BREAST-FEEDING: Many parents decide whether to breast- or bottle-feed before their baby's birth. This is a personal decision, of course. However, breast milk is the ideal food for an infant. The breast first produces colostrum, a yellow, watery fluid, rich in factors that protect against infectious diseases to which the mother may have been exposed. Feeding every two to three hours stimulates abundant milk production by the third or fourth day. After Caesarean births, this will take a few days longer.

Normally, babies feed fully in 30 minutes and can then go two to four hours between feedings. When breast-feeding, use both breasts each time, alternating which is offered first. A rigid schedule will not be necessary. Your baby will teach you his/her needs.

Continue your prenatal vitamins during breast-feeding, but consult us before taking any other medicines. Drink plenty of fluids. Do not eat any foods that do not seem to disagree with your baby.

FORMULA-FEEDING: Use only an iron-fortified formula, not a low iron formula! You will then prevent iron-deficiency anemia, a very important goal. By the way, the iron formulas do not cause constipation. Premix, concentrated, or powder formulas are all equal in nutritional content.

Bottles prepared with formula mixed with tap water do not need to be sterilized. Well-water is discouraged for use in infant feeding. Most infants average an intake of two to 4 ounces per pound of body weight per day after the first week. After the first month, most babies take 24 ounces per day.

WEIGHT: Before establishing normal weight gain (usually one ounce per day in the first few months), some babies will lose 10 to 15% of their birth weight in the first few postnatal days. After a week, however, the birth weight is usually regained.

NEWBORN SCREENING: New York State requires that a blood specimen from your infant be obtained before his/her discharge and sent to special labs for screening to prevent mental retardation from diseases that are treatable. Other problems, such as Sickle Cell Anemia and HIV, are also included. We receive prompt reports of any abnormality and will tell you immediately of any concerns about your baby.

JAUNDICE: Some infants will look yellow during the first few days of life. This color change is called "jaundice." We will explain what the significance of this is for your infant if it occurs. Usually, no disease is involved, and your infant will remain healthy through this period.

UMBILICAL-CORD CARE: The cord remaining after delivery will dry up and fall off in two or three weeks. Purple antiseptic dye applied in the nursery may stain the adjacent abdomen, causing it to look "bruised." It is not. Move the cord and cleanse the area around its base with alcohol every day. When it falls off, you may see a small amount of blood which is old, dissolving clot. Do not worry about this if it happens. Your baby will not bleed from this area, and the umbilical-cord area will not open up in any way. You may bathe your baby after the cord falls off.

CIRCUMCISION: Opinions change from year to year about circumcision. There is no harm done to your infant either way, if the baby is or is not circumcised. Obstetricians will perform the circumcision if you ask for and sign permission for the procedure. Keep the circumcised penis clean, applying an antibiotic ointment to the site daily until it is healed, usually about 5 days.

NEWBORN ACTIVITIES: Infants may sleep up to 18 hours per day. This is normal. They also normally sneeze, burp, spit up, and startle after sudden movements or loud noises. They also like to cry! You will quickly learn what your baby is trying to tell you. Listen and look. Do not panic when your baby cries. Call us if anything confuses or worries you.

GOING OUT: Babies do not need trips to McDonald's or nearby malls. They do not owe friends and casual acquaintances kisses or handling. Increased contact with people exposes your infant to disease.

FEVER UNDER FOUR MONTHS OF AGE: First of all, learn to take your baby's temperature rectally. Digital thermometers are cheap and easy to use. Ear thermometers are expensive and unreliable. If you think your baby has a fever and his/her rectal temperature is over 100 degrees, call us immediately! Do not give Tylenol or Advil without our permission. We presume your infant in this age group has a serious infection until we check for the cause of the fever and perform the indicated tests. An infant under four months of age who has a fever is seriously III until we prove he/she is not!

OTHER SIGNIFICANT SIGNS: Any change In activity from normal, poor feeding, decreased urination - if your intuition tells you things are not right with your infant, call us.

IMMUNIZATIONS: The schedule for immunizations in childhood is in a constant state of change. New vaccines replace old ones or are added as research and development creates a host of new protections against childhood and adult diseases. You will always be informed of our recommendations and our schedule for your infant. You will be asked to sign for any shots before they are given. See the schedule.

CLOTHING AND THERMOSTAT: Dress your infant in the same number of layers of clothing as you wear. A hat is an important addition to keep your baby warm and to allow calories fed to be used for growth instead of keeping the baby's temperature in the normal range. Any temperature from 68 to 72 degrees is satisfactory for your home. A wintertime humidifier in the home will help keep things more comfortable as well.

ODDS AND ENDS: Nursing babies get sucking blisters on their lips that peel off and recur. This is normal.

Face rashes resembling acne come and go and are normal. Greasy, scaling rashes on the scalp, forehead, or behind the ears should be treated. Call us. Also, red, pimply diaper-area rashes or white, patchy areas inside the mouth are not normal and can be treated.

Breasts and genitals of newborn infants are commonly swollen from the effects of maternal hormones. This will subside. Both boys and girls have also been seen to secrete milk from their swollen breasts. This is not a concern. Bloody mucoid vaginal discharge in female infants is also a normal finding.

Spitting up is a common event. Large regurgitated volumes should be reported. If you think your baby is not tolerating the formula recommended, call us for advice before making any changes.

You may cut your baby's fingernails with a cuticle scissor if long nails are scratching your baby's face.

When you go home, call us to schedule your baby's first appointment. We would like to see you about one week after discharge from the nursery.

Remember to enjoy yourself and your baby. These first weeks and months are a special time for your family.