data/hestat/circumcision_2013/Circumcision_2013.htm#x2013;2010</a>%20 Retrieved Nov 7, 2017

2. pediatrics.aappublications.org/content/pediatrics/early/2012/08/22/peds.2012-1989.full.pdf Retrieved Nov 7, 2017
3. cdc.gov/hivrisk/decreased_risk/male_circumcision.html
care team.

CAR SAFETY SEATS FOR BABIES
One of your first and most important jobs as a parent is choosing a car safety seat for your baby. It can be a
challenge! There are many to choose from and new models come out every year. This guide will give you the
basic information you need to make an informed choice about the best car seat for your baby.
HEALTH NOTES
Car safety seats have saved thousands of lives. All 50 states and the
District of Columbia have laws requiring safety seat use for infants and
children. All car seats for sale in the United States have met government
safety standards. The best car safety seat for your baby is one that fits
your baby’s size, has been installed correctly, and is used every time your
baby is in the car.
Tips for choosing a car safety seat

• Before choosing a car safety seat, review the information in the owner’s
manual for your car to find:
»» where the air bags are placed,
»» which safety seats will fit in your car, and
»» whether your car has a lower anchors and tethers for children (LATCH)
system. Most cars sold after September 1, 2002 and all new car
safety seats are equipped with a LATCH system. These make proper
For more information installation in the back seat easier. To view a video of the LATCH
Visit kp.org system, visit safercar.gov/parents and click on “Car Seats,” then
• Type car safety seats in the “Install your car seat correctly,” then LATCH.
search box. • Choose a car safety seat that fits your baby’s age and size (height
• Read about keeping your and weight).
child safe in the Health • Choose a rear-facing car safety seat. During a crash, a rear-facing car
encyclopedia. seat cradles and moves with your baby to reduce the stress to your
Call Kaiser Permanente baby’s fragile neck and spinal cord.
Medical Advice • Keep your child in a rear-facing car seat up to the maximum height and
weight limit of the car seat you are using. The American Academy of
Pediatrics (AAP) recommends keeping children rear-facing up to
their second birthday.
• There are three types of rear-facing car seats:
359-7878 or (800) 777-7904.
»» Infant-only seats that have carrying handles and a built-in harness.
TTY: (885) 632-8278.
Some infant-only seats come with a base that can be installed once
and left in the car. The car safety seat clicks into the base.
»» Convertible seats that can be switched to forward-facing when your
child is two years old and has reached the maximum height and
weight limit of the car seat.
»» All-in-One seats that can be used rear-facing, forward-facing, and as a
belt-positioning booster, when your child has outgrown the forward-
facing car seat.
Note: not every All-in-One seats are safe for newborns or babies who
weigh less than 15 pounds. Read the product recommendations.
Harness systems should have five points of attachment, two at the

shoulders, two at the hips and one between the legs. Choose a seat
with two or more harness slots at each shoulder to give your baby
growing room. Some seats have adjustable buckle positions between
the legs as well.
• Never buy a car seat when you do not know its airway open. Many car safety seats have an
full history. If you must use a car seat that has indicator that shows when the angle is correct.
been used before, follow these guidelines in You may have to place a rolled-up towel under
addition to those listed above: the base of the car safety seat to get a safe angle
»» Check the car seat frame for any cracks. If the of recline.
car seat was ever in a crash, do not use it. • To view videos on the correct installation of
»» Make sure the car seat has not expired. The rear-facing infant-only and convertible car safety
expiration date is stamped on the label or on seats, visit thecarseatlady.com and click on
the plastic frame. The date of manufacture is “Videos.”
not the same as the date of expiration. • It is very important that you have the car
»» Make sure there have been no recalls issued seat installation checked by a certified CPS
for the car seat. You can find out if a car safety technician before you bring your baby home
seat has been recalled by visiting recalls.gov from the hospital. Visit seatcheck.org to
and search under motor vehicle. locate a car seat check site near you. This may
»» Make sure the car safety seat instructions be available at local police or fire departments
are with the car safety seat. You need the for no charge. You will likely need to call for an
instructions to know how to use the car seat. appointment.
• For current information on specific car
safety seat makers, brands, and prices, visit Tips for positioning your baby in a car safety seat
consumerreports.org and select “Babies & • Be sure your baby is dressed in clothes that
Kids,” under Product Reviews, then “Car seats.” allow the strap to go between his/her legs. It
may be easier to tuck blankets around your baby
Tips for installing a car safety seat after putting him/her in the car safety seat and
• The car safety seat should be installed in the adjusting all the straps.
back seat of your car. Most crashes are front– • Bulky winter coats should not be worn by your
end, so your child will be more protected in the baby underneath the harness of a car seat. This
back seat. Also, if your car has passenger front can result in the harness being too loose in the
air bags and your baby is in the front, the force event of a crash. Instead, lay the coat over the
of the air bag opening could cause serious harm harness as a blanket for your baby.
or death. • The shoulder harness should be positioned at or
• Installing a car safety seat can be challenging. just below your baby’s shoulders and the strap
Be sure to refer to your car owner’s manual and guide at the chest should be at the level of your
the instructions that come with the car seat. If baby’s armpit. This should fit snugly and there
you need help installing the car seat, contact a should be no slack.
certified Child Passenger Safety (CPS) technician
by visiting seatcheck.org or by calling (866) Resources
732-8243. • Visit the American Academy of Pediatrics website
• Secure the car safety seat in the back seat of at aap.org/healthtopics for an on-line guide
the car using the LATCH system or the seat belt to car safety seats as well as links to finding a
restraint. Tighten the straps. The car seat should CPS technician, car seat recalls, and car safety
not be able to move more than one inch from information for parents of premature or small
side-to-side or front-to-back. You can test this babies. You can also download the “Car Seat
by grabbing the car seat near the seat belt or Check” App from your smart phone device.
LATCH path to try and move it side to side and • Visit safekids.org for information about car seat
forward to back. safety for babies under two years old.
• Adjust the angle of recline to no more than 45 • Visit mdkiss.org or call (800) 370-SEAT to learn
degrees. This angle will prevent your baby’s head about the Maryland Kids in Safety Seats program.
from falling forward and will keep your baby’s
care team. Kaiser Permanente does not endorse any brand names. Similar products may be used.
0038-0432 11/17 Mid-Atlantic Permanente Medical group. 2101 E. Jefferson St., Rockville, MD 20852
CHOOSING CHILD CARE
Choosing child care is a very important decision for parents to make. Even if you plan to spend the
first few months at home with your baby, start looking early. Give yourself time to learn and compare
your options and decide what will be best for you and your family.
HEALTH NOTES
Preparing to start child care - 4 step plan

1. Identify the child care options that meet your needs.
2. Schedule visits with child care providers of interest.
3. Compare locations, prices, schedules, and policies of different options.
4. Make your decision and start getting ready for your first day.
What are my child care options?

There are three main types of child care to choose from. Economic, social and
personal reasons may all play a role in what you choose.
For more information • In-home care: The provider comes to you and provides care in your home.
In-home child care is not regulated in DC, Maryland, or Virginia. Some
Visit kp.org/children families choose in-home caregivers because the caregivers are able to:
• Read about Child Care in the »» offer a flexible schedule,
Health Encyclopedia. »» provide more one-to-one time and attention to the baby, and
»» care for and transport older children to activities.
Healthy Living classes • Family child care: Provider offers care in their home to a small group of
• To register call Monday - children. Family child care providers are regulated by the state and must
Friday, 8:30 a.m.-5 p.m., (301) meet a set of health, safety, nutrition and program standards.
816-6565 or (800) 444-6696. • Center-based care: More than one caregiver provides care to larger groups
TTY: (885) 632-8278. of children. Center-based care takes place outside of the home at a place
designed for infants, toddlers, and/or preschoolers. All centers must be
Call Kaiser Permanente licensed by the state and staff must be trained.
Medical Advice
• Talk to your medical advice What to ask a caregiver
nurse 24 hours a day, 7 days Meet the caregivers. Get to know the people who will be spending time with
a week by calling (703) your child.
359-7878 or (800) 777-7904.
TTY: (885) 632-8278. Ask all child care providers:
• How much experience do you have with children?
• Are you trained in CPR, first aid, and early childhood education?
• Do you have references that I may contact?
In addition, ask family child care providers and child care center staff:
• Are you licensed or registered with the state?
• Have you taken any continuing education programs?
• How many children are in your care? What is your child to staff ratio?
• Can I review a copy of your written policies and procedures?
• What are your hours of operation? Which holidays do you observe?
What to look for in a child care program Choosing a child care location
Plan a visit. See where your child will play, learn, eat Things to consider when deciding whether to
and sleep. choose child care close to home or close to work:
• What activities are on the daily schedule? • Cost - Is child care more expensive in the area
• Are the toys clean, safe, and age-appropriate? you work in or in the area you live in?
• Are indoor and outdoor play areas safe? • Convenience - What is most convenient for
• Are healthy food and drinks served for meals and visiting your child during the day, picking up your
snacks? child in emergencies?
• Is screen time (TV, computer) limited? • Other children - Will your older children
• Does the caregiver interact with the child? attend school in that area? Do you want your
• What is the discipline policy? child in a program with familiar kids from your
• Is there a plan for responding to emergencies? neighborhood?
• Is this a place where my child will be happy,
learn, and grow? Preparing for your first day
• Schedule a practice day before you return to
For breastfeeding moms work. Take your baby to childcare for at least part
Choose a child care option that supports your of the day.
choice to breastfeed. Ask if there is a place • Pack the night before. Make sure the diaper bag
where you can breastfeed your baby at drop-off has diapers, wipes, extra clothes, and a favorite
and pick-up times. Sitting down to cuddle and toy. Put breastmilk in the refrigerator to thaw
nurse after a busy day is a wonderful way to overnight. Pack your lunch.
de-stress and reconnect with your baby. Be sure • Don’t forget to put the breastmilk in the diaper
that caregivers know how to correctly store and bag before you leave in the morning.
bottle-feed breast milk. • Relax. You have done your research. Trust that
your baby is in good hands.
For more information on combining work
and breastfeeding, attend Prenatal 4 Class, Resources
Breastfeeding Basics. Also refer to the Kaiser
Permanente Health Notes Breastfeeding • For more information on child care:
your baby: Returning to work or school and childcareaware.org/parents-and-guardians.
Breastfeeding your baby: Safe storage of • For a printable checklist of things to look for in a
breastmilk for full-term babies. quality child care program:
naccra.org/publications.
• Contact your local Child Care Resource &
Paying for child care Referral Network to find licensed child care in
Quality child care can be very expensive. The your area, and see if you qualify for financial
amount you pay for child care every year depends assistance.
on the age of your child, whether your child is »» In Virginia: Child Care Aware VA (866) 543-7852
full-time or part-time, and where your child care »» In D.C.: mychildcaredc.com
program is located. On average, center based care (202) 719-6500
costs more than family child care. In-home child »» In Maryland: marylandfamilynetwork.org
care prices vary. Contact your local Child Care (401) 659-7701
Resource & Referral Network to find out if you
qualify for financial assistance.
care team.

How to care for
yourself and your
new baby
FOURTH EDITION
i
IMPORTANT PHONE NUMBERS
Emergency. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 911
TTY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (885) 632-8278
Behavioral Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (866) 530-8778
If you are unsure if the situation requires an emergency room visit

and your baby’s physician is a Kaiser Permanente provider, call . . . . . . (800) 677-1112
If your baby’s physician is in the community, please call the physician’s office directly.
o make or cancel an appointment, call

T
Monday-Friday 7 a.m. to 8 p.m.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (703) 359-7878
(800) 777-7904
To talk to an advice nurse, 24 hours/day,

7 days a week call . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (703) 359-7878
(800) 777-7904
Membership services (for questions about benefits and services and

enrolling your baby) Monday-Friday 7:30 a.m. to 5:30 p.m. . . . . . . . . . (301) 468-6000
(800) 777-7902
Health education classes, including breastfeeding

(24-hour automated service). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (301) 816-6565
(800) 444-6696
Kaiser Permanente Certified Lactation Consultants and Breastfeeding Specialists

(Newborn Care Center)
Baltimore area. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (410) 737-5464
DC/Suburban Maryland area . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (866) 264-4766
Northern Virginia area . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (703) 922-1469
CONGRATULATIONS!
The birth of your baby is a wonderful, At the hospital, your baby will be cared for
exciting, and challenging time. Whether by pediatric health care practitioners who will
this is your first, third, or sixth baby, you will examine your baby and talk with you about
naturally have many questions. The Pediatric, your baby’s condition. They will also help you
Family Practice, Health Education/Health prepare for your baby’s first days at home and
Promotion, and Women’s Health departments discuss the schedule for your child’s regular
have prepared this booklet for you as an well-baby visits.
introduction to postpartum and infant care.
For you as a mom, even if it’s not your first
Your health care team will be glad to child, this is a special time for you and
answer questions. In addition to your baby’s your baby.
doctor and members of your baby’s health
care team, medical advice nurses also are The information in this guide will help you
experienced in dealing with parents’ concerns recover and manage some of the issues that
and questions. If you are worried or just might come up during the weeks right after
curious about something, please do not the birth of your baby.
hesitate to call.
USEFUL RESOURCES
American Academy of Family Physicians . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . aafp.org

American Academy of Pediatrics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . aap.org

Centers for Disease Control and Prevention. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . cdc.gov
CDC Information (24 hours/day) (800) CDC-INFO
(800) 232- 4636 (English & Spanish)
Consumer Safety Products Commission

(recalls and infant safety). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . cpsc.gov
Kaiser Permanente . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . kp.org

(pregnancy information and resources) . . . . . . . . . . . . . . . . . . . . . . . . . kp.org/pregnancy
(what to expect during pregnancy). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . kp.org/maternity
La Leche League International

(breastfeeding resources and support). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . llli.org
National Highway Traffic Safety Administration

(infant and child passenger safety). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . nhtsa.gov
Postpartum Support International (for perinatal mood and anxiety disorder,

including postpartum depression) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . postpartum.net
OB Name: ____________________________________________________________________
Postpartum visit date ____/___/___ time: ____________
2-week C-section follow up date ____/___/___ time: ____________
Pediatrician Name: ____________________________________________________________
3-5 day visit date ____/___/___ time: ____________
2 week visit date ____/___/___ time: ____________
4 week visit date ____/___/___ time: ____________
iv
Table of contents
Discharge instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Self-care for new moms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Well-baby visits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
The Newborn Care Center . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Feeding your baby . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Baby’s care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Safety reminders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
Growth and development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Recognizing the sick newborn . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
Books for parents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
Sources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
1
DISCHARGE INSTRUCTIONS
Your first few days at home are about rest, recovering from the birth, and getting to
know your baby. Try to get as much rest as possible. Limit your activities to caring for
yourself and your baby. This is the right time to let others help you. We recommend
that you allow others to cook, clean, and bring you meals, so you can spend time with
your baby.
It is common to feel unsure about what is and is not normal for you and your baby.
Please feel free to contact a medical advice nurse if you have any questions.
CALL THE ADVICE NURSES PROMPTLY IF:

Mom: Baby:
• Fever of 101º F or higher • Rectal temperature of 100.4º F or high-
• Vaginal bleeding that is soaking a pad er. See instructions on page 38.
every two hours or is bright red with • Urinating fewer than three times in 24
bright red blood clots hours
• Passage of large clots (golf ball-size) • Odor or profuse bleeding from umbili-
• Severe cramping, abdominal pain, or cus (also called navel, bellybutton,
a very tender hard abdomen when or cord stump)
touched • Bleeding from circumcision
• Vaginal discharge that has a bad odor • Skin or white of eyes look yellow (jaun-
• Severe headaches or visual changes that dice)
don’t go away with rest and • Skin unusually sweaty, pale, hot, or red
acetaminophen (Tylenol) • Sleeping six hours or more at a time
• Burning sensation when urinating, fre- • Nursing less than 10-15 minutes every
quent urination, or the urge to urinate two to four hours, taking less than
with only a tiny amount of urine ½ to 2 ounces of formula every three to
• Feelings of sadness or anxiety that make four hours, or any sudden changes
it hard to care for yourself or your baby in feeding schedule
• Chills or flu-like symptoms
Also see the section in this book on
“Recognizing the sick newborn”
on page 38.
2
MAKING FOLLOW-UP schedule to have this assessment com-
APPOINTMENTS pleted at Kaiser Permanente’s Newborn
Care Center in some Pediatric depart-
• You can usually leave the hospital 24-48
ments. Lactation Consultants in the
hours after a vaginal delivery and 48-72
Newborn Care Center can also assist
hours after a cesarean delivery.
with breastfeeding.
• If you have had a C-section, schedule a
• If you did not receive the Tdap vaccine
staple or suture removal for 10-14 days
during pregnancy or in the hospital, be
later.
sure to ask for it at your next visit. All
• You need to have a follow-up post-
adults caring for your baby should also
partum visit with your OB five weeks
receive the Tdap vaccine.
after delivery. This is a good time to
get answers to the questions that have
come up since you returned home.
• Please schedule these appointments OVER-THE-COUNTER MEDICINE
before leaving the hospital by calling You may take or use:
an appointment representative at (703) • two to three ibuprofen (200 mg) tablets
359-7878 any day of the week between every six hours, as needed for pain if
7 a.m.and 8 p.m. you are not allergic to ibuprofen
• Before leaving the hospital, make sure • prenatal vitamins, once daily for at least
you give a member of your healthcare six weeks or up to six months, if breast-
team your current contact information. feeding
• Within 30 days, call your employer and • iron supplements, if advised by your pro-
insurance to enroll your newborn and vider, continuing with the dose you were
register through Member Services to be taking during your pregnancy
able to make future appointments. • one to two tablets of Colace® (over-
• Your newborn will need to be seen with- the-counter stool softeners) twice daily,
in the first 1-3 days for a complete new- as needed, with a large glass of chilled
born assessment, including an evalua- water
tion for jaundice, weight, feeding, voids, • Tucks,® Benzocaine spray or hemorrhoid
and stools. If eligible, the Physician will medicine of choice.
Kaiser Permanente does not endorse any brand names; any similar products may be used.
3
SELF-CARE FOR NEW MOMS
The first few days at home are about • Breasts: whether you plan to breastfeed
rest, recovering from birth, and get- or not, your milk will come in within three
ting to know your baby. The weeks fol- to six days after delivery. Colostrum is
lowing the birth are important, as your very important too and comes in before
body returns to normal after pregnancy, your milk. Your breasts may feel full and
labor, and birth. Your health care team at heavy, and you may experience leak-
Kaiser Permanente is here to support you ing of breast milk from the nipples. Your
through the postpartum experience, as breasts will get larger and may feel hard
you care for yourself and your new baby. and uncomfortable. If you have any ques-
tions or concerns about breastfeeding or
After the birth of your baby, your body breast care contact a Kaiser Permanente
will take 4-6 weeks for your uterus, hor- certified lactation consultant.
mones and healing from any surgical • Uterus: as the uterus shrinks back to its
incisions to get back to its pre-pregnant normal size during the postpartum peri-
state, depending on the type of birth you od, you may feel pain similar to contrac-
had and other factors. This is called the tions, especially if you are breastfeeding.
postpartum period. You can experience After-birth pain is necessary to shrink the
a lot of physical and emotional changes uterus back to its normal size.
during this time. • Vaginal discharge: you will experience
a normal vaginal discharge after delivery
PHYSICAL CHANGES that may last four to six weeks. This is not
the same as a menstrual period. Within
• Bladder: it is important to empty the
the first few days the discharge will be
bladder often to prevent urinary tract
red, transitioning to a brownish color,
infections post pregnancy, as your body
then more watery. Vaginal discharge dur-
is getting rid of extra fluid caused by
ing this time should have an earthy or
swelling during the pregnancy.
musty odor. Passing small clots (the size
• Bowels: it’s not uncommon for the bowel
of a dime) or medium clots (the size of a
patterns to slow down due to reduced
quarter) is normal.
physical activity, changing hormones,
and medications used during labor and
delivery. The first bowel movement may
take two to three days. Developing hem-
orrhoids, experiencing constipation and
feeling gassy are all normal. If needed,
a laxative or stool softener prescribed
by your doctor can provide some relief.
Including fiber in your diet is also helpful.
Your body will take about

4-6 weeks to get back to
its pre-pregnant state
4
EMOTIONAL CHANGES nancy, and can last up to 12 months
As you prepare to welcome a brand new after the birth of the baby. Many signs
baby into your home, you will be flooded of “baby blues” are present, but are
with many emotions. Along with fatigue more intense. Postpartum depression is
and hormonal changes, there may be feel- a common PMAD. It can occur due to
ings of anxiety, and even depression. Be the physical and emotional changes that
patient with yourself. This process is nor- take place during pregnancy, birth, and
mal and should get better by two weeks the care of a newborn.
after the baby’s birth. Contact your health- • Contact your health care team right
care team right away if you are very sad away if feelings of sadness or anxiety
and have a hard time caring for yourself last longer than 2 weeks and you are
or your baby. Keep in mind your family having a hard time caring for yourself
and friends may notice changes before or your baby. You may have a condi-
you do. tion called Perinatal Mood and Anxiety
Disorder. PMAD is a common and
• Baby blues: during the first few days treatable condition. Your doctor may
after the baby’s birth, you may experi- suggest you attend a support group,
ence “baby blues.” At times you may receive individual counseling, or begin
feel irritable, lose your patience, or even medication to help you cope. You may
cry while trying to organize a home and also speak to a behavioral health rep-
meet the needs of a newborn. These resentative by calling the behavioral
feelings usually resolve quickly. health advice line at (866) 530-8778.
• Perinatal Mood and Anxiety Disorders: You do not need a referral from your pri-
perinatal mood and anxiety disorders mary care physician. You can also go to
can appear anytime during the preg- kp.org/pregnancy to learn about peri-
natal mood disorder.
5
BREAST CARE Bottle-feeding moms
Breastfeeding moms • If you are not planning to breastfeed,
• Encourage your infant to nurse fre- take an acetaminophen product, like
quently to relieve breast fullness. Other Tylenol,® for the discomfort of breast
ways to relieve discomfort include wear- engorgement (a feeling of hardness and
ing a sturdy nursing bra (without under- fullness).
wires) for support and using cold packs • Use ice packs to decrease breast pain
(try a bag of frozen vegetables) between and swelling. Do not place cold packs
feedings. directly on your skin, cover it with a thin
• Learn correct latching-on and position- towel or cloth.
ing methods to prevent nipple soreness. • Wear a snug-fitting bra 24 hours/day.
For proper latch-on, be sure the baby • Do not try to express milk from your
takes part of the flat, darker part of your breasts, it will increase milk production.
breast (the areola) in his or her mouth - The fullness should resolve after one
not just the nipple. week.
• Change positions; try sitting up for one • If your breasts are hot to the touch
feeding and lying down for the next OR red, OR if you have a fever, call
feeding. the Kaiser Permanente medical advice
• After breastfeeding, put a few drops line because you might have a breast
of breast milk on your nipples and air infection.
dry your breasts to reduce drying and
cracking. For more detailed information on breast-
• Do not use soap to clean your nipples feeding, see page 12.
because it can cause dryness. Plain
water is fine. If your nipples are very
sore, you might wish to apply a lanolin
cream after allowing them to air dry.
• Change breast pads before they are
wet.
• Do not use breast shields or bottle
nipples over your nipples unless rec-
ommended by your doctor or certified
lactation consultant because they may
interfere with milk production. Your milk
production is stimulated by your baby’s
direct contact with the glands beneath
the nipple.
• If your breasts are hot to the touch
OR red, OR if you have a fever, call
For more information on
the Kaiser Permanente medical advice
breastfeeding, attend Prenatal
line because you might have a breast
4 Class “Breastfeeding Basics,”
infection.
contact your pediatrician’s office,
• If you have any questions or concerns,
or call a lactation consultant.
call your Kaiser Permanente pediatri-
Phone numbers are in the front of
cian’s office or speak with a certified lac-
this book.
tation consultant.
6
CARE TIPS AND HYGIENE the risk of developing blood clots and
• Bathing: showers and sitz baths are usu- help with bladder and bowel functions.
ally fine after delivery. Avoid tub baths, Although spotting or bleeding is nor-
tampons, douching, and sexual inter- mal for the first six weeks after having
course until after your 5 week postpar- a baby, if it increases or is bright red,
tum appointment when your have been you may be doing too much. Limit your
cleared by you Physician. activities, especially stair climbing and
• Driving: talk with your doctor about lifting anything heavier than the baby.
how long you should avoid driving. • Rest and sleep: rest as much as pos-
Some women have dizziness or discom- sible, especially the first few days after
fort that may make driving difficult. you leave the hospital. Limit visitors.
• Episiotomy: If you received an episiot- Take naps often when your baby does.
omy during your vaginal delivery, make Ask friends and family to help with
sure you change your pad often. Use infant care, shopping, cleaning, and
a spray bottle, sitz bath, or hand-held making meals.
shower to clean the area two to three • Sex and family planning: avoid sexual
times a day, and after urination and intercourse and putting anything in
bowel movements. your vagina for six weeks. It can be
• Nutrition: maintain a balanced diet to very uncomfortable if you have stitches.
include protein, vegetables, fruit, grains, Normal vaginal dryness occurs after
and dairy. If you plan to breastfeed, you having a baby, which can increase your
should eat an additional 500 calories discomfort. Since you can become
per day. Drink at least eight glasses of pregnant again even before having your
fluids (mostly water) each day, especially period, talk with your doctor before
if you are breastfeeding. Drink low-fat resuming sex and/or use a barrier meth-
milk or try calcium-fortified juice or low- od of birth control, such as a condom,
fat yogurt for calcium. Nutritional needs to prevent pregnancy.
can still be met during the postpartum
period while keeping a vegetarian or
vegan diet.
• Physical activity: depending on the
type of delivery and how you are feel- Ask your doctor before taking
ing, get out of bed and move around medicines, including over-the-
soon after the birth. This will help lower counter medicines other than
those listed in this book. 7
CAESAREAN SECTION (C-SECTION) TAKE CARE OF YOURSELF:
• Gently clean stitches with warm, soapy TRACK YOUR HEALTH ONLINE
water. Pat dry with a clean, soft towel. Now that you’re a new mom, you might
• Use pillows to support your stomach be tempted to put managing your health
when turning, standing, coughing, and in the background. But now, more than
when feeding the baby. ever, it’s important that you take care of
• Let others do household chores like yourself.
cooking, cleaning, and laundry.
• Check the incision (cut) daily, or have It’s so convenient to keep track of your
someone else check it for redness, health and manage your health care tasks
which can be a sign of infection. at kp.org, where you have access to “My
• Do not lift anything heavier than your health manager”—right on the front page.
baby. If you are registered at kp.org and receive
• Although you have had a C-section, you care in Kaiser Permanente medical centers,
will have normal vaginal bleeding. you will be able to view your secure medi-
• The surgery might slow your diges- cal information and manage health care
tion. To help with constipation, try an tasks online.
over-the-counter stool softener, such as
Colace®. Drink plenty of fluids and eat Visit kp.org/myhealthmanager. To register,
foods high in fiber. visit kp.org/register.
• Gradually increase your activity each
day. Go for walks outside with your WHAT YOU CAN SEE ON KP.ORG
baby, if weather permits. After 4-6
weeks, you should be able to go back • Lab test results
to your normal routine. • E-mail alerts for upcoming appoint-
ments, lab results, and unread messages
• Immunization records
GETTING BACK IN SHAPE • Medication allergies
Finding the time and energy to exercise • Past office visit information
can be a challenge for new moms. But • Health care reminders
eating well and being active are impor- • Ongoing medical condition information
tant to keeping you healthy and shedding • Benefit and eligibility information
pregnancy pounds. Here are some tools • A summary of your medical history
that can help:
• Get started with a personalized weight
management plan with BalanceTM at
kp.org/balance
• Walking is a great way to ease back into
exercise. Use a pedometer (an easy- Learn about our national Every
to-wear device that senses your body’s Body Walk campaign and find tools
motion) to count your steps and moti- and support to get moving. Visit
vate you to increase your activity. everybodywalk.org
8
WHAT YOU CAN DO ON KP.ORG practice in a Kaiser Permanente medical
• E-mail your doctor’s office center and you are a registered user at
• Schedule and cancel routine appoint- kp.org, you can access some features: pre-
ments for primary care scription refills, some lab results (if tests are
• Order and check the status of prescrip- performed in our centers), and eligibility
tion refills and benefits, as well as the ability to act for
• Manage appointments a family member.
• Request a change to your medical
record Care from doctors you see outside our
• Complete a health assessment and send medical centers, or the results of tests and
the results to your primary care doctor screenings performed outside our medi-
• Print a summary of your ongoing health cal centers, are not part of your Kaiser
conditions Permanente medical record. As a result,
• Act for a family member. If your new they cannot be included in the personal
baby’s pediatrician practices in a Kaiser health information online at kp.org. If
Permanente medical center, you will be there is information you would like includ-
able to access all of the above informa- ed, please talk with your doctor about
tion for your baby. You will be able to releasing it to be viewed.
order prescription refills, e-mail your
baby’s doctor, etc.
These online health-information features

are available to you if you receive care,
tests, and screenings at Kaiser Permanente Visit kp.org/myhealthmanager.
medical centers. If your doctor doesn’t To register, visit kp.org/register.
9
WELL-BABY VISITS
YOUR BABY’S FIRST CHECK UP visit, your baby’s doctor, or a member of
your baby’s health care team, will examine
Your baby’s first complete check up occurs
your baby and discuss growth, develop-
one to three days after you return home
ment, safety, nutrition, and other age-
from the hospital. During the first complete
appropriate health matters with you. This
check up, your baby’s weight and nutri-
is a good time to ask questions. You will
tion will be assessed and your baby will
also be encouraged to have your baby
be evaluated for jaundice. If you deliver
receive immunizations, based on the
outside a KP Mid-Atlantic hospital part-
baby’s age and health history.
ner, bring your records. You may want to
write down any questions you would like
We strongly suggest that your baby
answered. (Just a reminder: medical advice
receive protection from the more than 10
nurses are always available by phone at
potentially dangerous, vaccine-prevent-
any time to answer questions.) Kaiser
able diseases. If you have questions or
Permanente lactation consultants can also
concerns, please discuss them with your
assist you with breastfeeding your baby.
baby’s doctor, or a member of your baby’s
They can make sure that your baby is latch-
health care team at your next visit. Also,
ing correctly and feeding well.
be sure to ask for a current schedule of
recommended health visits, screenings,
Kaiser Permanente strongly encourages
and immunizations. See Health Care Visit
you to bring your baby in for all recom-
Schedule for Newborn to 2 Years.
mended well-baby visits. During each
10
THE NEWBORN CARE CENTER
The Newborn Care Center (NCC) is here At the Newborn Care Center visit, your
for you and your newest family mem- baby will receive a complete checkup,
ber every step of the way. We want to including a weigh-in. You will also receive
help you with all the changes that hap- information and guidance on common
pen from prenatal to pediatric care. The newborn matters, including:
Newborn Care Center is staffed by expe- • cord care,
rienced Registered Nurses who are Board • circumcision care,
Certified Lactation Consultants and spe- • gas/colic,
cially trained in newborn care. Newborn • immunizations,
care and lactation services are provided • jaundice, and
to Kaiser members at no cost. Our trained • knowing when to call the doctor.
staff are also available to answer any
questions you may have by phone. During your visit, the Newborn Nurse who
is also a certified Lactation Consultant will
A healthy birth is just the start of our com- answer your questions about breast feed-
mitment to your baby’s well-being. Before ing, including:
you leave the hospital, we will schedule
an appointment for you and your baby to • feeding cues,
visit Kaiser Permanente’s Newborn Care • feeding on demand,
Center one to three days after you are • feeding positions,
discharged. • milk storage,
• proper latching,
• pumping basics, and
• skin to skin.
11
FEEDING YOUR BABY
BREASTFEEDING Mothers who breast feed have less bleed-
ing after delivery, a lower risk of devel-
Please refer to the handout Breastfeeding
oping post-partum depression, breast
your Newborn: The First Weeks.
cancer, and ovarian cancer. Women who
When you breastfeed, your baby receives breast feed may experience a quicker
the best possible nutrition.1 There is return to their pre-pregnancy weight.
strong evidence that breast milk provides
important protection against respiratory Your baby easily digests breast milk. It’s
and intestinal infections and allergies. The more convenient, because you don’t have
most benefits are seen when babies are to wash bottles or make formula in the
breastfed exclusively (no formula) for at middle of the night. Breastfeeding saves
least six months. Breastfed babies gener- money! You will save at least $900 by
ally have fewer colds, ear infections, diar- breastfeeding your baby for a year. These
rhea, and vomiting. Some studies also benefits are not available when using
suggest a lower risk of Sudden Infant commercial formula.
Death Syndrome (SIDS) in the first year of
life for babies that are breastfed. In older Breastfeeding can be a very enjoyable
children and adults who were breastfed, and successful experience, but requires
there is a lower rate of diabetes, and asth- patience and practice by you and your
ma. There is less risk of obesity in adults baby. You and your baby will progress
who were breastfed as babies. with breastfeeding more quickly if you
are well-prepared, supported by family
and friends, relaxed, rested, and well-
nourished.
1. American Academy of Pediatrics Web site: aap.org, “Breastfeeding and the Use of Human Milk Policy Statement,”
February 2005.
12
TYPES OF BREAST MILK TIPS FOR POSITIONING AND
By 16 weeks of pregnancy, your breasts LATCHING ON
are capable of making breast milk. The The first days of breastfeeding are a new
first milk produced is known as colostrum learning experience as you and your baby
or “liquid gold.” It is not uncommon for get to know each other.
some women to experience drops of
colostrum coming from the nipple during Some babies have no difficulty latching
the pregnancy, or closer to delivery. onto the nipple correctly. Other babies
are quite tired from delivery and do not
Colostrum: Colostrum commonly known seem interested in nursing. Both situations
as “liquid gold” is the first milk the baby are normal. Correct latch-on is the key to
will receive until your mature milk comes successful breastfeeding. When baby has
in between 2-4 days after the delivery. latched on successfully, the entire nipple
Colostrum is thick and may have a clear or and much of the areola is in the infant’s
yellow appearance. Colostrum is high in mouth. The lips are rolled out and the
protein, fat soluble vitamins, minerals, and cheeks are full and rounded when the
antibodies that coat the baby’s stomach infant is nursing. Mom feels a tugging
and intestines, protecting the baby from sensation and can hear audible swallow-
viral and bacterial illnesses. ing. Refer to the handout: Breastfeeding
your Newborn: The First Weeks. The fol-
Transitional milk: Transitional milk comes lowing steps will help:
in after the colostrum. It is white and
more watery. When you breast feed fre-
quently, your milk will increase in quantity.
Transitional milk is much higher in calories,
protein, fat, lactose, and water soluble
vitamins.
Mature milk: Mature milk comes in two to

four days after the birth. It may take lon-
ger if you waited to start breastfeeding,
or if you had a C-section. Mature milk is
more watery, which is necessary for infant
hydration. It also contains proteins, fats,
and carbohydrates necessary for growth
and development. The immune boost-
ing properties still remain, as breast milk
changes to meet the needs of a rapidly
growing baby.
13
Step one: Watch your baby for feeding 3. Hold your infant sideways so your
cues: rooting, smacking lips, or bring- baby’s tummy and your tummy touch,
ing hands to his/her mouth. Crying is a supporting the baby’s head in the bend
late sign of hunger. If your baby is cry- of your elbow. This is often called the
ing, try to calm your baby first. Hold your “cradle hold.”
baby in just his or her diaper against your -OR-
bare chest. This is called skin-to-skin con- 4. Lie on your side with your baby lying
tact and has many benefits to your baby, facing you, supporting the baby’s head
including calming ones. Let your baby suck with your hand. This is often called the
on your clean finger. Find a comfortable “side lying” position. This position is
position. Sit in an upright chair with back good for night feedings or if you had a
support and a footstool (or lie on your C-section. After you finish nursing, put
side). Use pillows to support yourself and your baby back in the crib or bassinet.
your baby. Here are five choices for posi- It is not safe for the baby to sleep in
tioning your baby. There are no “wrong” your bed.
positions as long as you are both comfort-
-OR-
able and the baby is breastfeeding effec-
tively. 5. Lean back on your sofa, recliner or bed
with your upper back and head sup-
1. Place a pillow on your lap under the
ported by pillows. Lay your baby on
baby, holding baby at breast level. If
your bare chest - baby’s front against
you are nursing from your right breast,
your front - with his/her cheek near
use your left hand and arm to hold
your breast. If needed, help your
your baby. Rotate your baby’s body, so
baby find the nipple. This is called the
the chest and tummy are directly fac-
“laid-back” breastfeeding position or
ing you. This is often called the “cross
“biological nurturing.” In this position
cradle hold.”
you may not need step two below and
-OR- you will not need step three. After you
2. Cradle your baby’s head in your hand finish nursing, put your baby back in
with the body extending toward the the crib or bassinet. It is not safe for
back along your forearm. This is often the baby to be left alone on the sofa,
called the “football hold.” recliner or bed.
-OR-
14
Step two: The goal is to have your When babies have finished nursing,
thumb across from the baby’s nose, and they will usually come off the breast. If
fingers by the chin of the areola so baby suckling has slowed down, if the baby is
can achieve a deep latch. These are two falling asleep while latched, or if the latch
methods: becomes uncomfortable, break the latch
1. Place your thumb on the top of the by sliding your finger between the corner
breast and the remaining fingers below of the baby’s mouth and your breast to
your breast so that your hand forms the break the suction. Do not pull the baby
letter “C.” Be sure to keep your fingers off the breast as it may cause nipple
behind the areola. damage.
-OR-
If you are experiencing problems with
2. P
lace your thumb on one side of your
breastfeeding before going home from
breast and your fingers on the opposite
the hospital, ask to speak with a lactation
side so that your hand forms the let-
consultant. After discharge, call your pedi-
ter “U.” Be sure to keep your fingers
atrician’s office or a Kaiser Permanente
behind the areola.
lactation consultant. You can also call a
Step three: Lightly tickle your baby medical advice nurse anytime, day or
above the upper lip with your nipple. Your night. See “Important phone numbers” in
baby’s head should be looking up slightly, the front of this book.
in a “sniffing” position. Wait until your
baby opens his or her mouth WIDE, then
FEEDINGS
quickly bring him or her onto the breast.
Aim the nipple towards the roof of your Feedings usually last about 20 to 30
baby’s mouth. This helps him/her grasp minutes for most babies, although the
all of your nipple and some of the areola. amount of time varies. Once your baby
Your baby’s chin should be against the is nursing correctly—long, drawing sucks
breast and his or her nose slightly away that tug at the nipple without pain—con-
from the breast. tinue until your baby releases the nipple.
Your baby is not latched on correctly if: The last milk in your breast, the hind milk,
has a higher fat content and provides
• he/she is only sucking on part of the
more calories for growth and weight gain.
nipple
Your baby receives some of this essential
• you feel pain
hind milk after 10-15 minutes of sucking
• you cannot see your baby’s lips above
and completely emptying at least one
and below the nipple easily, or
breast. Offer both breasts at each feed-
• you hear loud smacking noises.
ing, but offer the second breast only
after completely draining the first. To
BREAKING THE LATCH encourage your baby to drain the breast,
If your baby is not latched on correctly, you can gently compress your breast
break the suction by placing your finger when you see long pauses in your baby’s
into the corner of your baby’s mouth, then sucking and swallowing movements. Be
between the gums. Remove your nipple sure to gently compress with your fingers
from the mouth and try again. Be careful well behind the areola. Many newborns
not to pull the nipple from your baby’s fall asleep after feeding on only one side.
mouth without first breaking the suction. This is okay, unless your baby is not wak-
15
ing up at least every 2-3 hours to nurse. If on demand. This can be physically
your baby is very sleepy, try: demanding for moms, make sure you are
• undressing your baby down to the eating, drinking, and resting so you can
diaper, meet the demands of your infant during
• using breast compression (see above), these periods of frequent feeding.
• holding your baby skin-to-skin, or
• switching breasts and burping. If there are concerns about your baby’s
weight in the first few weeks, you may
Alternate the first breast offered with each have to wake your baby for feedings more
feeding. You can use a ribbon on your bra often. Discuss this with your pediatrician,
as a reminder, or leave the flap on your breastfeeding specialist or certified lacta-
bra open until the next feeding. There are tion consultant. Your rest is important too.
also apps for your smart phone to track Try to nap whenever your baby sleeps,
feedings. day and night. As time goes on, your
baby will sleep more at night.
SCHEDULES AND HOW OFTEN TO
BREASTFEED IS YOUR BABY EATING ENOUGH?
Sleeping more at night and eating more All babies lose weight in the first few days
during the day helps establish a routine of life. This is normal and expected. Most
for your baby. babies are back up to their birth weight
by two to three weeks of age. Breastfed
During the day, arouse your infant every babies usually gain about one half to one
two or three hours for a feeding. At night, ounce per day during the first several
wake your baby every three to four hours months of life.
until your baby has regained his or her
birth weight. You might find this table helpful during
the first sleep-deprived days. Circle the
After a feeding, your baby may want to hour each time you breastfeed. Circle a W
nurse again within two hours or less. Feed (wet) each time your baby has a wet dia-
your baby whenever they are displaying per. Circle S (soiled) each time your baby
signs of hunger or “feeding cues.” has a soiled diaper. Bring this chart with
Typically, breastfed infants need to eat you to your baby’s first appointment.
from the breasts 8-12 times per day. This
ensures they get needed nutrition and the
supply of breast milk remains high.
Once a schedule is established, most

infants nurse about every two hours from
the beginning of one feeding to the
beginning of the next. But don’t watch the
clock! Watch your baby for feeding cues.
Cluster feeding is when your baby feeds

often without long gaps in between. Day one Day three One week Two weeks
It is common in newborns and can be size of a cherry size of a walnut size of an apricot size of a large egg
associated with growth spurts. Watch 5 to 7 ml 22 to 27 ml 45 to 60 ml 80 to 150 ml
for feeding cues and nurse the baby 1 to 1.5 tsp 0.75 to 1 oz 1.5 to 2 oz 2.5 to 5 oz
16
DAY 1 DAY 6
AM 1 2 3 4 5 6 7 8 9 10 11 12 (noon) AM 1 2 3 4 5 6 7 8 9 10 11 12 (noon)
PM 1 2 3 4 5 6 7 8 9 10 11 12 (midnight) PM 1 2 3 4 5 6 7 8 9 10 11 12 (midnight)
Wet diapers: W W Wet diapers: W W W W W
Soiled diapers (black, tarry meconium): S Soiled diapers (yellow, seedy): S S S
DAY 2 DAY 7
AM 1 2 3 4 5 6 7 8 9 10 11 12 (noon) AM 1 2 3 4 5 6 7 8 9 10 11 12 (noon)
Wet diapers: W W W Wet diapers: W W W W W W
Soiled diapers (black or brown stool): S S Soiled diapers: S S S S
DAY 3 DAY 8
AM 1 2 3 4 5 6 7 8 9 10 11 12 (noon) AM 1 2 3 4 5 6 7 8 9 10 11 12 (noon)
Wet diapers: W W W W Wet diapers: W W W W W W
Soiled diapers (green or yellow): S S Soiled diapers S S S S
DAY 4 DAY 9
AM 1 2 3 4 5 6 7 8 9 10 11 12 (noon) AM 1 2 3 4 5 6 7 8 9 10 11 12 (noon)
Soiled diapers (yellow, seedy): S S S Soiled diapers S S S S
DAY 5 DAY 10
AM 1 2 3 4 5 6 7 8 9 10 11 12 (noon) AM 1 2 3 4 5 6 7 8 9 10 11 12 (noon)
Soiled diapers (yellow, seedy): S S S Soiled diapers S S S S
17
YOUR BABY IS EATING ENOUGH IF »» Manually express or pump to soften
HE/SHE: the nipple/areola so baby can latch
»» Nurse frequently.
• seems content (full, satisfied) for about
»» Apply a cold compress after feedings
one to two hours after feeding.
such a bag of frozen corn or peas, do
• self-detaches from the breast, becomes
not apply cold/ice directly to the skin.
relaxed, or falls asleep.
»» Breast Massage: Breast massage can
• urinates or has a wet diaper at least
help relieve engorgement. Before
once every eight hours during the first
expressing your breast milk by hand,
few days of life. Once your baby is nurs-
you should massage the breast first.
ing frequently, six to eight wet diapers
Using the pads of the fingers massage
in a 24-hour period is typical.
breast in a circular motion from chest
• passes soft, yellowish stools with visible
to nipple. You can also use a warm
seedy clumps after the first three or four
moist compress, as the combination of
days. Your newborn may have several
the two will trigger the let-down reflex
soft, often runny stools per day or with
to make manual expression more
each feeding. Older infants may pass
effective.
stools less frequently, perhaps only once
»» Manual Expression: To manually
every 3 to 7 days. These stools are often
express, place the thumb and first two
pasty in consistency and are not consid-
fingers in a C-shape around about
ered constipation unless the stools are
one inch away from the areola. Gently
small, hard pellets.
press back in the chest wall and roll
the thumb and fingers forward to
ISSUES YOU MAY ENCOUNTER express milk. Continue this technique
INCLUDE: moving around the areola. Hand
• Blocked Ducts: Usually felt as sore expressed milk can be collected and
bump under the skin in the breasts. stored for later use.
Blocked ducts can be caused by infre- • Sore/cracked nipples: Keep your
quent feeding, breast milk over produc- nipples dry and exposed to air
tion, or wearing a tight bra with under between feedings. Start feedings on
wire that can constrict the milk ducts. To the least sore side, then switch sides
treat, massage the area, apply a warm once the milk has let down. Nurse
moist compress and feed frequently more frequently, but for shorter periods
placing baby’s chin towards the blocked of time. Persistent sore nipples or
duct. Massaging the blocked area worsening soreness is usually caused by
towards the nipple while nursing with the way your baby is latching on to the
also help to treat the blocked area. breast. If you are having sore nipples,
• Engorgement: As your milk begins to contact a Kaiser Permanente lactation
come in 2-3 days after the birth, your consultant.
breasts may feel heavier, appear swol- • Redness or tenderness in one part
len, and feel firm in certain areas. If the of your breast: This may be a sign of
breasts are not emptied, milk produc- infection (called mastitis), which requires
tion can slow down. Though this may antibiotic treatment. If this occurs,
be very uncomfortable, here is what you contact a medical advice nurse. You
can do to treat engorgement: should continue breastfeeding since
»» Apply warm moist heat such as a the infection is in breast tissue, not
warm wash cloth with breast massage. the milk.
18
PARTNER SUPPORT ize what her partner is thinking and feel-
Partners often feel left out of the breastfeeding. It is important for the couple to share
ing experience shared by mom and baby. their feelings and concerns, and take time
There is so much you can do to support this to reconnect. Maintaining healthy adult
special bonding experience, while bonding relationships will positively impact parent-
with your baby in so many other ways. ing, and overall emotional health and well-
being within the family. When in doubt and
• Change diapers and bring baby to mom you don’t know what to do, ask mom what
for feedings. she needs!
• Assist mom by burping the baby after
breast feeding. Here are some ways that the partner can
• If mom is breastfeeding, make sure help once the new baby comes home:
pump parts are cleaned and breast milk
is stored properly. • Limit visitors coming to the home so
• If mom is formula feeding, make sure mom and baby can rest and learn new
bottles are cleaned and formula is pre- routines.
pared correctly. • Make sure mom is taking time to rest,
• Encourage mom when challenges arise. eat, and stay hydrated.
• Look out for signs of “baby blues” or
It is quite common for the partner to expe- PMAD and intervene as needed.
rience feelings of loneliness as the new • Help out around the house with light
baby enters the family. The mother may chores, grocery shopping, and meal prep.
have such an intense focus on the care of • Postpone big household projects to a
the newborn, that she may not even real- later date.
19
ADDITIONAL BREASTFEEDING »» Breastfeeding your baby: Getting your
RESOURCES baby to accept a bottle
• We encourage you to attend Prenatal 4 »» Breastfeeding your baby: Safe storage
Class “Breastfeeding Basics” of breast milk for full-term babies
• Watch an interactive breastfeeding »» Breastfeeding your baby: Tongue-Tie
video. Visit kp.org/doctor and locate
your provider or your baby’s provider. SUPPLEMENTAL FLUIDS AND
Under QUICK LINK on the left side of ARTIFICIAL NIPPLES
the screen, click on “Prepare for Your
During the first six months of life, your
Procedure or Manage Your Ongoing
baby does not need any other fluids
Condition (Emmi). After completing the
than breast milk, unless your pediatrician
brief registration, choose Breastfeeding
advises. Artificial nipples (from a bottle
from the list of options.
or pacifier) before two weeks of age can
• Review the Breastfeeding Support sec-
affect how your baby learns to suck on
tion on the Community Resources for
the breast. Your baby’s doctor or a mem-
Expectant and New Mothers handout.
ber of your baby’s health care team will
• Kaiser Permanente offers a series of
advise you if supplemental bottle feeding
breastfeeding Health Notes that cover a
with formula is necessary.
wide variety of breastfeeding topics. Ask
a member of your health care team for
any of the Health Notes listed below: PUMPING BREAST MILK
»» Breastfeeding your newborn: The First After your milk supply is well estab-
Weeks. lished, usually by the time your baby is
»» Caring for your newborn: Skin to skin one month old, you may give your baby
contact expressed (pumped) breast milk, especial-
»» Breastfeeding: Preventing and manag- ly if you are returning to work or need to
ing plugged ducts and mastitis be away from home. Sometimes, babies
»» Breastfeeding your newborn: refuse the bottle from the mother because
Preventing and managing breast the breast is nearby. Try letting someone
engorgement else, like dad, introduce the first bottle.
»» Breastfeeding your newborn:
Preventing and managing sore nipples Your expressed breast milk can be stored
»» Breastfeeding your newborn: How to safely in the refrigerator for five to seven
wake your sleepy baby days or kept frozen for six months. To
»» Breastfeeding your newborn: Manually freeze, pour the milk into a soft plastic
expressing breast milk storage bag, carefully squeeze out air bub-
»» Breastfeeding your newborn: How bles, seal it closed, label the bag with the
partners can get involved date it was expressed, and store in freezer.
»» Breastfeeding your newborn: Using Feed expressed breast milk to your baby
nipple shields at room temperature or gently warmed.
»» Breastfeeding your baby: Returning to Never use a microwave to defrost or warm
work or school the milk. Instead, heat it in a cup or pan
»» Breastfeeding your baby: Increasing of warm water. Once expressed milk is
milk supply defrosted, always store in the refrigerator.
»» Breastfeeding your baby: Choosing Once defrosted, the milk must be used
and using a breast pump within 24 hours. Do not save or re-use any
20
breast milk left in a bottle from which your RETURNING TO WORK
baby has been drinking. Chilled breast No matter when you are going back to
milk may separate. This is normal. Simply work, a Lactation Consultant can advise
swirl it around to re-mix the contents. Do you on the best pump to meet your
not shake breast milk. Shaking breaks breastfeeding needs while you are away
apart the protective proteins in the milk. from your infant. Depending on the hours
you spend at work, expect to pump
Kaiser Permanente strongly supports at least 3-4 times. Make sure that your
breastfeeding. We recognize the health employer has a place for you to pump
advantages babies and mothers receive. and store your breast milk. A cooler bag
We are aware that mothers may need with frozen gel packs will also do the trick
to pump breastmilk when they are away to keep your breast milk cold until you
from the baby. This may be occasional or can take it home.
on a regular basis, such as returning to
work or school. Many new breastfeeding Here are some other tips to remember as
moms in Kaiser Permanente are eligible plan to return to work:
to receive a breast pump at no charge. • Confirm there is a safe, clean, private
To determine if you have this benefit, ask place with access to an outlet for your
your OB nurse or lactation consultant, or breast pump.
contact your Human Resources depart- • Have a conversation with your employer
ment or Kaiser Permanente Member or manager about your need to take
Services. Breast pumps are routinely dis- breaks to pump.
tributed from the Newborn Care Center, • Wear comfortable clothes that allow
or during the postpartum visit. If you do quick access for pumping.
not have the benefit, breast pumps are • Talk to your child care provider about how
available for purchase in some medical you want your pumped milk handled.
centers. • Continue to maintain a healthy diet with
snacks and plenty of water.
• Offer a bottle to your baby 2-3 weeks
before you return to work.
• Nurse as often as possible when you
are with your baby to help keep your
supply up.
21
YOUR DIET need a Vitamin D supplement. Your
Maintaining a well-balanced diet and pediatrician will recommend a Vitamin
drinking plenty of fluids are important for D supplement.
you and your baby. • Don’t take other medicines or drugs
of any kind (including over-the-counter
• Avoid dieting for weight control. It may medicines) unless approved by your
lead to reduced milk production and doctor or a member of your health care
fatigue. team.
• In general, while nursing you may eat as
you normally do. Maintain your prenatal
BOTTLE FEEDING
diet plus 500 extra calories a day (one
healthy snack). If you decide not to breastfeed, the only
• Make healthy selections for your meals acceptable alternative during your baby’s
and in-between snacks most of the time. first 12 months is iron-fortified formula.
• Drink low-fat milk daily or try calcium- A variety of commercial formulas provide
fortified juice or low fat yogurt. the nutrients necessary for adequate
• Breastfeeding will make you thirsty so growth and development. Formulas come
drink plenty of fluids (especially water). in several forms including ready-to-feed,
You need fluid to make milk so try to concentrated, and powdered. Cow’s milk
drink 8-12 ounces of water after each and evaporated milk are not formulas
feeding (except night feedings). and should not be used until after your
child is 12 months old.
Sometimes, a baby reacts to a mother’s
intake of cow’s milk products. You may Prepared formula may be refrigerated in a
replace your milk intake with other fluids clean glass container and used to fill bot-
as long as the rest of your diet is nutri- tles as needed. We recommend to throw
tious. out open or prepared formula not used
within 24 hours.
If you don’t consume milk products for a
few weeks, consult your doctor, certified Fluoride is an essential element for
lactation consultant, or a member of your the development of strong teeth in all
health care team about taking a calcium infants and children under age 12. Your
supplement. You can also get calcium baby will get fluoride from the tap water
from green, leafy vegetables and from you use to prepare concentrated or
calcium-fortified products. powdered formula. If you use well water,
bottled water, or ready-to-use formulas
If there is a strong family history of allergy which do not contain fluoride, be sure to
to certain foods, you may want to elimi- tell your baby’s doctor or a member of
nate them from your diet. your baby’s health care team.
• Every day, take a multi-vitamin and min-
Babies eat for calories. How much your
eral supplement, such as your prenatal
baby eats depends on his/her individual
vitamins.
physical growth as well as activity.
• All babies are at risk for low levels
Within the first few weeks, your baby will
of Vitamin D. The amount of Vitamin
establish a routine.
D in breastmilk cannot be increased
by taking Vitamin D yourself. Babies
that are exclusively breastfed will
22
• By two weeks, most infants take up to • Consider using glass bottles, opaque
two ounces, every two to four hours. plastic bottles, or disposable plastic liners
• By two months, most take three to four instead of clear, hard plastic bottles. Clear
ounces every two to four hours. plastic bottles, when filled with warmed
• By four months, infants average five to formula, leach a chemical into formula
six ounces per feeding. which may pose a risk to babies. Look for
“BPA free” on the package of bottles
When feeding your baby, be aware of the before purchasing.
size of the nipple hole. If it is too big, milk • Before adding water to formula, let the
will run out of your baby’s mouth. If it is cold water run for a minute to wash out
too small, your infant will tire before drink- lead and other minerals from the cold
ing enough. water pipes. You may filter the cold
water if you desire. You may also boil all
If your baby falls asleep while feeding, tap water for five minutes to sterilize it,
wake gently by rubbing the skin of the then allow it to cool. Do not use hot tap
legs and thighs, or by patting the soles of water to prepare formula.
the feet. »» If you are using bottled water to make
formula, it should not be distilled or
EQUIPMENT AND STERILIZATION carbonated.
• You may heat bottles before feeding
Several different types of feeding bottles
your baby by putting them in warm
are available. No one nipple or bottle
water. Do not use a microwave oven to
style is better. The choice is up to you,
heat bottles. Microwaved bottles may
but be sure to select bottles and nipples
remain cool on the outside while the
that are appropriate for your baby’s age.
liquid inside is scalding hot—called “hot
spots.” Also, bottles have exploded
Before initial use, wash all new equipment
upon removal from the microwave.
in hot, soapy water.
After each use, wash the equipment thor- POSITIONING

oughly in hot, soapy water using a bottle Feed your baby in a semi-upright position
and nipple brush. Rinse and air dry. You may by holding the bottle so that the nipple is
also put bottles and hard plastic parts in the filled with milk. Although air is still swal-
dishwasher. Nipples should not be put in lowed, this position lessens the amount of
the dishwasher unless they are “dishwasher air that gets into the stomach.
safe.” (See package for details.)
Do not “prop” bottles. Propping means
PREPARING BOTTLES placing your baby in an infant seat and
arranging small blankets or towels to hold
Establish a daily routine so that formula
the bottle in your baby’s mouth, instead
is always available for your infant. In the
of a person holding the bottle. Propping
morning, for example, you can prepare
may cause choking. It also deprives your
bottles for the entire day and store them
baby of the stimulation and human con-
in the refrigerator.
tact vital to his/her development.
• Follow the directions on the formula can
or package for preparation.
23
BABY’S CARE
BURPING SPITTING UP
Whether breastfed or bottle-fed, burp After a feeding, healthy infants often
your baby halfway through the feeding “spit up.” Spitting up is not the same as
and at the end of the feeding. In addition, vomiting, which occurs in a sick infant.
burping is often necessary after crying to Projectile or forceful vomiting is not
bring up air bubbles. normal. A little drooling with a burp is
common. Examine your feeding practices
To burp: Place your baby on your shoul- to ensure that you are not overfeeding
der or support in an upright position on your infant. If spitting up occurs frequently,
your lap. Gently pat or rub your baby’s check your baby’s temperature and call
back while supporting his/her head. It is a medical advice nurse. See “Important
not unusual for your baby to spit up a phone numbers” in this book.
small amount of milk. If your baby spits up
alot after every feeding, try placing him/ STOOLS
her in a semi-upright position for at least
Just as an adult establishes a bowel pat-
15 minutes.
tern, so will your baby. While some babies
have bowel movements after every feed-
HICCUPS ing, others go without one for three to
Hiccups are spasms of the diaphragm seven days. The first bowel movements,
muscle. They are normal and will not harm called meconium, are black and sticky.
or be painful to your baby. Within a few days, bowel movements turn
a light, yellowish-green with a soft, pasty
SNEEZING consistency. A breastfed baby’s stool is
usually seedy and yellow with less odor
Sneezing is common in infants. Until
than a bottle-fed baby’s stool. Breastfed
three to six months of age, your infant
babies usually have more frequent bowel
uses the small nasal passages to breathe,
movements, often occurring with each
rather than the mouth. In addition, normal
feeding, because breast milk is more eas-
mucus or lint may cause sneezing.
ily digested.
To help clear out an infant’s stuffy nose,
place 1 or 2 drops of normal saline in DIARRHEA AND CONSTIPATION
each nostril and wait a few minutes. If Diarrhea refers to watery and frequent
your baby is still stuffy, gently suction the stools. Constipation, on the other hand,
mucus out using a bulb syringe. Squeeze refers to stools that are infrequent, small,
the syringe to make a vacuum, then place and hard. It is normal for babies to strain
the tip in one nostril and slowly release and cry while having a bowel move-
the bulb. Clean the bulb syringe in warm ment—it does not necessarily mean that
soapy water and rinse after each use. your baby is constipated. If your baby has
If you would like more help learning to diarrhea or constipation, please contact
use a bulb syringe, call a medical advice a medical advice nurse. See “Important
nurse. See “Important phone numbers” in phone numbers” in the front of this book.
the front of this book.
24
BREAST ENLARGEMENT CARE OF THE UMBILICAL CORD
After birth, breast enlargement is com- Usually, by one to three weeks of age
mon for both boys and girls, because (although sometimes longer), the umbili-
the mother’s hormones pass to the baby cal cord dries and falls off. After this
through the placenta. There may also be occurs, you may notice a few drops of
a milk-like discharge. Do not squeeze blood or mucus on the navel.
your baby’s breasts. The enlargement • Until the cord stump has separated,
disappears gradually, usually over the first give your baby sponge baths only—
several months of life, as the hormones do not give tub baths. Keep the area
and their effects vanish. If breastfed, the clean and dry.
infant’s breast enlargement may continue. • Fold or tuck the diaper down so that the
Talk with your baby’s doctor or a member cord stump stays dry when your baby
of your baby’s health care team if you are wets. If you have a boy, make sure his
concerned. penis is pointed down when you put on
a new diaper.
Your baby’s breasts should not feel hard, • It is not necessary to use alcohol to
look red, feel warm, appear tender to the clean around the umbilical cord.
touch, or suddenly enlarge. If this occurs,
call a medical advice nurse. If persistent foul-smelling drainage, red-
ness around the base, or a rash occurs,
please call a medical advice nurse.
25
FEMALE GENITALIA CARE YOUR BABY’S SKIN AND SCALP
The genitalia of boys and girls are often swol- Most bumps and rashes you may see on your
len after birth. For several weeks after birth, newborn are normal and will clear up on their
girls may have a thick, white, cloudy discharge. own. Common skin conditions for newborns
Gently clean the labia, but do not scrub the include:
thick discharge away. When cleaning girls, • Dry, peeling skin, especially around the
always wipe from front to back to avoid wrists, ankles, and other creases is expect-
spreading bacteria into the urinary or vagi- ed in most infants and no special care is
nal area. Some girls have a bloody discharge need. The peeling will usually disappear in
in the first week of life, caused by the transfer one to two weeks.
of mother’s hormones before delivery. This is • Little white bumps on your baby’s face,
normal and is no reason for concern. especially the forehead, nose, and cheeks
are called milia. This condition needs no
MALE GENITALIA CARE treatment and will clear up over time.
During diaper changes, gently clean the • Heat rash, or small red bumps on your baby’s
penis and scrotum. In most uncircumcised skin folds can be treated by lowering the tem-
baby boys, the foreskin cannot be completely perature in rooms where your baby spends a
pulled back. While you may gently retract lot of time. Dress your baby in loose clothing,
the foreskin during baths to help loosen it, especially around the neck and arms. Avoid
do not force it. It is not necessary to pull powders, because they tend to cake and are
the foreskin back during the first year of dangerous to babies if inhaled. Ointments
life. The foreskin will loosen with time, often and creams also should be avoided, because
by school age. When this occurs, it can be they tend to block skin pores.
retracted gently during baths to wash under- • Mild acne may occur between two to eight
neath. Be sure to wipe underneath the weeks of age, because of exposure to your
scrotal sac. hormones before birth. Acne clears by itself
and usually needs no treatment.
• Flat red patches at the nape of the neck
CIRCUMCISION CARE
(called “stork bites”) or forehead and/or
If your baby has been circumcised, the penis eyelids (“called angel’s kisses”) are normal.
should heal within seven to 10 days. Until “Angel’s kisses” and “stork bites” will usu-
then, do not bathe your baby in the tub. ally fade over time and are not noticeable
Use a mild soap and warm water to clean by age two years.
the area. During the healing process the • A dark discoloration around your baby’s
head of the penis will appear red and you buttocks is not a bruise. This normal discol-
may notice a green or yellow crust. This is oration, called “Mongolian spot,” is usually
normal, healing tissue. Do not try to clean it seen in darker-skinned infants and will slow-
off. Apply petroleum jelly (such as Vaseline®) ly fade, or may go away on its own.
after sponge baths and diaper changes to • Birth marks often develop during the first
keep the penis from sticking to the diaper. In few weeks of life.
some cases, there may still be a small amount • Red, itchy rash and white scales, especially on
of foreskin that can be retracted. It is impor- the scalp and behind the ears, is often called
tant to continue to retract and wash this area “cradle cap.” To treat, wash your baby’s hair
to prevent it from re-sticking. See Newborn frequently with a mild shampoo. Rubbing the
Circumcision Health Notes. scalp with baby oil and gently brushing it with
a baby hairbrush or soft toothbrush before
washing may soften thick patches.
26
DIAPER RASH water controls the smell and keeps the
One of the most common rashes is diaper diapers soft. Be sure to dump the solid
rash. To help prevent diaper rash: feces into the toilet before putting the
soiled diaper in the pail. The diaper cov-
• Change your baby’s diapers frequently ers usually do not require pre-soaking.
to avoid a constantly wet diaper. Be sure Wash the diapers with a mild soap or
to rinse the area with water, pat dry, non-phosphate detergent. Rinse the
and completely air dry. If a rash devel- diapers twice, adding ½ cup of distilled
ops, use a lubricating diaper cream (like white vinegar to the last rinse. This
A+D®, Desitin®, or Balmex®). helps counteract irritants present in nor-
• Test your baby’s reaction to disposable mal urine. Do not use bleach or fabric
diapers. Call a medical advice nurse if softeners. Dry in the dryer for about 60
your infant develops blisters, the diaper minutes.
rash seems to be more prominent in the
skin folds, the rash goes beyond the
BATHING, SKIN AND NAIL CARE
diaper area, or if the rash is persistent.
Bath time can be an enjoyable and relax-
USING CLOTH DIAPERS ing experience for both you and your baby.
At first, your infant will probably cry during
• If you use cloth diapers, wash brand baths, but by three months, he/she should
new ones a few times to fluff up the cot- enjoy splashing and playing in the water.
ton fibers. Use a cup of distilled vinegar
for the first wash, then a mild soap or • Give sponge baths until your baby’s
non-phosphate detergent for another umbilical cord and circumcision have
two washes. Dry the diapers in the dryer healed. Then, your baby is ready for tub
between each washing. This process will baths a few times a week.
make the cloth much more absorbent • Before you begin, make sure that all
and help to prevent stains in the future. bath items are conveniently within
• Keep a bucket with a lid handy to store reach.
wet and soiled diapers until laundry day. • Prop your baby up in a small tub of
Adding ½ cup Borax® to the bucket of warm water in a warm area. Be sure to
27
support your baby’s head and neck rounded. Do not rip, bite, or pull hang-
with your hand during the entire bath. ing nails or cuticles. Continue this habit
Be careful. Wet babies are very slippery! with older children.
• To avoid the risk of dropping your baby
during a sponge bath, lay your baby on CLOTHING
a towel before bathing. This allows you
• Wash all new baby clothes before wearing
to avoid lifting your baby while he or
with a mild, fragrance-free detergent to
she is wet.
remove any traces of chemicals and dyes.
• DO NOT leave your infant unattended
• Avoid overdressing or underdressing
or with another child—even for a brief
your baby. A good rule of thumb is to
moment.
dress your baby as you would yourself.
• Always use plain water on your baby’s
If you need a sweater, cover your baby’s
face. Soaps are not necessary to bathe
arms and legs with clothing and/or a
the body. If you do use soap, choose a
blanket. If you are warm, your baby
mild, unscented type, like Dove®. This can
is also likely to be warm. In the first
also be used to wash your infant’s hair.
few weeks of life, if the environment is
• Use firm, but gentle finger pressure to
cool, keep your baby’s head covered to
massage the entire scalp (including the
reduce body heat loss.
soft spot) and rinse well.
• Avoid lotions and creams that contain
perfumes and additives. These may ENVIRONMENT
cause skin irritation or rashes. • Make your baby’s room bright, stimulat-
• Protect your baby from direct sun expo- ing, and at a comfortable temperature
sure with shade, a hat and clothes. Your (68-72º F). Do not have a TV, iPad, or
baby’s skin is extremely sensitive—it can other electronic devices in your baby’s
burn easily after just five minutes of sun room.
exposure. One serious sunburn during • Do not use bumper pads, pillows, blan-
infancy or childhood doubles the risk of kets, soft toys, or other fluffy materials in
developing the most dangerous form of your baby’s crib. Do not put your baby
skin cancer in adulthood. in a crib with sides that can move up
• Until your baby is six months old, ask and down (drop-side cribs).
your pediatrician before using sun- • For the first two months, avoid unnec-
screen. Then choose a sunscreen that is essary exposure to crowds and people
made for babies, has at least an SPF of with symptoms of infection.
15, is waterproof, and made for sensitive • Make sure your home has working
skin. Look for titanium dioxide, which is smoke and carbon monoxide detectors.
hypoallergenic, in the list of ingredients. • If air pollution is at dangerously high
• At three weeks, gently cut the finger levels, avoid excessive time outdoors.
and toe nails with baby nail scissors and • Do not smoke cigarettes, cigars, or
file them to remove the sharp edges. pipes around your child—even smoking
This is when the nails begin to harden. in another room can be harmful to your
Until then, use a nail file, or you can baby’s lungs. If possible, stop smok-
cover the hands to prevent the baby ing for the health of both you and your
from scratching his/her face. Baby socks baby. Kaiser Permanente offers classes
can be used for this purpose. Cut the to help you stop smoking. (Call Kaiser
nail of the big toe straight across to pre- Permanente at (301) 816-6565 or (800)
vent ingrown toenails. All others may be 444-6696). If you can’t quit, step out-
28
side whenever you smoke. (Remember: • Use a crib with a firm, tight-fitting mat-
Don’t leave your baby unattended!) tress. The spaces between the crib bars
Afterwards, be sure to wash your hands. must be less than 23/8 inches. Do not
It is also best to change your clothes use a pillow or featherbed mattress.
after smoking before coming into con- • Do not put bumper pads, sleep posi-
tact with your infant. tioners, pillows, quilts, comforters,
• Make sure the home is equipped with sheepskins, pillow-like stuffed toys, or
working smoke/carbon monoxide other fluffy objects in the crib.
detectors. • Once breastfeeding is well-established,
usually at about four weeks, a pacifier
SLEEPING is recommended. If your baby spits the
pacifier out, do not replace it.
For infants under 12 months of age, fol-
• Consider using a sleep sack instead of a
low these practices to reduce the risk of
blanket.
Sudden Infant Death Syndrome (SIDS) and
• Use only a fitted-bottom sheet specifi-
suffocation2:
cally made for crib use.
• Place your baby on his/her back to • Keep the baby’s room temperature com-
sleep for naps and at nighttime. This is fortable to prevent overheating.
the best way to reduce your baby’s risk • Use an electric fan in the room where
of SIDS. Do not put your baby to sleep the baby sleeps, but not within reach of
on his/her tummy. Do not put your baby the crib.
in a drop-side crib. The U.S. Consumer
Product Safety Commission found these According to the American Academy of
cribs to be unsafe. Pediatrics, bed-sharing or co-sleeping
with your baby may be dangerous in cer-
tain situations.3 A safer option would be
to place the infant’s crib or bassinet next
to your bed to allow for easier contact.
2.N
ational Institute of Child Health and Human Development Web site: nichd.nih.gov, “Safe Sleep for Your Baby,” 2003.
3. American Academy of Pediatrics Web site: aap.org, Policy Statement from the Task Force on Sudden Infant Death
Syndrome “The Changing Concept of Sudden Infant Death Syndrome: Diagnostic Coding Shifts, Controversies
Regarding the Sleeping Environment, and New Variables to Consider in Reducing Risk” November 2005.
29
During the first two weeks, do not let your CRYING
baby sleep longer than four hours. If your Crying is a normal expression for all
baby is premature, ask your pediatrician, babies. Within a short period of time,
since the sleep guidelines may be differ- you will be able to figure out why your
ent. Establish day and night patterns of baby is crying. Your baby may be wet,
activity by waking your baby for feedings tired, hot or cold, or just want to be held.
or play during the day and allowing lon- Remember that not all crying means hun-
ger sleep periods at night. ger. Babies often cry when you are chang-
ing their clothes or diaper. An occasional
Sleeping requirements vary greatly. For lengthy cry will not harm your baby.
babies, there is no difference between
day and night until about three to four Some babies need less stimulation and
months of age. By this age, teach your some need more. It is normal for most
baby to fall asleep without your help. babies to cry if left alone, because
After a meal (when food is digested), put they want to be held and comforted.
your baby to bed while quietly awake and Newborns may feel more secure with
allow him or her to fall asleep unattended. “swaddling” (wrapping in a light blanket
If you “teach” your baby to fall asleep snugly around baby).
at the breast or bottle or to be rocked
before sleeping, this is what your baby Sometimes, nothing you do will relieve
will expect upon awakening each night. your infant’s irritability. Fussiness for two
Reserve play for daytime only. Every baby to three hours a day, usually during the
is different and will sleep through the late afternoon or evening, is not unusual
night when ready. and will decline gradually over the first
four to six months of age. During a
fussy period, hold and rock your baby.
30
Comforting and holding your baby will If you feel that your baby has colic, discuss
not spoil him/her; it will make your baby this with your baby’s doctor or a member
feel more secure. of your baby’s health care team or call a
medical advice nurse for suggestions and
Do not shake or spank your baby. support.
Shaken-baby syndrome can occur when
an infant or young child is shaken. This SPOILING
can cause serious injury or death.
A baby cannot be spoiled during the first
nine months. Your baby is completely
COLIC dependent on you for physical and emo-
Colic is prolonged crying—for more than tional comfort. Infants need frequent
three hours a day, at least three days attention. Touching, holding, and rocking
a week, that has lasted at least three give your baby a sense of security and
weeks—for which no satisfactory reason trust.
can be found. It usually begins in the
second week of life and usually ends by PACIFIERS
four months of age. With colic, parents
Babies gain great comfort and satisfaction
normally feel frustrated, anxious, or angry.
from sucking. Some have a great need to
Remember two things: your baby is not
suck—more than they can get from nurs-
trying to upset you and it’s not your fault
ing or a bottle. After your baby is about
that your baby cannot be comforted.
four weeks old and your milk supply is
There are many proposed remedies, none well-established, you can use a pacifier to
of which work all the time. These include: calm a fussy baby. Use a soft, one-piece
• wrapping your baby snugly (swaddling) pacifier that is not filled with liquid. Most
• rocking breastfed babies do not need a pacifier.
• carrying the infant, and There is no reason to be concerned if
• taking car rides. your baby chooses to suck a thumb.
31
SAFETY REMINDERS
CHILD SAFETY SEATS It’s the law to use a child safety seat, or
car seat, during every car ride, includ-
Each year, thousands of children under
ing baby’s first ride home from the
the age of five are injured or die in auto-
hospital. A safety seat securely holds your
mobile accidents.4 You can protect your
child inside the car and absorbs the forces
child from this danger! It is not safe to
of minor and serious accidents. Make
hold a baby in a moving car. Even a low
sure that the seat has been tested and
speed crash produces forces of almost
approved by the Federal Motor Vehicle
300 pounds that can rip your baby out
Safety Standard 213 as safe for the age
of your grip. In addition, if you are hold-
and weight of your child. See Car Safety
ing a baby and not wearing a seat belt,
Seats for Babies. This Health Note lists
the child can be crushed between your
websites with lots of information to help
body, the windshield, and the dashboard.
you make a decision about which car seat
Do not put your baby inside a seat belt
is best for your car. Car seats can be pur-
shared with an adult. In these cases, forc-
chased at a department store or children’s
es from the adult’s body are even more
furniture outlet. Car beds and infant-car-
likely to hurt your baby.
rier seats are not designed for crash pro-
tection and should not be used. If you are
taking a taxi, insist that your safety seat
be properly installed.
4. National SAFE KIDS Coalition

website: safekids.org, Safety In
and Around Cars, 2010.
32
We do not recommend used seats, For questions about car seats, call the
because the seat may have defects that Auto Safety Hotline between the hours of
you cannot see. If you choose to go with 8 a.m. and 10 p.m. at (800) 424-9393.
a used seat, be absolutely certain that it
is in excellent condition and has never Keep safe. Everyone should always
been in an accident. Check for breaks buckle up!
and weak areas that can put your child
at risk. Be sure to use the seat exactly SAFETY TIPS
as recommended. Some seats require
Most accidents involving infants or young
installation of a tether strap. Secure
children can be anticipated and prevent-
the car seat in the back seat facing
ed by following simple safety hints:
backwards. Car seats should never be
placed in the front passenger seat. • Always wash your hands before holding
When your child is two years old and has your baby.
outgrown the recommended height and • Be careful when drinking hot liquids
weight limit for the seat, turn the car seat near your infant. Avoid cooking over the
to forward-facing. stove while holding your infant.
• Before using a steam or cool mist vapor-
Car seats are expensive. If you are izer, talk with your baby’s personal
unable to afford a safety seat, the hos- physician or a member of your baby’s
pital where you plan to deliver may be health care team. We do not recom-
able to arrange for you to rent or borrow mend vaporizers for anyone with aller-
one. Your auto insurance company also gies or asthma.
may have a program to help you obtain • Select safety-approved and age-
a car seat for your baby. Look into these appropriate clothing, toys, and teething
options well before your due date. objects. Avoid small, hard objects that
can cause choking.
33
• Do not put your baby in a crib that has • Make sure that smoke detectors are
drop-sides. placed strategically and work properly.
• Lower the crib mattress before your Test batteries monthly and replace as
baby can sit alone. The mattress should needed.
be at its lowest point before the baby • Install a carbon monoxide detector if
can stand. you have fuel-burning appliances in
• Do not leave your baby unattended your home, such as room heaters, a
anywhere, including the house, car, tub, furnace or water heater, gas stove, fire-
or yard. place, and/or an automobile in a closed
• Do not give your baby raw honey or garage.
herbal teas during the first year of life. • Keep items with cords at least 3
Honey has been shown to carry botu- feet away from your baby’s crib. This
lism spores which can cause serious includes baby monitors and mini blinds.5
disease. Some herbal teas may contain Check all recall lists before buying any
chemicals that cause diarrhea or other infant sleeping or safety products.
problems. • Keep all weapons or objects that could
• Be sure that your water heater is set be of danger locked in a secure place.
no higher than 120º F and test the • Be sure your pets are up to date with
temperature of bath water. their veterinary care and discuss with
• Do not use a microwave to heat liq- your vet the behavior changes that may
uids for a baby. be helpful to ease the transition.
5. US Consumer Products Safety Commission (cpsc.org/onsafety/2012/09/safe-bedding-pillows-safety-and-more/).
34
GROWTH AND DEVELOPMENT
Babies grow rapidly. Most double their Your baby’s hearing is usually the same
birth weight by four to six months. By one as yours. He or she may be startled when
year, most triple their birth weight. Growth hearing a loud, sudden noise, but enjoy
occurs in spurts. listening to music or your singing.
Newborns tend to keep their hands fisted Babies have a full sense of smell at birth.
and knees tucked up. Initially, newborns They often recognize a parent by smell
have very little head control. Support alone.
your baby’s head, neck, and back when In the first few months of life, your baby
lifting and holding. begins to develop a special relationship
with you. He/she knows that family pro-
Parents often wonder how well their infant vides trust, peace, and comfort.
is able to see, hear, and smell. During the • Cuddle and hold your baby closely.
first two months, babies can focus best • Allow for plenty of skin-to-skin contact.
at a distance of about eight to 12 inches. • Rock, sing, and talk to your baby.
They especially enjoy looking at human • Encourage relaxation by gently stroking
faces. The ability to focus at a distance your baby.
increases with time. Infants are attracted • Let your baby kick with no clothes on.
by brightness, movement, and contrast, Moving arms and legs gives your baby a
as well as three-dimensional objects. sense of body awareness.
Brightly colored mobiles and pictures by
the crib will attract attention. Remember Also, remember that it’s never too early
that your baby will be looking up at the to begin reading to your child. Reading
bottom of the mobile! When your baby helps develop language skills.
is not sleeping or feeding, allow some
time for tummy play. Babies learn about
their environment and develop skills in
this position. A good reminder is “Back to
sleep. Tummy to play.”
35
DEVELOPMENT CHART
Age Physical development
0 to 3 months Searches with eyes and focuses. Hands fisted; may “bat” at objects. Head
and shoulders droop when sitting. Turns body from side to back. Reflexes
are strong.
3 to 5 months Eyes focus well. Moves eyes vertically and horizontally. Has awkward
grasp. Thumb grasp begins, can reach-grasp-release. Controls head well.
Turns from back to side.
5 to 7 months Turns head toward bell and listens to own sounds and sounds of others.
Can accept one object when given to him/her. Transfers hand-to-hand.
May roll completely over.
7 to 9 months Follows dropped objects with eyes. Accepts two objects. Starts thumb-
forefinger grasp. Sits alone. Rocks on knees, may roll across surface.
10 months Searches for hidden objects. Creeps and crawls. Begins to hold cup.
May pull up or stand with support.
11 to 12 months Throws ball. Builds small tower of blocks. Points with index finger.
Crawls up and down stairs. Walks with support.
36
Social & language development Suggested toys & activities
Enjoys cuddling and motion. Responds Mobiles, unbreakable mirror, bells, pictures with
to presence of others. Stops activity on contrasting colors. Avoid toys or clothing with long
hearing sound. Begins to smile. strings that may entangle the baby. Read, sing and
play music to your baby.
Watches a moving person. Turns toward Rattles, cradle gym, squeak toys, small plastic
voice. Knows parents, shows interest in blocks, rubber squeeze blocks, weighted toys. Read,
other family members. Stares at strangers. sing and play music to your baby.
Fear of strangers; affection for family. Grip balls, soft animals and blocks, teething toys,
squeak toys. Give praise and show affection. Play
games like peek-a-boo and pat-a-cake.
Waves hands. Initiates play. Chooses toys Activity boxes for crib and bath, soft stacking
deliberately. Listens to conversations and blocks, sturdy cloth or cardboard picture books,
singing. bath toys. Play games and music with your baby.
Shows moods. Begins sexual identity. Colorful, sturdy cars and trucks, musical toys,
Listens with interest to familiar words. baby cup, stacking squares or rings, push-button
Understands own name and commands. and pop-up toys. Read books to your baby.
Produces more sounds. Babbles sounds Unbreakable mirror, push-pull toys, shape and/
repeatedly. May begin single words. or color-matching toys. Begin hide-and-seek for
Solicits attention, offers object to familiar objects, clapping, names of body parts. Play
person. Talks to mirror image. games with and music to your baby. Read books.
37
RECOGNIZING THE SICK
NEWBORN
If your newborn develops any of the follow- TAKING A RECTAL TEMPERATURE
ing symptoms, call a medical advice nurse. The most accurate and safest way to find
your baby’s temperature is to use a
• Rectal temperature above 100.4º F digital rectal thermometer. We do not
• Refuses to eat (three feedings in a row) recommend the use of glass mercury-
or sudden changes in feeding schedule containing thermometers due to the risk
• Repeated vomiting (two complete of breakage and mercury toxicity.
feedings)
• Inability to sleep due to spitting up Before each use, clean the thermometer by
• Diarrhea or sudden changes in stool washing it in cool water or rubbing alcohol.
pattern, or no stool for three days Be sure to read the instructions that come
• Infrequent urination (fewer than three with the digital thermometer carefully.
times a day)
• Excessive bleeding or oozing from the 1. Lubricate the tip of the thermometer
umbilical cord; redness or rash around with a water-based soluble jelly (such as
the area Vaseline®).
• Body rash or diaper rash that does not 2. Place your baby across your lap or on a
go away firm surface with his/her belly down.
• Discharge or swelling of the eyes that 3. Press your hand firmly against your
does not go away baby’s lower back to keep him/her still.
• Sudden breast or testicle enlargement 4. Turn on the thermometer and insert
or redness it about ½ inch into your baby’s anal
• Severe nasal congestion or cough opening.
• Irritability that does not go away, is not 5. Talk to your baby to soothe him/her.
satisfied by feeding or cuddling 6. Remove when indicated and read the
• Excessive sleepiness number on the screen.
It is helpful to note what time the reading
Kaiser Permanente does not endorse any brand names;
any similar products may be used.
was taken.
38
A FEW WORDS ABOUT JAUNDICE brain damage. This is why your newborn
Jaundice occurs in most newborns. It will be checked carefully for jaundice and
is caused by a yellow substance called treated, if needed, to prevent a high bili-
bilirubin which is a natural by-product rubin level.
of blood. It shows up as a yellow color
seen on the skin. Jaundice can occur in Your baby’s bilirubin level will be checked
babies of any race or color, but may be before leaving the hospital. Depending on
harder to see if your baby has a darker the result, you may be asked to bring your
skin color. Jaundice usually appears first baby for his or her initial health assess-
in the face and then moves to the chest, ment earlier.
abdomen, arms, and legs as the bilirubin
level increases. The whites of your baby’s Breastfed babies are more likely to have
eyes may also be yellow. The best way to jaundice until mother’s milk comes in. This
see if your baby has jaundice is in good is expected and can be managed by you
light, such as daylight or under fluorescent and your pediatrician. Early and frequent
lights. feeding will help. If you are having trouble
breastfeeding, call a lactation consultant.
Most babies develop jaundice in the first Phone numbers are inside the front cover
few days after birth because it takes a few of this book.
days for the baby’s liver to get better at
removing bilirubin. Usually, babies have
mild to moderate jaundice that is harm-
less, but in unusual situations the bilirubin
level can get very high and might cause
39
BOOKS FOR PARENTS
American Academy of Pediatrics, Caring Jana, Laura A., M.D., and Shu, Jennifer,
for Your Baby and Young Child: Birth to M.D., Heading Home with Your Newborn:
Age 5
(ISBN: 978-0553386301) From Birth to Reality (ISBN: 978-
Ferber, Richard, Solve Your Child’s Sleep 1581104448)

Problems (ISBN: 978-0743201636) Karp, Harvey, The Happiest Baby on the
Ginott, Haim G., M.D., Between Parent Block (ISBN: 978-0553381467)
and Child (ISBN: 978-0609809881) Murkoff, Heidi and Mazel, Sharon, What to
Growing Parent, Growing Child (monthly Expect the First Year
news), North Second Street, Lafayette, (ISBN: 978-1847379740)

IN 47902 Newman, Jack, M.D., and Pitman, Teresa,
Hill, David L., M.D., Dad to Dad: Parenting Dr Jack Newman’s Guide to Breastfeeding
Like a Pro (ISBN: 978-1581106503) (ISBN: 978-1554683499)

Huggins, Kathleen, The Nursing Offit, Paul A., M.D., Bell, Louis M., M.D.,
Mother’s Companion 6th ed. (ISBN: 978- Vaccines: What You Should Know
1558327207) (ISBN: 978-0471420040)
40
SOURCES
“How to Care for Yourself and Your New 4. Juvenile Products Manufacturers
Baby” was prepared by your Kaiser Association website: jpma.org
Permanente Pediatric, Family Practice, 5. La Leche League International website:
Health Education/Health Promotion, and lalecheleague.org
Women’s Health departments. The follow- 6. National Maternal and Child Health
ing sources were also used to develop this Clearinghouse website: nmchc.org
publication: 7. National Institute of Child Health and
1. American Academy of Pediatrics Human Development website:
website: aap.org nichd.nih.gov
2. American Academy of Family Physicians 8. National SAFE KIDS Coalition website:
website: aafp.org safekids.org
3. Centers for Disease Control and
Prevention Website: cdc.gov
41
Index
bathing........................................................................................................................ 7,27
books for parents........................................................................................................... 40
bottle feeding............................................................................................................ 6, 22
breast enlargement........................................................................................................ 25
breastfeeding............................................................................................................. 6, 12
burping........................................................................................................................... 24
check up, your baby’s first.............................................................................................. 10
child safety seats............................................................................................................ 32
circumcision.................................................................................................................... 26
clothing........................................................................................................................... 28
colic................................................................................................................................ 31
colostrum.................................................................................................................... 4, 13
crying........................................................................................................................ 14, 30
diaper rash..................................................................................................................... 27
diarrhea.......................................................................................................................... 24
diet, your........................................................................................................................ 22
discharge instructions....................................................................................................... 2
environment................................................................................................................... 28
feeding your baby.......................................................................................................... 12
fluoride........................................................................................................................... 22
formulas.......................................................................................................................... 22
genitalia care.................................................................................................................. 26
growth and development............................................................................................... 35
42
hiccups........................................................................................................................... 24
illness, recognizing......................................................................................................... 34
immunizations ............................................................................................................... 10
iron ............................................................................................................................. 3, 22
jaundice .................................................................................................................. 2,3,39
meconium....................................................................................................................... 24
pacifiers.......................................................................................................................... 31
pumping breast milk...................................................................................................... 20
safety reminders............................................................................................................. 32
self-care, moms................................................................................................................ 4
skin and scalp, baby’s..................................................................................................... 26
smoking, parents............................................................................................................ 28
sleeping.......................................................................................................................... 29
sneezing......................................................................................................................... 24
spitting up...................................................................................................................... 24
spoiling your child.......................................................................................................... 31
sterilization–bottles........................................................................................................ 23
stools.............................................................................................................................. 24
umbilical cord care......................................................................................................... 25
visits, well-baby.............................................................................................................. 10
vitamins ............................................................................................................... 3, 13, 22
43
The information presented here is not intended to diagnose health problems or to take
the place of professional medical care. If you or your baby have persistent medical
problems, or if you have further questions, please consult your or your baby’s doctor or
member of your or your baby’s health care team.
Members of Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. rely on
the physicians of the Mid-Atlantic Permanente Medical Group, PC, who practice
at the Kaiser Permanente Medical Centers located throughout the Washington/
Baltimore area, to provide or arrange for their health care needs. To learn more about
Permanente physicians, visit kp.org.
©2002, The Mid-Atlantic Permanente Medical Group, Inc. All rights reserved.

44
Newborn Care Center visit information
Kaiser Permanente offers enhanced well-child visits and lactation consulting for new mothers and
our newest members. Your pediatric team has scheduled an appointment for you and your baby
for 24 to 72 hours after you leave the hospital. Here is what you can expect at this appointment.
MEDICAL CENTER:
DATE:
TIME:
During this visit, your baby will receive a

complete checkup. This includes a weight
check and physical assessment, as well as
information regarding:
• Circumcision care • Jaundice
• Cord care • Problems that
• Gas/colic require a call
to the doctor
• Immunizations
Our Newborn Care Center staff are certified

lactation consultants, and will happily answer
your questions about breastfeeding. You
may also request a personal breast pump on
this visit. A lactation consultant will walk you
through using the device and answer any
questions you may have about pumping.
During this initial visit, the Newborn Care

Center staff can also schedule follow-up
appointments for you and your baby, as well
as visits with your pediatrician if necessary.
If you have any questions about your visit, or

would like to speak with a lactation consultant
at any time, please give us a call:
• Washington, DC, and suburban Maryland:
866-264-4766
• Northern Virginia: 703-922-1469
• Baltimore area: 410-737-5464
Newborn Care Center visit information
If your visit is scheduled for a weekend or holiday, please ask security to escort you to the appropriate department/floor.
MEDICAL CENTER DEPARTMENT/FLOOR DAY(S)
Camp Springs Pediatrics, 1st floor Tue and Thu
Columbia Gateway Pediatrics, 1st floor Mon, Wed, and Fri
Fair Oaks Pediatrics, 2nd floor Tue and Thu
Falls Church Pediatrics, 1st floor Mon, Tue, Wed, Thu, and Fri
Fredericksburg Pediatrics, 3rd floor Tue and Thu
Gaithersburg Pediatrics, 5th floor Mon, Wed, Fri, and Sat
Kaiser Permanente Capitol Hill Pediatrics, 8th floor Mon, Wed, and Fri
Kensington Pediatrics, 3rd floor Tue and Thu
Largo Pediatrics, 3rd floor Mon, Wed, Fri, and Sun
Manassas Pediatrics, 1st floor Mon, Wed, and Fri
Prince George’s Pediatrics, 1st floor Tue and Thu
Reston Pediatrics, 2nd floor Sun
South Baltimore County Pediatrics, 4th floor Tue, Thu, and Sat
Springfield Pediatrics, 8th floor Mon, Tue, Wed, Thu, and Fri
White Marsh Pediatrics, 2nd floor Sun
Woodbridge Pediatrics, 1st floor Mon, Wed, Fri, and Sat
kp.org/maternity
Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. 2101 E. Jefferson St., Rockville, MD 20852 2019MC1996 MAS 10/1/19-12/31/20
ONLINE
PRENATAL 2 & PRENATAL 3
CLASSES
ENGLISH/SPANISH
Get prepared and ease your mind by signing
up for a prenatal class today. The class details

Take One
are listed on the back of this flyer.
Health Engagement
0039-0645 Revised July 2020
Online Prenatal Education Classes
Prenatal 2: Late Pregnancy, Labor, and Delivery

Participate in this class during your seventh or eighth month of pregnancy to learn about the
changes your body is going through and how to minimize discomforts of late pregnancy. This
class will also cover what to expect during labor and delivery. Online classes are available in
both English and Spanish.
Prenatal 3: Preparing for Your Newborn

Participate in this class during your last months of pregnancy to learn how to care for your newborn
baby. This class will cover bathing, feeding, and soothing techniques. If this is your first baby
with Kaiser Permanente, we strongly suggest you attend. Online classes are available in both
English and Spanish.
ONLINE PRENATAL CLASSES:

Prenatal 2: TUESDAYS from 6:00pm to 8:00pm
Prenatal 3: THURSDAYS from 6:00pm to 8:00pm
Prenatal 2: SATURDAYS from 1:00pm to 3:00pm
Prenatal 3: SUNDAYS from 11:00am to 1:00pm
There are many ways to check class dates and sign up for a class:
• Go online at kp.org/appointments
• Call an appointment representative by calling (703) 359-7878 or

1-800-777-7904, toll free; TTY: 711
• Speak with a receptionist in a Kaiser Permanente medical center
*Note: Classes that are full or more than three months out will not display
on the screen.
*Our classes are notLearn more

intended to about
replacepregnancy at kp.org/maternity.
childbirth preparation classes, such as Lamaze. If you are
Health Engagement
0039-0645 Revised July 2020
HEALTH ENGAGEMENT
Community resources for expectant and new mothers

CONGRATULATIONS! YOU'RE HAVING A BABY—INFORMATION SHEET
PHONE NUMBER
PREMIER HOSPITAL1 OTHER CLASSES 2
WEBSITE
DISTRICT OF COLUMBIA
MedStar Washington Hospital Center (202) 877-6161 • Hypnobirthing • Single mom childbirth &
medstarwashington.org • Infant & child CPR baby care
MARYLAND
Anticipated start: 1/11/2021 (443) 481-1000 • Infant safe sleep
Anne Arundel Medical Center3 aahs.org/Get-Care/Birth-and-Baby • Newborn care
Baltimore Washington Medical (410) 595-1794 • Sibling class • Newborn care
Center3 umbwmc.org • Preparing for twins • Infant CPR
Greater Baltimore Medical Center3 (443) 849-2229 • Car seat installation • Marvelous multiples
gbmc.org/parent-education • Infant & child CPR • Sibling class
Holy Cross (301) 557-2140 • Becoming a father
Germantown Hospital3 holycrosshealth.org/hcgh-maternity- • Mom & baby yoga • Grandparents-to-be
services • Infant & child CPR and • Birth by cesarean
safety
Holy Cross Hospital Silver Spring (301) 754-8800 • Becoming a father
holycrosshealth.org/find-a-service-or- • Infant & child CPR • Sibling class
specialty/maternity-services/ • Prenatal/postpartum • Teen pregnancy
fitness
VIRGINIA
Anticipated start: 1/11/2021 703-391-3600 • Grandparenting
Inova Fair Oaks Hospital inova.org/locations/inova-fair-oaks- • Infant massage
hospital-birthing-center
Ending: 1/11/2021 (877) 689-3627 • Baby care basics
Reston Hospital Center restonhospital.com • Infant & child CPR
Stafford Hospital (540) 741-1404 • Parents expecting
• Home with baby
marywashingtonhealthcare.com/ multiples
• Infant & child CPR
stafford-hospital • Sibling class
Virginia Hospital Center (703) 558-5000 • Childbirth express • Infant skills
virginiahospitalcenter.com • Grandparenting • Sibling class
1 All locations offer maternity tours, childbirth and breastfeeding classes.
2 Classes listed may change
3 Offer virtual tours
Breastfeeding support after delivery Infant car seats Postpartum support
Kaiser Permanente’s Newborn Care Center KISS (Kids In Safety Seats) Kaiser Permanente .............. (866) 530-8778
has International Board Certified Lactation Program .................................... (800) 370-7328 Postpartum Support
Consultants (IBCLCs) who are available to
or visit mdkiss.org. International ............................ (800) 944-4773
help you. Contact the Newborn Care Center
to talk to an IBCLC. The Maryland Department of Health and or visit postpartum.net
Mental Hygiene has a car seat loaner program
Baltimore ............................... (410) 737-5464 Special services
and is a resource for questions about
Doulas (certified for support during birth and/
Washington DC and installing car seats.
or after delivery) visit dona.org
suburban Maryland ........... (866) 264-4766
Holy Cross Hospital ................ (301) 754-8800 Check your local newspaper or Yellow
Northern Virginia.................. (703) 922-1469
Holy Cross Hospital has a car seat loaner Pages for the following service suggestions:
You may also be interested in joining program for babies delivered there. (KISS homemaker service for personal assistance,
a breastfeeding support group in your participant). Call for information as soon as meal preparation, light housekeeping, and
community. La Leche League International is a possible and plan to pick up the car seat at assistance with shopping. Also look under
non-profit organization dedicated to providing least three weeks before your due date. Home Health Services. You can also use the
education, support, and information to women internet. Include the name of your county
who want to breastfeed. La Leche League New mothers support groups and “home care” or “home health care” as
International has many local peer support and Greater Baltimore keywords.
support groups in Baltimore, Washington D.C., Medical Center .................... (443) 849-2229
suburban Maryland and Northern Virginia. Visit
Teen pregnancy
Mother to Mother Connection
llli.org to find a group near you. Teen Alliance for Prepared Parenting
at Holy Cross Hospital ........ (877) 811-6660
(TAPP) .................................. (202) 877-0755
Childbirth preparation classes Virginia Hospital Center.......... (703) 558-2468
Your health and your ability to take care of your baby
Lamaze International .............. (202) 367-1128 Stafford Hospital...................... (540) 741-1404 can be seriously affected by violence or abuse. If you are
or visit lamaze-dc.org hit, hurt, or threatened by a partner or spouse, there is
help. Call the National Domestic Violence Hotline at
(800) 799-SAFE (7233) or visit thehotline.org.
This list is provided as a source of information within Kaiser Permanente and the community. The community resources may have fees associated with them which are not covered
by Kaiser Permanente.
HEALTH ENGAGEMENT
0036-0087 10/20 © 2020 Mid-Atlantic Permanente Medical Group, P.C. 2101 E. Jefferson St., Rockville, MD 20852
HOW TO TELL WHEN
YOU ARE IN LABOR
Congratulations, you are now full term which is 37 weeks and beyond. You may be wondering how you
will be able to tell when you are in labor. Here are a few tips to help you figure that out.
HEALTH NOTES
Signs you may be in labor

• Labor contractions are often stronger than the normal “Braxton-Hicks”
contractions that you may have in late pregnancy. They also last
longer, often 45 seconds to a minute.
• If you have three long, strong contractions that are about 10 to 15
minutes apart, you may be starting labor.
If you think you are in labor, you should:

• First, empty your bladder. When you have a contraction with a full
bladder there is more discomfort than when your bladder is empty.
Then, walk around for an hour or do other activities like house work
or cooking. If you have any health problems (such as high blood
pressure), check with your health care team to be sure you can walk
for an hour.
• If the contractions are not getting closer and stronger after an hour,
Visit kp.org/maternity you may stop walking. You are probably not in real labor yet. If you
are really in labor, the contractions will continue whether you are
Visit kp.org/pregnancy
doing activity or resting.
• Read about labor in the Health • If the contractions are getting closer and stronger, continue walking
Encyclopedia. until they are every 5 to 7 minutes apart if this is your first baby; or
Call Kaiser Permanente every 7 to 10 minutes apart if this is not your first baby. You could also
Medical Advice do light housework or take warm showers. You may take a break and
sit down as needed but remember that the more you move, the faster
• Talk to your medical advice your labor may progress. Don’t forget to empty your bladder when it
nurse 24 hours a day, 7 days feels full.
• When the contractions are every 5 to 7 minutes (for first babies) or
359-7878 or (800) 777-7904.
every 7 to 10 minutes for one hour, call Medical Advice. If you have
TTY: (885) 632-8278.
a history of fast labors, ask your doctor how long you should labor at
home before calling Medical Advice.
Call your medical advice nurse sooner if:

1) Bloody show can occur several days before labor begins or when
labor starts. Bloody show is thick mucous and may be clear, pink or
slightly bloody. Bleeding like a period is not normal. Call Medical
Advice if you have bright red bleeding that fills a pad.
2) You think that your water has broken, whether • When your uterus starts to get hard, write down
or not you are having contractions. When your the time. This is the beginning of the contraction.
water breaks, it may be a big gush of fluid, When the contraction goes away, write down
or trickling every so often. If you notice your the time. This is the end of the contraction. The
underwear feels wet, change it and see what duration of a contraction is how many seconds
happens with the second pair. If that one starts it lasts from beginning to end. True labor
to feel wet too, call Medical Advice. contractions usually last between 30 and 70
seconds.
3) Your baby’s movements slow down to less than
the amount your doctor has told you to look for • From the beginning of one contraction to the
and you cannot make him/her move by drinking beginning of the next contraction is how far
cold water, milk, or juice. It is not normal for the apart the contractions are.
baby to stop moving before birth. The baby • When you call the Medical Advice Nurse, you will
cannot move as hard, but a healthy baby should need to be able to tell him or her how far apart
move. the contractions are and their duration.
If your doctor gives you different instructions, We are looking forward to hearing from you after
follow them. you have your baby. We hope you have a safe
labor and deliver a beautiful healthy baby.
How to time contractions Your health and your ability to care for yourself and your baby
can be seriously affected by violence or abuse. If you are hit,
• Use a watch or a clock with a second hand. There
hurt, or threatened by a partner or spouse, there is help. Call
are also many free apps to time contractions on the National Domestic Violence Hotline at (800) 799-7233 or
your smart phone. visit thehotline.org.
• Lie down on your left side and feel your uterus
(belly). When it becomes hard, you are having a
contraction.
beginning beginning
how far apart
end end
Contraction 1 Contraction 2
duration duration
care team.

UNDERSTANDING “BABY BLUES,”
AND PERINATAL MOOD AND
ANXIETY DISORDERS (PMAD)
Emotional ups and downs are a normal part of adjusting to being a new mother. It’s important to know
the difference between the “baby blues” (which are temporary) and postpartum depression and anxiety
-also called Perinatal Mood and Anxiety Disorders - which is a more serious condition. This handout
explains these differences and gives advice for caring for yourself and when to get medical help.
HEALTH NOTES
Having a baby can be exciting and joyous. While your life with a new baby
can be thrilling and rewarding, it can also be stressful. Childbirth causes
changes to your body and to your emotions. These changes may leave
you feeling sad, anxious, afraid, or confused. These feelings are sometimes
called the “baby blues.” The baby blues are very common after childbirth,
affecting about 80 percent of all new mothers.1
Feeling sad after the baby arrives?

The baby blues are caused, in part, by the rapid changes in hormones
within your body after giving birth. Fatigue that comes with the healing
process and the demands of caring for your new baby also add to the baby
blues. Often, the baby blues begin two to three days after delivery and last
one to two weeks.
For more information In the days right after childbirth, there may be times when you react in ways
Visit kp.org/health that may seem out of character for you. These can include:
• Read about postpartum • crying for no reason,
depression in the Health • feeling depressed, sad, or lonely,
encyclopedia. • feeling anxious or restless,
Call Kaiser Permanente • feeling irritable or angry for no reason, and
Behavioral Health Services
• having trouble sleeping or eating.
• If you are a Kaiser
Permanente member, you These feelings may come and go. One minute you may feel happy, and
can call Behavioral Health at the next, you may be crying. Mood swings are common after the birth of
1-866-530-8778 TTY: (885) a baby. New mothers often start to feel better after they get some rest
632-8278. You do not need a and when others can help with the baby. Baby blues are normal and no
referral from your Primary Care treatment is needed.
Physician.
Sometimes though, the feelings may last longer or be more intense. In this
Call Kaiser Permanente case, you may be having postpartum depression or anxiety. If these feelings
Medical Advice last more than two weeks or seem overwhelming, call your doctor or a health
care team member for help (see phone numbers on the left).
359-7878 or 1-800-777-7904. 1 Bennett, S.B.(2003), Beyond the Blues: A Guide to Understanding and Treating Prenatal and
Postpartum Depression. San Jose, CA: Moodswings Press
TTY: (885) 632-8278.
What is postpartum depression and anxiety? Symptoms of postpartum depression
and anxiety include:
Postpartum depression and anxiety, also known
as Perinatal Mood and Anxiety Disorders (PMAD), • Feeling restless, irritable, or crying a lot.
is more serious than the baby blues.Women • Having trouble sleeping, even though you are
with postpartum depression or anxiety have really tired, or sleeping all the time.
stronger feelings of sadness, despair, anxiety, or • Unplanned weight gain or weight loss, or a
feeling irritable. About 13 percent of mothers change in your appetite.
have postpartum depression or anxiety in the • Problems concentrating, remembering, or
first year after giving birth.2 It can occur after the making decisions.
birth of any child and can begin at any time, but
symptoms typically begin two to three weeks after • Feeling overwhelmed, not good enough,
giving birth. ashamed, guilty, or worthless.
• Extreme anxiety or worry.
If left untreated, symptoms can get worse and may
• Losing interest in doing things you used to enjoy
last for as long as a year or more. The good news
or not finding pleasure in these activities.
is that postpartum depression and anxiety can be
diagnosed and treated. • Thoughts or worries that are difficult to control.
If you are having any of these symptoms, please

Who is at risk for postpartum depression call Medical Advice. If you feel you are about
and anxiety? to cause harm to yourself or your baby call 911
immediately.
Any woman who has had a baby, miscarried, or
recently stopped breastfeeding a child can suffer
from postpartum depression and anxiety. No How is postpartum depression
matter your age, income, or number of children, and anxiety treated?
you can be affected. Postpartum depression is
Postpartum depression and anxiety can be
more likely to happen if you have had:
treated much like other types of mood disorders.
• postpartum depression or anxiety with another Treatment options may vary depending on the
pregnancy, type you have and how severe it is. The most
• depression or anxiety during pregnancy, common treatments for postpartum depression
• a history of depression yourself, or a family and anxiety are:
history of depression, • Psychotherapy (talk therapy)/counseling.
• troubled relationships with your partner, family, or • Anti-depressant/anti-anxiety medicine.
friends, • Alternative therapies (massage therapy, morning
• a recent stressful event, such as a divorce or bright light therapy).
separation, marriage, job change, or financial • Self care (see “self care strategies” on the next
problems, page).
• a difficult birth experience, or • A combination of these treatments.
• struggles with early breastfeeding.
There are medicines to treat postpartum
depression that are safe for mothers who
Can father’s have postpartum depression, too? breastfeed. If you are breastfeeding, talk with your
• Yes. About 4% of fathers have depression in the doctor or Certified Lactation Consultant to decide
first year after their child’s birth.3 on the medicine that is best for you.
2 O’Hara MW, Swain AM. Rates and risk of postpartum depression -- A meta-analysis. Int Rev Psychiatry 1996; 8:37-54.
3 cdc.gov/reproductivehealth/Depression
How others can help Resources
Whether this is your first baby or your fourth, Local Support Groups (MD, VA and D.C.)
there are many ways that close friends and family • Postpartum Support International
members can assist you through your transition to postpartum.net
motherhood. All mothers need help and support 1-800-944-4PPD
after the birth of a baby. Books
Ask your partner, family, and friends to help in • The Pregnancy and Postpartum Anxiety
these ways: Workbook: Practical Skills to help you overcome
• Listen when you need to talk. Anxiety, Worry, Panic Attacks, Obsessions and
• Help with cooking, shopping, cleaning, other Compulsions (2009) Pamela S. Wiegartz, Kevin L.
household chores, and errands. Gyerkoe
• Help in caring for the baby. • Beyond the Blues: Understanding and Treating
Prenatal and Postpartum Depression and Anxiety
• Give you time alone each day to sleep, bathe, (2015). Shoshana S. Bennett
exercise, read, or meditate.
• Overcoming Postpartum Depression and Anxiety
(2009). Linda Sebastian
Self care strategies
• This Isn’t What I Expected: Overcoming
There are several self care strategies that you can Postpartum Depression (2013). Karen Kleiman,
practice after the birth of your baby to help take Valerie Raskin
care of yourself. They include: • Life Will Never Be the Same: The Real Mom’s
• Rest as much as you can. Sleep while the baby Postpartum Survival Guide (2010). Ann L.
naps. Try not to let your visitors keep you from Dunnewold PhD, Diane G. Sanford PhD
getting the sleep you need. Turn off the phone Your health and your ability to take care of your baby can be
and put a sign on the door when you are napping. seriously affected by violence or abuse. If you are hit, hurt,
• Take good care of your body. Try to do some or threatened by a partner or spouse, there is help. Call the
National Domestic Violence Hotline at 1-800-799-7233 or
gentle exercises, eat healthy foods, and drink
connect to ndvh.org.
plenty of fluids.
• Try to spend time outdoors. Take the baby out
for a walk.
• Ask for help. Have family and friends help you
with household chores and errands.
• Talk with friends, especially other new parents,
about your experiences as a parent.
• Try to spend some alone time with your partner.
• Go to a support group for new parents.
care team. Adapted from Understanding the Baby Blues and Postpartum Depression © 2002, The Permanente Medical Group,
Inc. All rights reserved.
REGIONAL HEALTH EDUCATION & HEALTH PROMOTION

0038-0319 Revised/reprinted 7/17 Mid-Atlantic Permanente Medical Group. 2101 E. Jefferson St., Rockville, MD 20852

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Prenatal 3: Preparing for Your Newborn

Health Engagement 10/20

Resources for members that did not attend Prenatal 2 class

REGIONAL HEALTH EDUCATION, HEALTH PROMOTION

Your Kaiser Permanente pediatric and family practice doctors have

Call (703) 359-7878 or 1-800-777-7904 to schedule your child’s health

Join us as a partner in your child’s health.

2 months 3 • Diphtheria, Tetanus, and • Growth and development

REGIONAL HEALTH EDUCATION & HEALTH PROMOTION

We’re here to help you reach your breastfeeding goals!

Sore or cracked nipples

1 www.aap.org/breastfeeding/PolicyOnBreastfeeding.html Viewed 12/5/2011.

1 www.aap.org/breastfeeding/PolicyOnBreastfeeding.html Viewed 3/1/2016.

REGIONAL HEALTH EDUCATION, HEALTH PROMOTION

Circumcision is generally safe and can be completed in a few minutes. Your

1. cdc.gov/nchs/data/hestat/circumcision_2013/Circumcision_2013.htm#x2013;2010</a>%20 Retrieved Nov 7, 2017

REGIONAL HEALTH EDUCATION, HEALTH PROMOTION

Tips for choosing a car safety seat

Harness systems should have five points of attachment, two at the

Preparing to start child care - 4 step plan

What are my child care options?

REGIONAL HEALTH EDUCATION, HEALTH PROMOTION

If you are unsure if the situation requires an emergency room visit

 o make or cancel an appointment, call

To talk to an advice nurse, 24 hours/day,

Membership services (for questions about benefits and services and

Health education classes, including breastfeeding

Kaiser Permanente Certified Lactation Consultants and Breastfeeding Specialists

American Academy of Family Physicians . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . aafp.org

Consumer Safety Products Commission

Kaiser Permanente . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . kp.org

La Leche League International

National Highway Traffic Safety Administration

Postpartum Support International (for perinatal mood and anxiety disorder,

Postpartum visit date ____/___/___ time: ____________

2-week C-section follow up date ____/___/___ time: ____________

Pediatrician Name: ____________________________________________________________

3-5 day visit date ____/___/___ time: ____________

2 week visit date ____/___/___ time: ____________

4 week visit date ____/___/___ time: ____________

Self-care for new moms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

The Newborn Care Center . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Feeding your baby . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Growth and development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

Recognizing the sick newborn . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38

Books for parents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40

CALL THE ADVICE NURSES PROMPTLY IF:

Your body will take about

These online health-information features

Mature milk: Mature milk comes in two to

Once a schedule is established, most

Cluster feeding is when your baby feeds

After each use, wash the equipment thor- POSITIONING

4. National SAFE KIDS Coalition

5. US Consumer Products Safety Commission (cpsc.org/onsafety/2012/09/safe-bedding-pillows-safety-and-more/).

Age Physical development

Ferber, Richard, Solve Your Child’s Sleep 1581104448)

news), North Second Street, Lafayette, (ISBN: 978-1847379740)

Like a Pro (ISBN: 978-1581106503) (ISBN: 978-1554683499)

1558327207) (ISBN: 978-0471420040)

REGIONAL HEALTH EDUCATION, HEALTH PROMOTION

During this visit, your baby will receive a

Our Newborn Care Center staff are certified

2 months 3 • Diphtheria, Tetanus, and • Growth and development

o make or cancel an appointment, call

Postpartum visit date __/_/_ time: __________

2-week C-section follow up date __/_/_ time: __________

3-5 day visit date __/_/_ time: __________

2 week visit date __/_/_ time: __________

4 week visit date __/_/_ time: __________

4. National SAFE KIDS Coalition