Starting a family is a great challenge. To help parents take better care of  their children, this issue of the ACMA Medical Forum will publish an  article by Dr. Maddie Hao.  The article focuses on the healthy baby and  covers normal developmental milestones from the prenatal period to age 6 months.  Dr. Hao is a pediatrician at New York University Medical Center. She will move to Boston to join the South Cove Medical Center in this summer.  She will also be working as an attending physician at Children's  Hospital, Boston.  Dr. Hao is an ACMA founding member and co-director of the ACMA Administrative Committee.

  Baby care should start prenatally
     * Knowing your pediatrician
     * Q: Is the length of labor the same for male and female babies?
     * Q: Why does a woman have to take prenatal vitamins and iron?

  New borns
     *  Healthy habits and safe environments.
     *  Nutrition
     *  Infant Care.
     *  Q: How do I know when the baby has been fed enough if she/he is breast-feeding?
     *  Q: Can a baby hear, smell and see?

First to second week
     *  Developmentally
     *  Nutrition
     *  Q: What are some of the advantages of breast-feeding?
     *  Q: What is the best regimen for breast-feeding?

  One Month visit
     *  Developmentally
     *  Q: How much do babies normally cry each day?
     *  Q: What are some signs and characteristics of colic in an infant?

Two months visit
     *  Developmentally
     *  Q: Should immunization be delayed in children with minor non febrile illness?
     *  Q: When will the baby sleep through the night?

Four months visit
     *  Developmentally
     *  Q: Do breast-fed infants require vitamin supplements?
     *  Q: When can the infant start eating solid foods?

Six months visit
     *  Developmentally
     *  Nutrition
     *  Teething
     *  Safety
     *  Q: When do primary teeth erupt?
     *  Q: When can an infant "taste"?

Baby care should start prenatally

Knowing your pediatrician.
The healthcare partnership between the family and the doctors begins with
the first prenatal visit. Get to know your pediatrician several weeks
before the baby is born. Make yourself comfortable in communicating with your
doctor; this is especially important for patients of different language and
cultural backgrounds. Discuss with your pediatrician your concerns regarding potential
health problems in the family and the newborn's gender. Fathers should be
involved in the entire process.

Common Questions
Q: Is the length of labor the same for male and female babies?
A: No. On average, delivering a male infant lasts an hour longer than girls.

Q: Why does a woman have to take prenatal vitamins and iron?
A: Anemia is a common problem during pregnancy, it can affect the infant's
growth. Vitamins help the fetus grow and they can also prevent some
congenital problems of brain development.


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Newborn

Healthy habits and safe environments.
1) Parents should use a car seat to transport a baby; ensure the crib is
safe.  The ideal sleeping position for a baby is on their back.
2) The bath water for temperature should be < 120F
3) Maintain a smoke-free environment.
4) Know the early warning signs of illness: fever (temperature > 100.5F); failure to eat;
dehydration (Please see previous issue of the ACMA Medical Forum by Dr.Taosheng Haung);
diarrhea irritability; lethargy (baby has difficulty being aroused, poor
sucking and inconsolable crying); jaundice (yellow staining of the skin);
and skin rash.

Nutrition.
1) Breast-feeding should start as soon as the baby is born. Maternal care
is very important for successful breast-feeding: good rest, plenty of
fluids, appropriate nipple care and diet.  Mothers should try to pump the
milk if she cannot feed the baby due to medical or physical circumstances.

2) For formula-fed babies, make sure the formula be properly prepared.  Do
not use a microwave.  They can cause uneven heating and burn injury.  Babies should
never be bottle-fed while they are asleep.

Infant Care.
1) Provide a good cord, skin and nail care to prevent infection
2) Feeding techniques: comfortable feeding position; burping during feeding;
slightly elevate the baby's head after feeding.
3) Physiological changes of the newborn: vaginal bleeding and discharge;
changes from meconium (black dark stool) to regular stool.

Common questions
Q: How do I know when the baby has been fed enough if she/he is
breast-feeding?
A: Newborn infant should gain 20-30g/day. Checking baby's urine output is
another way to monitor the feeding.  The baby should have about 6 wet diapers
a day.

Q: Can a baby hear, smell and see?
A: Hearing and smelling are well developed at birth.  The retina is
well developed by birth, but the lens is rather immobile, so fixation and
tracking through the vision field won't develop until aged 2 months.
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First to second week

Developmentally
At one week of age, an infant responds to sound by blinking, crying,
becoming quiet, looking startled or a change in breathing pattern.
Newborns look at faces and follow with their eyes at a close distance.
Newborns recognize the parent's faces and voices.

Nutrition
An infant usually has physiological weight loss up to 5-10% of the birth
weight in the first week, than catches up or exceeds the birth weight by the
end of the second week.  Doctor's visits are very important to follow up on
weight gain around 2 weeks of age.  Starting from birth, each baby should
have her own growth curve.

Common Questions
Q: What are some of the advantages of breast-feeding?
A: The following are some advantages: easily available, inexpensive,
promotes mother-child bonding, medically, less immunogenic, contains
antibodies which may reduce the incidence of
infections.  Breast feeding is highly recommended.

Q: What is the best regimen for breast-feeding?
A: Feed your baby as early as possible.  The milk supply may not be
established for the first one or two days.  Intervals between feedings can
be gradually increased as the length of each feeding increases.
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One Month visit

Developmentally
At one month, an infant responds to sound; recognizes parent's faces and
voice; if put him on stomach, infant can lift head momentarily.  A
one-month-old infant can move arms, legs and head; can sleep for three hours at a time;
can stay awake for one hour or longer; when crying, can be consoled most of
the time by being spoken to or held.

Common questions
Q: How much do babies normally cry each day?
A: Studies have shown that at 2 weeks of age the average crying time is about
2 hours per day, increasing to nearly 3 hours at 6 weeks and then declining
to about 1 hour at 12 weeks.

Q: What are some signs and characteristics of colic in an infant?
A: Colic is present when for more than 3 days in any 1 week during the
first 3-4 months of life your baby is crying and irritable on an average of  3 hours
per day. Also, if the infant is feeding well and healthy, but emits considerable
flatus. Colic typically presents itself by 3 weeks of age and lasts until
3-4 months regardless of the management strategy used.
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Two months visit

Developmentally
At two months, an infant coos and vocalizes reciprocally; pays attention to
voices, other sounds, and sighs; smiles responsively; shows pleasure with
parents; lifts head, neck and upper chest with support on forearms and they
have some head control in an upright position.

Common questions
Q: Should immunization be delayed in children with minor non febrile illness?
A: No.

Q: When will the baby sleep through the night?
A: At about 4 months of age.
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Four months visit

Developmentally
At four months, the infant babbles and coos; smiles, laughs, and squeals;
can hold head erect while on stomach and raises body on hands; rolls over from
stomach to back; opens hands; holds onto hands, grasps rattle; controls head
well; reaches for and bats objects; recognizes parent's voice and touch.

Common questions
Q: Do breast-fed infants require vitamin supplements?
A: Yes. Breast-fed infants require vitamin D, fluoride (after 6 months), and
iron (after 4-6 months) supplementation.

Q: When can the infant start eating solid foods?
A: When the baby's demand for feeding continues for a week or more,
and he is over 4 months of age, it is time to consider solid food. Usually
we start with single-grain cereal, fed by spoon.
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Six months visit

Developmentally
A normal infant says "dada" or "baba"; babbles reciprocally; rolls over;
has no head lag when pulled to sit; sits with support; stands when placed;
grasps and mouths objects; shows differential recognition of parents;
transfers cubes from hand to hand; rakes in small objects; self-comforts;
smiles, laughs, squeals, imitates noises; turns to sound; may show signs of
teething.

Nutrition
Parents can introduce solid food 2-3 times/day. Be careful about the
potential choke foods like peanuts, popcorn, carrot sticks, whole grape,
candy, raisins and beans. When solids are first introduced, most babies
frown sputter, drool and extrude them. This is normal.  Learning to swallow
rather than to suck is a challenge for the baby.

Teething
Oral health should be a concern at this age due to teething. Do not put
baby to bed with a bottle or prop in mouth. Brush teeth and consult your
doctor to see if the infant is taking enough fluoride in it's daily diet.

Safety
This is when a playpen comes in handy because the baby is now safe
to be left alone.  But if you do not use a playpen, it is very important to
have a safe room in the house for the kid to play if left unattended.

Common questions
Q: When do primary teeth erupt?
A: Mandibular teeth usually erupt first. The central incisors appear by 5-7
months and the second molars are in place by 23-30 months.

Q: When can an infant "taste"?
A: Taste is present at birth and infants demonstrate a definite preference
for sweetness over saltiness or plain water.

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