Place Your Baby’s Photo Here
Baby’s Name___________________________ Date of Birth____________________________ Birth Weight________ Birth Length________ Cleaning and Scrubbing can wait til tomorrow For babies grow up… we’ve learned to our sorrow… so quiet down cobwebs, dust go to sleep — I’m rocking my baby, and babies don’t keep. 2
270.759.9200
•
1000 South 12th St.
•
Murray, Ky
INTRODUCTION Congratulations on the birth of your baby! The days and weeks ahead will be very special for you and your family. We are pleased that you have chosen us as your baby’s doctor and hope we can help you get your baby off to a good start in life. Your baby’s growth and development, and the unfolding of his personality over the next months and years will be fascinating to you as parents. There will be days of despair, confusion, and tears and you will have fun with your baby, learn from him, and share a wonderful kind of love with him. All new parents have questions and concerns regarding the care of their babies and children. This booklet will answer some of the most common questions. We hope you will take the time to read it carefully, even if this is not your first baby, and keep it handy at home for reference. Many new mothers feel very unsure of themselves at first. As long as your baby is well fed, well loved, warm and comfortable, he won’t mind that you are less than an expert. You will be surprised at how fast you get to know and understand your baby’s needs. The most important thing is for you to relax and enjoy your infant. You will have many well-meaning relatives, friends, and neighbors to offer you advice on child care.
www.PrimaryCareEverywhere.com
3
Remember that while they mean well, their way is not the only
way. Listen politely, thank them and make your own decisions for what is in the best interest of you and your baby keep in mind that you are the one who must care for, provide for and love your baby. Therefore what you do must make you comfortable and your family content. No general rule works for everyone – use your own judgment and feelings but when any questions or concerns arise please feel free to call on us to help you find the answers.
IN THE HOSPITAL While you and your baby are in the hospital we will see you daily. We will thoroughly examine your baby on our first visit, and again upon discharge, and attend to any medical needs that arise in between. Any problems that arise concerning your baby will be discussed openly and completely with you. We hope you will take advantage of our visits to ask questions about your baby, so that your arrival at home will be as smooth as possible. Routine blood tests for PKU, thyroid disorders, galactosemia, cystic fibrosis, sickle cell anemia, and other disorders as well as
4
270.759.9200
•
1000 South 12th St.
•
Murray, Ky
blood type will be done on all infants. Other blood tests and Xrays will be done only as the need arises. We make our hospital rounds daily. Please try to be available in your room so we don’t miss you. Unless you understand what newborns do and how they vary from older children, your baby can perplex and worry you unnecessarily. The following information can relieve some of your concern and help you enjoy your baby.
WEIGHT LOSS. Your baby is born with an excess of calories and water which is self-nourishing for the first few days. For this reason the baby will want very little of the first feedings offered, and may lose up to 10 percent of his weight. For example, a 7 ½ pound baby can lose up to 12 ounces before starting to gain. Most of this weight loss occurs in the first 24 hours; by the 4th or 5th day your baby will begin to show an increased appetite and then slow but steady weight gain.
THE HEAD. For several days after your baby’s birth you may notice the head has an elongated, bruised appearance. This is a normal situation and is the result of the stresses of labor and the baby’s passage through the birth canal. The bones of the baby’s skull are pliable and will gradually assume a more normal shape over several days. Any bruises which are present should resolve over 3 – 6 weeks without harm to your baby.
THE EYES. Irritation induced by the erythromycin ophthalmic ointment used to prevent eye infection causes some newborn babies to develop swelling of their eyelids, a bloodshot appearance, and a yellow discharge from the eyes. This usually ends in two to five days and does not result in any damage. It is common for small blood vessels on the surface of the eyeball to rupture during birth. This occurs in one of every four babies and is temporary. It clears in seven to ten days without treatment. www.PrimaryCareEverywhere.com
5
SKIN. The newborn is usually the source of the much concern to the new parent because of the numerous variations and rashes that occur. Understanding these insignificant variations will save you from needless worry. At birth the baby’s skin is purplish red in color. With his first breath it brightens to a deep red. Occasionally, a baby’s hands and feet will remain blue during the first one or two days, or whenever he is chilled. Within a day or two, the redness fades and peeling of the skin occurs. Although the peeling skin may be unsightly, in no way does it harm or disturb the baby. Many babies, while still in the hospital, develop a rash characterized by small areas of redness with small white centers. They usually appear in the first 24 hours on the trunk, face, or diaper area, and may last from five to seven days. The condition is harmless. It does not disturb the baby, and does not require any special attention. There are also a number of non-specific facial rashes that usually appear during the first few months. These rashes do not represent an illness and do not require treatment. They include: Minute shiny white pimples without any redness around them. Collections of a few small red spots or smooth pimples on the cheeks. At times they fade, and then get red again.Less commonly, rough red patches on the cheeks that come and go. Another skin problem that disturbs new parents results in red blotches or lines, usually on the upper eyelids or over the bridge of the nose. These are birthmarks that usually fade with time. Frequently, you’ll find them also on the scalp and on the back of the neck.
PRICKLY HEAT. This common rash is caused by the plugging up of the sweat glands. It is usually found in an area covered by 6
270.759.9200
•
1000 South 12th St.
•
Murray, Ky
clothing, such as the neck, trunk, or other diaper area. Sometimes it may even be found on the cheeks. It often follows fever, exposure to sun, or overheating due to excessive clothing. To prevent prickly heat, try to keep the baby from becoming too warm. If the rash breaks out, treat it with powder or lotion. If it becomes infected please consult us.
HICCUPS. Many infants have hiccups after each feeding; others just occasionally. This is not disturbing to your baby. Usually a few swallows of warm water will stop hiccups or they will stop spontaneously after 10 – 15 minutes.
SPITTING UP. Many parents become worried because their baby spits up during the first few days. Fluids which the baby has in his stomach after birth may cause it to be upset. Also, it is not unusual for your baby to bring up food during the first few months whenever he burps or after he has been active. Propping the baby in an upright position in an infant seat for 20 to 30 minutes after feeding may also decrease spitting up. Avoid excessive handling and jostling after feeding. Burping may help.
www.PrimaryCareEverywhere.com
7
Although spitting up is an inconvenience, it seldom is a serious problem in a baby who is growing and developing normally. Be patient, all babies stop spitting up eventually. Time and acceptance on your part usually handle this problem best.
BOWEL MOVEMENT. Just as your baby develops his own feeding pattern, he will also develop his own schedule for moving his bowels. There is considerable variation in size, color, consistency, and frequency of stools in newborn babies. Normal stool patterns can include a movement after each feeding or one every second or third day. Initially, the stool is a tar-like black sticky material. With the onset of milk feedings the stools become yellow, and can be pasty, semi-formed, or loose. Formula-fed babies will have curds or seeds in their stools, while breast fed babies will have a thin, smooth stool. The consistency varies daily with each movement. Diarrhea means frequent (8-10 day) loose and very watery stools. You may have noticed that the baby’s muscles are generally weak; that is why he doesn’t sit up or control his head well. The same applies to the abdominal muscles which, in older children and adults, provide the force to move the bowel with control. Your baby has to work harder and longer to have his movement. It is not unusual for a baby to grunt, turn red in the face, and draw up his legs while having a bowel movement. This does not mean he is constipated or in pain. Instead of becoming anxious, keep him secure and comfortable. Never use enemas or cathartics unless we recommend them. Two problems concerning bowel movements should be brought to our attention: 1. Stools are excessively watery. 2. Recurring small, hard, bead-like stools. (Constipation means hard, pellet-like stools, not infrequent ones.)
8
270.759.9200
•
1000 South 12th St.
•
Murray, Ky
INTESTINAL GAS. Babies pass gas freely without control from the gastrointestinal tract. This gas comes from a combination of swallowed air and fermentation of food in the digestive process. It is normal and it is not necessarily the cause of colic. SNEEZING AND NOISY BREATHING. It is very common for your baby’s nose to become slightly congested or stuffy during the first few months. Sneezing is his way of clearing this congestion from his tiny nasal passages. He might also sneeze in order to cleanse his nose of mucus, lint or milk curds. Babies breathe through their nose for the first few months. Sometimes, the breathing sounds noisy or snorty because the air turbulence caused by the mucus in the nasal passages is amplified by the chest. Babies can become cranky and may feed poorly if their noses are stuffed up since this blocks their breathing. Usually normal saline drops (one-fourth teaspoon of salt to 4 ounces of water) and an infant nasal aspirator can solve these problems. A cold mist vaporizer in the room can prevent the mucus from drying out.
www.PrimaryCareEverywhere.com
9
SLEEPING. You may find that your baby will do a lot of sleeping. Newborn’s sleeping habits are usually very erratic for the first three months. When baby is sleeping, always place your baby on his side or on his back. These are the latest recommendations by the American Academy of Pediatrics made after numerous studies showing these positions decrease your baby’s chance for Sudden Infant Death
JAUNDICE. (yellowing of the skin) On about the second or third day, two out of three normal full-term babies become yellow tinted, or jaundiced. This coloring of the skin results from a combination of two normal processes which involve the immaturity of the infant’s liver and the breakdown of red blood cells. Bruising of the skin and the presence of a cephalohematoma make the occurrence of jaundice more likely. At times the jaundice may progress to such a degree that a blood test will be necessary to test the level of bilirubin in the baby’s system. We will inform you of these results and discuss the need for any treatment which may be necessary. It is not unusual for the jaundice to progress to the point where the infant is placed under the bilirubin lights, or phototherapy. This helps the infant to eliminate the bilirubin more quickly, and hopefully be ready to go home when you are. Frequently jaundice is more prolonged in breast-fed babies. Usually, nothing has to be done, but, on occasion, we ask that breast feeding be discontinued temporarily. If this occurs, you will be instructed to pump your breasts until the baby is ready to resume breast feeding.
GENITALIA. Baby girls respond to the hormones in their mother’s system during pregnancy. The uterus and vaginal lining of the baby are stimulated, and after deliver there may be a “withdrawal” phenomenon. Occasionally, this is manifested 10
270.759.9200
•
1000 South 12th St.
•
Murray, Ky
by vaginal bleeding, or, most often, by a white mucus discharge which lasts about a week. Your baby’s breasts, both male and female, also respond to hormones and may be enlarged after birth. On occasion they may even secrete milk. There is no reason for alarm unless the skin over the breasts is red or extremely warm to touch.
LEAVING THE HOSPITAL. When you leave the hospital you should dress your baby with current weather conditions in mind. If you are comfortable dressed a certain way your baby will most likely be comfortable dressed in a similar manner. Your car should have an approved rear-facing infant car seat for your child’s protection. DO NOT HOLD THE INFANT while the car is moving. Acquiring an approved car seat is the first expression of love and concern parents can show for their newborn baby. Each year more children are killed by automobile accidents than any other disease or injury. To protect your child in the car be sure the infant is buckled in his seat whenever the car is in motion. Holding a baby on your lap in a moving car is not only the most dangerous way to transport a child in a car, but is also against Kentucky state law.
AT HOME. When you arrive at home, the baby should be put to bed, always on his back or side, and not disturbed except for feeding, diaper change, or bathing. Every baby must adapt
www.PrimaryCareEverywhere.com
11
to new surr-oundings, and the first 24 to 48 hours at home should not be expected to be smooth sailing.
VISITORS. Having a baby can be physically stressful, and most new mothers need time to rest and to become accustomed to their new routine. Babies are quite susceptible to infections and should not have exposure to many people in the early weeks of life. In addition, the baby and family need time to adjust to one another with a minimum of stress. Friends and relatives are going to be interested in your baby and will want to hold and hug him. Unfortunately, you may not know who has a cold, sore throat, cough or dirty hands. Do your utmost to keep visitors and especially children away from your baby. There will be lots of time for that later on. We suggest that visitors be limited in the first several weeks and that the baby be handled only when necessary.
THE NURSERY. If possible your baby should have his own room. It should be well lit and ventilated. Pai-nted items should have lead free paint and furnishings should not easily collect dust. Babies grow and develop better socially and mentally if
12
270.759.9200
•
1000 South 12th St.
•
Murray, Ky
the surroundings are bright and interesting. Don’t be afraid to use bright colors when decorating the nursery. No pillow should be used in the crib, the mattress should be firm and flat, and one baby blanket or quilt is usually sufficient cover even in cold weather. A night light may be helpful for middle of the night feedings and diaper changes. Bumpers may be used to keep head, arms, and legs from getting caught between the bars of the crib. Probably no device is as helpful in raising babies as the rocking chair. Both you and your baby will enjoy a rocker during dressing, changing, feeding and especially for those cozy moments you and your baby will share. Mother will feel relaxed while she is rocking and babies love the rhythmic motion and often will fall asleep while being rocked.
OUTDOORS. A fairly good rule to follow is to take your baby out whenever the weather is pleasant. Babies born in the summer may be taken out on a nice day after they are two weeks old. Babies born during the other seasons should be kept indoors for 3 to 4 weeks unless the weather is particularly balmy. Plenty of sunshine is most beneficial, but avoid exposing the baby to direct sunrays and excessive heat and cold.
BATHING. It’s good to have a fairly regular time for bathing baby. The room should be
www.PrimaryCareEverywhere.com
13
warm, with no drafts. Keep bathing supplies together to save yourself steps. Until the navel (and circumcision) is healed, wash baby by sponging. After healing your can us a tub or bathinette. The face, ears, and nose should be washed with a soft cloth and plain water. There is no need to clean inside the ears, nose, or mouth. Wash the baby’s head with mild soap or baby shampoo daily, or as needed. Use a mild soap (baby soap, Dove, or Ivory) on the skin, wash into the creases, rinse thoroughly, and pat dry. In general, it is wise to avoid deodorant, perfumed, creamed or beauty soaps, because they tend to cause skin rashes. Baby lotion on the body is helpful for dry skin. A light powdering is acceptable, but oils should not be used, especially on the head. If a scaly, oily, dandruff-like area (cradle cap) appears on the scalp, an anti-dandruff shampoo (Selsun Blue, Sebulex, etc.) should be used for several days until the condition has cleared. Never for any reason leave your child unattended in bath water. Ignore the phone or doorbell during bath time, or else take your baby with you.
UMBILICAL CORD. The cord remnant will fall off between 1 – 3 weeks of age. In the meantime special care should be taken to assure no infection occurs at the site of the umbilical cord. Some things you can do to help prevent problems include: Be sure the diaper is turned down below the cord to prevent irritation, apply alcohol to the stump 3 – 4 times daily to help dry the cord and also prevent infection. Contact us at the first signs of redness around the area. It is not unusual for the cord to have some clear drainage or blood tinged drainage for 1 to 2 days after the cord comes off, however, any drainage after that time isn’t normal and we should be called. The infant should be given sponge baths only until the cord has fallen off. Afterward 14
270.759.9200
•
1000 South 12th St.
•
Murray, Ky
he/she can be given tub baths. Don’t worry if the belly button protrudes. Belly bands are not recommended.
THE CIRCUMCISION. Your baby will be circumcised by your obstetrician the day before or the day of your discharge. A ring called a “plastibell” may be placed. There is usually some mild bleeding for approximately 2 hours. The Plastibell will fall off in 5 – 6 days. Clean the area gently with a washrag or baby wipe. There is usually no need to apply any medications. If a plastibell is not used, just keep the area clean and apply vaselnie with every diaper change until healed. If swelling or bleeding occurs, we should be notified.
DIAPER AREA. Change your baby’s diaper as soon as possible after each bowel movement as well as after each wetting. Wash the area thoroughly with soap and water, rinse well, and pat dry. When cleaning girls, always wipe from front to back, to avoid contamination of the vaginal area. Do not attempt to remove all the white film under the labia.
DIAPER RASH. Because babies have sensitive skin, they are prone to have rashes and irritations, especially in the diaper area. Usually, irritation is due to prolonged periods of wetness or contact with fecal material. Prevention and treatment both require frequent diaper changes. Exposure of the rash to air for several hours a day, avoidance of plastic or rubber pants, and thorough cleansing of the area will heal most rashes. If, after a few days of such treatment, the rash persists, then ointments or creams such as Vaseline, A&D, Desitin, Caldesene, etc., may be used. If these bring no improvement, we should be consulted. www.PrimaryCareEverywhere.com
15
THE PACIFIER. All babies have an instinctive need to suck. This need goes beyond the sucking that accompanies feedings, and is usually confused with a need for more food. If your baby has been fed, but is busily chewing his thumb or fingers, you may wish to substitute a pacifier. Do not over feed the baby in an attempt to satisfy his sucking. At first a pacifier may not be acceptable to the baby, but usually with persistence or trying different types, it will be taken. Of course, there are some babies who prefer their own hand, and this is quite acceptable. Usually, a baby will outgrow this need to suck and will voluntarily give up the hand or pacifier. Remember that a pacifier is not meant as a substitute for parents love. WHEN YOUR BABY CRIES. All normal newborn babies cry a certain amount of time, just as they sleep and suck, during the first few weeks. Crying is about the only way they have of expressing themselves and of telling you their needs. A baby may cry when he is hungry, too cold, too warm, has an “unburped” burp, has a wet or soiled diaper, wants to be held, or just because he feels out of sorts. When your child cries it is best to first check him. If he/she has not been fed recently offer formula or breast milk but we want to emphasize that hunger should not be assumed to be the cause of crying and your baby should not be over-fed to prevent crying. It is normal for an infant to be fussy in the early evening for 30 – 60 minutes prior to going to sleep. Holding or cuddling your child will help. Don’t be afraid of spoiling your infant by holding him a lot in the first several months of life. Infants need to develop a feeling of security with their caretakers, and need
16
270.759.9200
•
1000 South 12th St.
•
Murray, Ky
to know that their needs will be met. Taking a ride in a car or buggy, swinging or being given a warm bath may calm the baby. An infant carrier which attaches over mother’s shoulders may also help. Babies who fuss for inordinately long periods of time (often many hours) are said to have colic. No one knows how to cure colic and all babies outgrow it even though it doesn’t seem that way when your baby is crying and you are tired and frustrated. There are a few treatments that can help such babies; so call us if your baby has this problem. Anxiety on the part of parents increases the baby’s crying. Therefore, try to stay calm. Any family with a colicky baby should get out of the house at least once a week and leave the baby with a relative. A reassuring fact about crying is that it causes no physical harm to the infant, so you need not worry if your baby cries or fusses for a while before you attend to his needs. In fact, many new babies fuss for fifteen or twenty minutes after each feeding before going to sleep; it is really pretty good exercise.
NUTRITION: FEEDING YOUR INFANT Feeding your baby will be one of the most enjoyable experiences of parenthood. It is a time for quiet closeness with your infant, and a time for expressing love and concern for him or her. The baby also will begin to develop a sense of security, comfort, and satisfaction from his caretaker. How you decide to feed your infant is an important and personal decision, and we hope you have given this some thought prior to delivery. Breast feeding is recommended by the American Academy of Pediatrics, and we certainly endorse this as being the most natural and healthy way to feed your infant. However, we realize that for some mothers this is not possible or www.PrimaryCareEverywhere.com
17
convenient, so in these instances we recommend infant formula that has been developed to closely approximate breast milk, so it is a very acceptable and adequate source of nutrition for your infant. In no cases do we suggest the use of regular cow’s milk in the first year of life. Regardless of whether you breast feed or bottle feed your baby, remember no two infants are alike, and no strict rules will apply to every child. Don’t be frustrated if the baby is very slow with feedings or seems uninterested in the first few days. It is not unusual, as infants are often tired from the stresses of labor and delivery. When you get home, let the baby set his own schedule at first, and don’t be surprised if he wants to feed more often than he did in the hospital. Many babies, especially those being breast fed may need to be fed every 2 – 3 hours at first, so be flexible! If your baby is crying less than 2 hours after a feeding however, look for other causes. You should not assume that all crying indicates hunger, and you should not over-feed him just to keep him quiet. After a few weeks you can gradually try to adjust your infant’s feeding times to fit into your schedule also.
BREAST FEEDING Nursing your infant should be a fun, exciting, rewarding and loving experience for you and your infant. But nursing mothers, especially those nursing for the first time must realize that it takes time and patience. However, you will find that breast feeding is the most inexpensive form of feeding your infant, it
18
270.759.9200
•
1000 South 12th St.
•
Murray, Ky
requires the least amount of equipment, and is certainly the most convenient especially late at night! We are pleased that you have decided to breast feed your baby and will make every effort to help you have a successful and enjoyable time of it. The information in this booklet will hopefully get you off to a good start, but probably will not answer all the questions you may have. You will probably receive other information from the hospital or from books you may have. Please don’t hesitate to ask us if you have any other questions or concerns.
PREPARATION FOR BREAST FEEDING. This should begin 1 – 2 months prior to deliver. During this time expectant mothers may notice some engorgement of the breasts, and may be able to express small amounts of creamy fluid. You should massage the nipples and areola daily, express some of this “colostrum” to keep the ducts open. Use crease such as A&D ointment, lanolin, or Vitamin E. You may help toughen the nipples by exposing them to air, going braless for some periods of time, leaving the trap doors down on a nursing bra, and even using a hair dryer on them after bathing. If you have done these preparatory www.PrimaryCareEverywhere.com
19
things before delivery the transition to nursing your infant should be an easier one. If you have not done any preparation it is still possible to breast feed but you may need more help in the beginning.
GETTING STARTED. This may be the most difficult time for the nursing mother, but don’t give up – there is plenty of help around, and don’t be afraid to ask for it! Most babies are very sluggish in the beginning and will need some help in getting started. Don’t forget – this is new to them too! It is good to try and nurse the infant shortly after delivery but don’t be surprised if he is not interested. Chances are he’s not too hungry and is simply worn out from the birth process. Probably the most important thing is for the mother to relax. Get yourself comfortable before you get started – either sitting or lying on your side. Use a warm wet washcloth to clean the breasts before the infant nurses. Don’t try and force the nipple into the baby’s mouth – it is easier to take advantage of the “rooting reflex”. Hold your nipple and areola between the 2nd and 3rd fingers and touch it to the baby’s cheek. He should naturally turn his head toward the nipple and grasp it with his mouth. Try to get as much of the areola as possible into his mouth. This will be more comfortable for you, and also the baby to empty the breast more completely. Be sure to hold your breast away from the baby’s nose so he can breathe easily. Babies will not usually suck continuously, but stop then start again while nursing. If he seems to be going to sleep and forgets to suck, try stroking the cheek – from the corner
20
270.759.9200
•
1000 South 12th St.
•
Murray, Ky
of the mouth toward the ear. This usually stimulated him to start again. To remove the nipple from baby’s mouth, break the suction by pressing the breast away from the corner of the baby’s mouth. Never pull the nipple abruptly from the baby’s mouth as this can injure the nipple.
THE FIRST FEW DAYS. The first few days after delivery the baby will be getting colostrum – not milk from your breasts. Colostrum is a yellowish and creamy fluid which is very rich in antibodies. It helps to protect your baby from infection, and helps prepare the intestinal tract for the milk which will be coming. The stimulus for milk production is the emptying of the breasts, so more frequent feedings should help the milk “come in” more quickly. The milk usually comes in 2 – 4 days after deliver, and you will know when this happens. Your breasts may become engorged fairly rapidly and the colostrum changes to the thinner, whiter milk. Although breast milk may appear watery, it contains all the important nutrients your baby needs with the exception of some vitamins which will need to be provided.
HOW LONG TO NURSE. To avoid sore and painful nipples, it is usually recommended to start with shorter times and gradually increase over the first few days. 1st day – 5 minutes each breast 2nd day – 7 – 8 minutes each breast 3rd day – 9 – 10 minutes each breast Feed the baby from both breasts with each feeding alternating the side with which you start. When you get settled into breast feeding, generally the baby should nurse no longer than 10 – 15 minutes on each side. The infant will get the majority of milk in the first 5 minutes, so much of the time spent is simply to satisfy their need to suck. www.PrimaryCareEverywhere.com
21
HOW OFTEN TO NURSE. Breast milk is very easily digested in the baby’s intestinal tract, so your infant may want to feed every 2 to 3 hours for the first several weeks at home. Don’t worry that you aren’t making enough milk. Many babies go through a stage at 2 – 3 weeks of age when they seem hungry all the time. Don’t be reluctant to feed your baby as often as he may desire during this time – maybe every 1 ½ to 2 hours. This is a natural growing spurt for the baby, and also his way to help increase your milk supply. IS BABY GETTING ENOUGH MILK? You can usually answer this one yourself if you consider the following things. Does baby fall asleep on your breast after a feeding? Does he sleep well for 2 ½ to 3 ½ hours between feedings? Does he frequently have wet diapers? TAKING CARE OF YOURSELF. The first several weeks of nursing is a time to pamper yourself. Lots of rest, relaxation and good nutrition are very important to build up good milk supply. This is the time for your spouse to pitch in and help around the house – cleaning, fixing meals, and running errands. Try to sleep yourself when the baby is sleeping. If you can, keep visitors to a minimum in the first few weeks – you and your baby need to adjust to being home together. Discourage visitors from handling the baby, as this will increase his exposure to illnesses. A good balanced diet is also important and you should continue to take a prenatal vitamin daily. Be sure and drink lots of fluids too! You may find that some foods you eat will upset your infant – causing gas and discomfort. It is best to avoid the following: cabbage, brussels sprouts, beans, broccoli, excessive citrus fruits, chocolate and highly seasoned foods. If the baby seems unusually fussy after a particular food, leave it out of your diet for a while, then try again in a few weeks. Please let us know before taking any medications while breast feeding. Some medicines will cross over into your milk and be
22
270.759.9200
•
1000 South 12th St.
•
Murray, Ky
harmful to the infant such as birth control pills, thyroid medicine, ergot, etc. Fortunately most over-the-counter products are safe if taken in moderation but please call us if you have any concerns about what you are taking.
SUPPLEMENTAL FEEDINGS. For the first few weeks while you are establishing your milk supply, it is probably best not to supplement with formula. If you do need to be gone for a longer time and miss a feeding, have some formula available or if you can, have a bottle of breast milk which you have pumped and kept frozen. If at all possible while you are gone, try to pump your breasts. You will be more comfortable, maintain your natural supply, and also have another bottle of your own milk to give the baby the next time you need to be gone. There is generally no need to give your infant solids, or other foods until about 4 – 6 months. Grandmothers, other relatives and friends may encourage you to start other foods much sooner, but be patient. We will discuss these issues with each visit to the office, and let you know when the best time is for your infant.
PUMPING YOUR BREASTS. Many breast feeding mothers would like to have more freedom to be gone for longer periods from their infant, yet still provide only breast milk for feedings. It is possible to pump the milk and freeze it for later feedings. This also allows many mothers to return to work yet continue nursing their infant on a full time basis. And mothers whose nipples are very sore may want to pump temporarily while they heal. There are several breast pumps available which are easy to use, and very effective, or you may find it easier to simply hand express the milk. The least expensive hand pump is a small plastic one which works the same way as a bulb syringe. There are other more expensive pumps – i.e. the Lloyd-B (Lopuco) pump and the Marshall pump which are easy to use and relatively compact.
www.PrimaryCareEverywhere.com
23
The milk you pump should be stored in sterile bottles – preferably plastic ones if you freeze it. It can be refrigerated if used within 24 hours, otherwise should be frozen. Frozen milk should be used within a month unless it is in a deep freeze in which case it can be stored longer. The milk can be thawed by running lukewarm tap water over the bottle for ten minutes or so. If you first try to pump while you are nursing full time you may have difficulty obtaining even an ounce. Don’t be discouraged – it takes time, patience and practice to become an expert at it. Once you have a good milk supply established, however, it should become easier. Not only will you have more freedom, but your husband and relatives or close friends will finally have a chance to feed the baby occasionally.
YOUR INFANT’S STOOLS. Breast fed babies tend to have more frequent bowel movements which are very loose – almost liquid. This is very normal. The number of stools may vary from 5 – 15 per day, (although a few babies may have stools once every 2 – 3 days) and it is yellow to green in color. Fortunately though, the odor is not unpleasant, and the frequency of bowel movements will gradually diminish after 6 to 8 weeks of nursing.
REFERENCES WHICH MAY BE HELPFUL: 1. Nursing your baby by Karen Pryor 2. The Complete Book of Breast Feeding by Marvin Eiger, M.D. and Sally Olds.
24
270.759.9200
•
1000 South 12th St.
•
Murray, Ky
3. Preparation for Breast Feeding by Donna and Rodger Ewy. 4. The Womanly Art of Breast Feeding La Leche League.
BOTTLE FEEDING If you elect not to breast feed your baby there are several commercial infant formulas available which provide excellent nutrition for infants in the first year of life. These formulas are made from cow’s milk base which is modified to closely resemble human breast milk. We recommend starting your infant on an iron fortified formula. Occasionally infants show an intolerance to cow’s milk and need a milk-free substitute, such as a soybean based formula. Soy formulas are also sometimes used in infants from highly allergic families. Other formula we may recommend for your baby include lacto-free formulas, hypoallergenic formulas, premature baby formulas, or special formulas for gastroesophageal reflux. Infant formulas come in a variety of forms – powders, concentrated liquid, Ready-To-Use cans, and even individual Ready-To-Use bottles. The most convenient type is naturally the most expensive. You may find it easier to start with the Ready-To-Use form at first, while
www.PrimaryCareEverywhere.com
25
you are getting adjusted to the new routine. Afterwards, the concentrated or powder would be more economical. Remember, your baby should be kept on an infant formula throughout the first year of life.
PREPARATION OF FORMULA. It is very important that you prepare the formula exactly as stated in the directions. Feeding your infant too concentrated or too dilute formula could cause very significant problems. You can prepare enough bottles at one time for 24 to 36 hours, and store them in the refrigerator. Always clean the top of the cans thoroughly before opening. For the Ready-To-Use: simply pour formula into individual bottles. No additional water is needed. For the concentrate: mix 13 oz. (one can) of concentrate with 13 oz. of water then pour into individual bottles of about 4 oz. each. For the powder: use 2 level scoops of powder for every 4 oz of water.
STERILIZATION. We no longer feel that sterilization of water, formula or bottles is necessary. Cleaning your bottles and nipples thoroughly in very hot water or in the dishwasher, with special care to remove any dried milk particles is all you need to do. If however your water supply is from a well or cistern, we do recommend boiling it for 5 minutes prior to using the water in formula preparation. Since milk which has not been sterilized is more quickly spoiled, it should be promptly refrigerated after preparation. Partially used bottles may be refrigerated then used again within 6 hours, otherwise discarded. Do not keep even refrigerated formula for more than 24 hours after preparation. TYPES OF BOTTLES. There are a variety of bottles and nipples available for feeding your baby, and we have no particular 26
270.759.9200
•
1000 South 12th St.
•
Murray, Ky
preference for what type you use. The conventional glass bottles, the hard plastic ones, or the plastic shells with disposable liners are all certainly adequate. The person to decide which is best will be your own infant. You may find by trial and error that he seems to prefer one type of nipple or bottle over another. Whatever is most convenient for you and satisfying to your baby will be acceptable to use.
NIPPLES. Be sure and test the nipple holes regularly to be sure they are the right size. The holes should be large enough to allow milk to drip fairly rapidly but without forming a stream. If the holes are too small, the infant may tire out before getting enough formula. If they are too large, the baby may get too much formula too fast, and not get enough sucking to satisfy him. Holes which are too small may be enlarged by pushing a #3 or #5 red hot sewing needle through them from the outside. It is easiest if you put the blunt end in a cork while heating the other end with a match or cigarette lighter. If the holes are too large it means the nipple is worn out and should be discarded. If the holes become gummy place them in a pan of water add a pinch of salt, and boil for a few minutes.
FEEDING THE BABY This is the time for you to relax, forget about everything else, and hold your baby close. Don’t try to rush him – take your time and let him enjoy it! www.PrimaryCareEverywhere.com
27
Get yourself comfortable, then hold the baby in the crook of your arm, almost upright. Tilt the bottle so the nipple and neck of the bottle are always filled with formula. Otherwise, he will get too much air. Remove the nipple from the baby’s mouth occasionally to keep it from collapsing. You should never prop the bottle and leave the baby to feed himself. He may choke on the milk, and you won’t be there to notice. Also, it is never a good idea to put your baby to bed with a bottle of milk or any other sugar-containing liquid. It will pool in the baby’s mouth for several hours and may lead to very early tooth decay or recurrent ear infection. Your baby should be burped frequently especially early in the feeding. It is surprising the amount of air a hungry, vigorously feeding baby can swallow. There are several positions you can place the baby in to burp him: upright on your shoulder, sitting in your lap, leaning forward slightly, or face down on your lap. Pat or rub his back gently until he releases the air bubble.
SET A FLEXIBLE SCHEDULE. Although your baby may seem to be on a schedule when you leave the hospital, it may be disrupted as he adjusts to being at home. You probably should feed the baby on demand for the first week or so while you catch up on your rest, then begin to develop a fairly flexible schedule. Feed the baby when he is hungry – generally any time between 3 and 5 hours after the previous feeding. In order to establish a reasonable schedule, you should try to wait at least 2 – 3 hours between feedings. Should the baby cry before this time, chances are he is not hungry. Check for other things first, and if all else fails try some water.
HOW MUCH MILK SHOULD THE BABY TAKE? This varies from one baby to another, and the amount your baby takes may vary from one feeding to the next. A good rule of thumb is that the average infant will take 2 – 2 ½ oz. of milk per
28
270.759.9200
•
1000 South 12th St.
•
Murray, Ky
pound each day. Initially he may take somewhat less than this, but as he grows he will take more. Don’t force your baby to finish a bottle if he is not hungry! Most infants will take 26 to 32 ounces a day, and the maximum amount should never exceed 40 ounces per day.
WATER. Except on the hottest days or during times of illness, no additional water is needed. Breast milk and/or formula supply is all the water your baby needs.
VITAMINS. Babies on formula do not require extra vitamin supplements until solid foods are started at about 6 months of age. Breast fed babies need iron and fluoride supplements. If you are breast feeding we will prescribe a vitamin with iron and fluoride, at your baby’s first check up.
www.PrimaryCareEverywhere.com
29
SOLID FOODS. Traditionally, mothers have viewed switching their baby from formula to cow’s milk and adding solid foods as a major step in their baby’s growth and development. However, this switch comes too soon in most cases. Recent scientific evidence indicates that what you feed your baby in infancy will be very influential on his health status in adulthood. New studies show that there is NO advantage in adding solid foods or cow’s milk at any early age. Indeed, there are several disadvantages. These include: unnecessary caloric intake leading to obesity and its complications; undesirable feeding habits, solids fill your baby up without supplying the readily available dietary iron needed to maintain growth and prevent anemia; solid foods provide more salt than a baby’s system can handle causing an extra work load on the kidneys and the increased risk of hypertension; also evidence indicates that food allergy may also be a potentially undesirable effect of the early introduction of solid foods. Thus, we recommend that your baby receive formula or breast milk as his sole source of nutrition during the first 6 months of life, and that these be the primary source of nutrition during the second six months of life. While this practice may be different than what your friends and relatives may have done, you can be sure that we are following the latest thinking in infant nutrition and that your baby is receiving sound nutrition during the critical first year of life. We will discuss the introduction of solid foods during your office visits.
REMEMBER – INFANT FEEDING IS NOT EQUAL TO INFANT NUTRTION. 30
270.759.9200
•
1000 South 12th St.
•
Murray, Ky
INTRODUCTION OF SOLID FOODS Fruit Infant No Solid Food Foods Cereal Interval 4 2 (months) AGE (months)
0-3
4
Vegetables
Meat
Finger Foods
2
1
2
9
10-12
Rice 1 5
7
WHEN TO CALL THE DOCTOR Sometimes a parent finds it difficult to decide when the baby is sick. When you are concerned it is advisable to call us and describe, in as much detail as possible, what you see as well as what you believe is wrong with the baby. The more facts we have, the more meaningful our advice will be. Signs and symptoms which usually occur with illness include: 1. 2. 3. 4. 5. 6. 7. 8.
Persistent lethargy and inactivity. Refusal to eat after normal periods between meals. Persistent crying that cannot be soothed. Fever (Rectal temperature greater than 101 degrees) Unusual rash. Repeated vomiting (not spitting up). Diarrhea (frequent loose, watery stools). Difficulty in breathing.
Please note that at night, on weekends and holidays, our phone is answered by an answering service, whose personnel have no medical training. We ask that routine
www.PrimaryCareEverywhere.com
31
questions, minor problems, and prescription refills be deferred until regular office hours, and that calls at night or on weekends be placed only for urgent or emergency situations. Such calls are relayed periodically to the doctor on call, unless an absolute emergency is specified by the caller. In such a case the caller should give his name and phone number, clearly state the problem, and then keep his phone line open for a return call. The call should be returned by a doctor in a few mintues. If this does not happen, then the call should be placed again. Calls that are not absolute emergencies will be returned in a reasonable period of time. When you call it would be very helpful if you have with you: • PEN AND PAPER FOR INSTRUCTIONS • PHARMACY PHONE NUMBER • CHILD’S TEMPERATURE • A LIST OF THE CHILD’S SYMPTOMS • A LIST OF MEDICATIONS ON HAND In cases of severe emergencies, call us or our answering service before starting to an emergency room. If your child needs to be sent to the hospital, we can prepare the way for your. If it is a case of poison, call the Poison Control Center, telephone (502)589-8222 or 562.7275. If transportation is a problem, call your local police or rescue squad.
FEVER MANAGEMENT Babies over 2 months of age commonly run fever, with temperatures usually higher than in adults with similar illnesses. Temperatures as high as 105 to 106 degrees are not rare in children, and do not necessarily mean a serious illness. Fevers do not cause brain damage, therefore there is no need to panic.
32
270.759.9200
•
1000 South 12th St.
•
Murray, Ky
TREATMENT FOR FEVER: 1. Sponge Bath: For temperatures over 103 degrees, sponge bathing followed by medication is usually successful. Place the baby in cool (not cold) water and rub the skin all over vigorously with sponge or cloth. Do not just pour the water on the baby. At least 15 minutes are necessary. 2. Medication: Acetaminophen is recommended. It should be given every 4 to 6 hours while the fever lasts. 3. If temperature persists after acetaminophen and sponge bathing, Ibuprofen (Motrin) may be given alternating with Tylenol ever 6 to 8 hours. Tylenol and Motrin can be staggered so a medication can be given every 2 hours if needed.
DOSAGES: Tylenol (160 mg/5 mL Q 4-6 hrs) AGE & WEIGHT
SUSPENSION DROPS
0-3 ms/6-11 lbs 4-11 ms/12-17 lbs 12-23 ms/18-23 lbs 2-3 yrs/24-35 lbs 4-5 yrs/36-47 lbs 6-8 yrs/48-59 lbs 9-10 yrs/60-71 lbs 11 yrs/72-95 lbs
1/2 drops 1 dropper 1 1/2 droppers 2 droppers
CHEW TABS
SUSPENSION LIQUID 1/2 tsp 3/4 tsp 1 tsp 1 1/2 tsp 2 tsp 2 1/2 tsp 3 tsp
2 tabs 3 tabs 4 tabs 5 tabs 6 tabs
DOSAGES: Children’s Motrin (100 mg/5 mL Q 6 hrs) AGE & WEIGHT
FEVER UNDER 102.5
FEVER OVER 102.5
6-11 ms/13-17 lbs 12-23 ms/18-23 lbs 2-3 yrs/24-35 lbs 4-5 yrs/36-47 lbs 6-8 yrs/48-59 lbs 9-10 yrs/60-71 lbs 11-12 yrs/72-95 lbs Adult/96-154 lbs
1/4 tsp 1/2 tsp 3/4 tsp 1 1/2 tsp 1 tsp 1 1/4 tsp 1 1/2 tsp 2 tsp 2 tsp
1/2 tsp 1 tsp 2 tsp 2 1/2 tsp 3 tsp 4 tsp 4 tsp
www.PrimaryCareEverywhere.com
33
VOMITING AND DIARRHEA Illness causing these problems are common in infancy and childhood. Usually they are relatively minor infections caused by viruses. An infant will vomit several times over a few minutes time period, then feel better for a while, after which the sequence may repeat itself. This could happen several times until the infection improves. It is good to rest the infant’s stomach by giving nothing to drink for 2 to 3 hours (longer in older children). Then give clear liquids in somewhat small but frequent feedings. Advance the diet to bland foods as tolerated. Infants will often vomit when they swallow mucus from their nose and sinuses. See below for treatment of this problem. Diarrhea is generally easier to treat than vomiting because the loss of fluid from the body can usually be replaced by giving plenty of fluid to drink. An infant should be taken off milk and given clear fluids for 24 hours. The best fluids are Gatorade, Jello water (made by adding twice the amount of water required to make Jello), or a commercial product such as Infalyte. After 24 hours, a soy formula should be given for several days before the infant is placed back on his formula. Breast fed infants would continue to be nursed during the illness. They can be given extra clear fluids between feedings. Do not use diet colas for vomiting or diarrhea, because the lack of sugar in these products may cause the infant to have low blood sugar. Also, do not use red Jello because it may make the stools look like they have blood in them. Infants who are on solid foods can be given bland foods such as Jello, applesauce, cereal, custards, and bananas after 24 hours. After a bout of diarrhea, an infant may not have totally normal bowel movements for up to 2 weeks. When vomiting and diarrhea occur together, follow the same directions as for vomiting above. Bear in mind that the infant may be more likely to become dehydrated if he cannot hold down enough fluids to replace what is lost in the stools. The following are suggestions for when to call the doctor:
34
270.759.9200
•
1000 South 12th St.
•
Murray, Ky
1. When signs of dehydration occur such as listlessness, lack of urination for several hours, eyes appearing to be “sunken” into the head or very dry mouth and tearless eyes. 2. When an infant has bloody diarrhea, especially associated with a fever. 3. When an infant less than 6 months has persistent vomiting, especially if associated with abdominal pain and swelling of the abdomen. 4. When there is persistent bile stained (dark green) vomiting, especially if associated with abdominal pain and swelling of the abdomen. 5. When a child has severe vomiting along with behavioral changes, such as disorientation, hallucinations, or extreme listlessness.
RUNNY NOSE AND CONGESTION There is another problem that all infants will have at some time. Young infants may have some trouble breathing or taking their feedings if they become severely congested. This is because they can breathe only through their nose until they are about 4 months old. A few simple treatments can usually improve the situation. Give plenty of fluids and use a vaporizer. Lay the baby on his stomach over your lap and form your hand into a “cup”. Then rapidly hit the baby’s back for a few minutes. Afterwards put some salt water nose drops in the nose and suction with a bulb suction (see under “Sneezing and Breathing”). This can be done several times a day, especially before feedings. We would prefer to avoid medications for infants under 6 months, but if congestion is severe they may be needed. www.PrimaryCareEverywhere.com
35
EMERGENCY AND FIRST AID INSTRUCTIONS LACERATIONS. Stop bleeding by applying firm pressure directly on the wound using a dry, clean cloth or handkerchief for about 10 to 15 minutes at a time. In deep, dirty wounds, allow to continue bleeding for a few seconds to cleanse the wound. If not severe, you may wash it with mild soap and copious amounts of tap water. Bring your child to the office if suturing is required. If there has not been a tetanus booster within 5 years, or if the child is soon due a tetanus shot, one may have to be obtained within 48 hours.
SPRAINS AND CONTUSION. Apply ice to reduce swelling and cold compress after that for the first 24 hours. If fracture or dislocation is possible or obvious, do not move the injured part and immobilize it with a splint or sling and bring your child to the office. Do not move if there is a question of neck or back injury.
BURNS. Immerse in cold water immediately for about 15 minutes. If it is first degree (redness without blisters) usually no medical treatment is required. Cool, wet compresses and emollient creams (kept cool) in the refrigerator may help. For second degree burns with blisters, call our office or bring your child in for evaluation.
HEAD INJURIES. If unconsciousness or loss of memory about the accident exists, take the child to the emergency room. If injury is not severe, watch for the following signs: • They may sleep but should be aroused every 3 to 4 hours. Check the pupils which should be round and equal in size
36
270.759.9200
•
1000 South 12th St.
•
Murray, Ky
•
• • • • •
and should become smaller when light is directed into them. Some nausea and vomiting can be expected. Give only clear liquids in small amounts. If vomiting is persistent or is forceful, call immediately. Seizures or convulsions. Discharge from the nose or ears. Paralysis of arm(s) or leg(s). Persistent crying or headaches. Crossed eyes (when awake) or staggering when walking.
NOSE BLEEDS. Place nose between thumb and index finger keeping a steady and tight pressure for at least 10 minutes by the clock. Let him inhale through his mouth and tell him to spit out the blood as it will cause nausea when swallowed. Keep the child as quite as possible. Many nose bleeds are caused by dry heat in the winter. A vaporizer may help.
POISONING. Identify the poison and try to determine how much was taken. Call the Poison Control Center in Louisville, 1-800-222-1222 immediately.
CONVULSIONS. Usually these are triggered by high fevers in children and last no more than 5 to 10 minutes. They are almost always not as dangerous as they seem. Place the child in a safe place and use a tongue blade or brush handle between the teeth to prevent biting his tongue. Turn his head to the side so as to prevent choking in the case of vomiting. Take the child to the emergency room, or, if the seizure does not stop, call an ambulance. Try to give the child a dose of acetaminophen after the seizure before leaving for the emergency room if he has a fever. ANIMAL BITES. Cleanse the wound immediately with soap and large amount of water. Place an antiseptic like hydrogen peroxide in the wound. Notify the health department, and keep the animal locked up for observation. www.PrimaryCareEverywhere.com
37
A WORD ABOUT SITTERS. It is important for parents to get out now and then to resume outside interests and enjoy an evening together. Select your babysitter with care. Learn something about her, her family, and home conditions, if possible. Both you and the sitter will feel better if you take time to acquaint her with your ways of doing things. Have her come over and let her watch you give a bottle to the baby if she is to feed the child. When the baby is old enough to be frightened by strangers it is wise to have the sitter come early a few times to help undress the child and put him to bed. Also, playing with him will gain his confidence in the sitter. It is a good idea to write instructions out. Anyone left to care for your baby, even for a brief time, needs to know such information as: where you can be reached, the telephone number of your doctor, fire department, police department, the name of another responsible person (neighbor or relative), details about your house as well as how to regulate the heat, diaper supplies and other needs for the baby, what, when, and how to feed the baby. Also give an estimated time in which you will return.
VISITS DURING YOUR BABY’S FIRST YEARS After you leave the hospital please call our office to make an appointment for your new baby’s first check up. Your baby should be seen initially between 1 and 2 weeks of age.
38
270.759.9200
•
1000 South 12th St.
•
Murray, Ky
Your baby’s first year of life is by far his most critical time. The infant develops more socially, physically, and mentally in the first year than at any other time in his life. It is important he be seen frequently during this time to monitor his progress, as well as pick up any problems that my arise early so they don’t become serious. The following is a schedule of visits during the first two years of life and what will occur. www.PrimaryCareEverywhere.com
39
First Year Visits - at the time of each visit AGE 2 weeks 1 month 2 months
4 months
6 months
9 months 12 months 15 months 18 months 2 years
Purpose of Visit Check-up Check-up Check-up; D Tap, Polio, Hep B, Hib (Haemophilus Influenza B), Pneumonoccal, Rotavirus Check-up;D Tap, Polio, Hep B, Hib (Haemophilus Influenza B), Pneumonoccal, Rotavirus Check-up; Blood Count, D Tap, Polio, Hep B, Hib (Haemophilus Influenza B), Pneumonoccal, Rotavirus Check-up Check-up; Blood count, Hib, Chickenpox, Urinalysis Check-up; Pneumococcal, MMR(Measles, Mumps, Rubella) Check-up; Dtap, Hep A Check-up; Bloodcount, Hep A Booster, Urinalysis
*Some vaccines are combined for fewer shots* Then check ups are continued yearly with booster shots at 4-5 years of age and 11 years of age.
OFFICE PROCEDURES Dr. Joyce Hughes and Dr. Kimberly Burch are pleased that you have chosen them as your baby’s doctor and are sure that our relationship will be a pleasant one. The following comments are designed to anticipate questions which frequently arise concerning office policies. If there are any further questions, please feel free to discuss them with us or our staff. Dr. Joyce Hughes and Dr. Kimberly Burch are experts in the care of newborns, premature babies, sick children, older children,
40
270.759.9200
•
1000 South 12th St.
•
Murray, Ky
and teens. Dr. Hughes has been in practice in Murray since completing her pediatric residency in Louisville and continues to enjoy caring for your children. Dr. Kimberly Burch joined Dr. Hughes in 2006 to care for your baby or child giving the up to date medical care necessary to ensure the best care for your little one. In addition, they are assisted by a group of Family Providers – Dr. Robert Hughes, Dr. Michael Adams, Dr. Daniel Butler, Dr. Susan Heffley and Emily Gupton, all with years of experience in the care of children. We also have a pediatric Nurse Practitioner on staff daily. With this comprehensive group of health care providers, Primary Care Medical Center is able to offer office hours 7 days a week including night and weekend hours.
(Left to right) Dr. Heffley, Dr. Butler, Dr. Burch, Dr. Adams, Dr. Joyce Hughes, Dr. Gupton and Dr. Robert Hughes
Together, the physicians of Primary Care Medical Center feel your child will receive the most advanced and consistent medical care offered in all of Western Kentucky. We follow the standards of American Academy of Pediatrics in the care of infants, children, and young adults. These guidelines www.PrimaryCareEverywhere.com
41
are set up to insure maximum health care for your child. Your child will need regular routine physical examinations to detect problems, immunizations, skin tests, blood and urine tests, and hearing and vision checks to assure that he remains healthy.
URGENT CARE Seven day a week walk-in services with extended office hours and 24-hour coverage, which eliminates the need for a costly emergency room visit.
OFFICE HOURS Office hours are from 8:00 a.m. to 8:00 p.m. Monday thru Friday and 8:00 a.m. to 6:00 p.m. on Saturday and Sunday. Office visits should be made by appointment so that you don’t have to wait long periods in the office with a sick child and so we can be prepared to see you as soon as possible when you arrive. If you have scheduled an appointment that you are unable to keep please let the office know so we can reschedule you and adjust our daily routine as is necessary. We understand emergencies arise so for your convenience we offer a walk-in clinic available when you need it and open throughout our office hours. Occasionally Dr. Hughes or Dr. Burch will be called to the hospital for an emergency or to attend the delivery of a baby where possible complications may occur. They will return as soon as possible to complete the office schedule or will notify you if the delay is excessively long. If needed, your appointment will be
42
270.759.9200
•
1000 South 12th St.
•
Murray, Ky
rescheduled or your child seen by another physician or our pediatric nurse practioner.
FEES AND BILLING We believe our fees are reasonable. Medical costs are rising yearly and we will make our best effort to keep costs down. In order to do this we ask that you make full payment for services each time you visit the office as sending bills and keeping books of accounts is very expensive an may cause prices to increase significantly. If you have medical insurance, please bring your card to every office visit to help in the processing of your bill. We know that at times it may be difficult for you to pay at time of service and such situations can be discussed with our bookkeeper and arrangements will be made. No child will be refused treatment as long as the parents are making a reasonable effort to keep their account up to date. If an error occurs in billing please contact customer service immediately so corrections can be made. Finally, we wish to emphasize that our primary concern is quality health care for you and your children. We hope to promote this through open discussion and communication with you. Please be assured that we are ready to serve your family to the best of our abilities. Primary Care Medical Center has launched a secure online bill-pay solution. This will allow you, our valued patient, to pay your Primary Care bill conveniently online. Please go to www.primarycareeverywhere.com for more information.
www.PrimaryCareEverywhere.com
43
PATIENT PORTAL PRIMARY CARE EVERYWHERE. Our Patient Portal gives you constant access to you and your family’s medical history, detailed information about previous visits and educational material specifically related to your conditions. You can also view your lab results and imaging results, view open appointments and schedule upcoming appointments for you and your family. Direct communication with the office and clinical staff is also provided through a messaging system within your patient portal.
SIGNING UP. There are two ways you can sign up for the Patient Portal (Primary Care Everywhere). One option is to visit our office and create your secure username and password with one of our friendly staff members either at check in or check out. Or, you can visit www.primarycareeverywhere.com/everywhere and click “register”. Fill out the form completely and you will soon be contacted with your username and password.
44
270.759.9200
•
1000 South 12th St.
•
Murray, Ky
QUESTIONS. If you have any questions regarding our Patient Portal you can visit our new Frequently Asked Questions page and find solutions to som of the most frequent questions users ask when accessing Primary Care Everywhere Patient Portal. The FAQ page is www.primarycareeverywhere.com/media/faq
RECOMMENDED READING Brazelton, T. Berry, Infants and Mothers, 1969 Caplan, Frank, ed., The first Twelve Months of Life, 1973 Dobson, James, Hide and Seek, 1979 Frailberg, Selma, The Magic Years, 1959 Hart, Terril, ed., The Parents’ Guide to Baby and Child Medical Care, 1982 Kelly, Marguerite, The Mother’s Almanac, 1980 Lansky, Vicki, Feed Me! I’m Yours – A Recipe book for Mothers, 1974 Milburn, Joyce, Helping Your Children Love Each Other, 1983 Shiller, Jack, Childhood Illness, A Common Sense Approach, 1972 Spock, Benjamin, Baby and Child Care, rev 1976 Weiss, Joan, Your Second Child, 1981 White, Burton L., The First 3 Years, 1975.
www.PrimaryCareEverywhere.com
45
CHILDREN LEARN WHAT THEY LIVE If a child lives with criticism, He learns to condemn. If a child lives with hostility, He learns to fight. If a child lives with ridicule, He learns to be shy. If a child lives with shame, He learns to feel guilty. If a child lives with tolerance, He learns to be patient. If a child lives with encouragement, He learns confidence. If a child lives with praise, He learns to appreciate. If a child lives with fairness, He learns justice. If a child lives with security, He learns to have faith. If a child lives with approval, He learns to like himself. If a child lives with acceptance and friendship, He learns to find love in the world.
- Dorothy Law Nolte
Dr. Joyce Hughes
Dr. Kimberly Burch
1000 South 12th St. • Murray, KY 42071 Phone answered 24 hours a day:
270.759.9200
www.PrimaryCareEverywhere.com