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Melanie Cole (Host):  There's no handbook for your child's health, but we do have a podcast featuring world-class clinical and research physicians covering everything from your child's allergies to zinc levels. This is Kids Health Cast by Weill Cornell Medicine. I'm Melanie Cole. And I'm so glad you could join us today to talk about what to expect at your first pediatrician's appointment and encouraging development. This is such a great topic for new parents and I, myself remember those days, and it's such an exciting time. Joining me in this panel are Dr. Nicolina Wawrin and Dr. Alison Austin. They're both Instructors in Pediatrics at Weill Cornell Medicine and Assistant Attending Pediatricians at New York Presbyterian Weill Cornell Medical Center. Doctors, I'm so glad you could join us today. As I said in my intro, what an exciting time, it's a scary time, but it's an exciting time. So, Dr. Austin, I'd like to start with you. When is that first newborn follow-up appointment. First, tell us a little bit about that first night in the hospital. Is it the pediatrician who shows up to give a little kind of go over of the baby after the initial birth? And then when is that first appointment?

Alison Austin, MD Guest): Well, typically we would recommend that you follow up with your pediatrician one to two days after you're discharged from the hospital. And oftentimes your pediatrician's office will actually have some slots reserved to accommodate newborns who were just discharged from the hospital. I know at Cornell, we also offer some weekend hours for newborns who are discharged on Friday. So, we understand it's a stressful time, but we're going to make that first appointment as easy as possible for you.

Host: Dr. Wawrin, what information should we be sharing with our pediatrician at that visit? Do they need to know mom and dad's medical history, events during pregnancy? Should we be bringing lists to that appointment or is it mainly baby that you're looking at?

Nicolina Wawrin, MD (Guest): For the first appointment, is usually a lot of the information about just the pregnancy. So, we'll typically ask mom if there were any really remarkable events during the pregnancy, such as if mom had any issues with diabetes, issues with hypothyroidism. So, it's usually events during pregnancy. However, we still do like to know if there are any major medical issues for mom or dad, if the grandparents are still living and if the grandparents have any remarkable medical histories as well, particularly at the younger ages before the age of 15. It's also important for us to know too, if the prenatal ultrasounds were normal.

We like to know if all of the screening blood work that the OB GYN did before the delivery were normal. Then it's also good to know, too, if there are any remarkable things that happened in the hospital during the delivery. Not only if the baby was just delivered via C-section or vaginal delivery, but if there were any complications that might've led to a C-section, if there were any complications, after the baby was born, that might've led to the baby being monitored more closely, either in the NICU or just in the well-baby nursery.

Host: That's such a good, great time for new parents, but we always have so many questions. Dr. Austin, what do we expect our pediatrician to review during that visit? Are you going to give us guidance? And we're going to talk about some of these great recommendations a little bit later in the podcast, but do you give us guidance on that newborn care and feeding and safety and all those things?

Dr. Austin: Of course we will. We will review all of your questions that you have about taking care of the baby. We get a lot of questions initially about feeding. And so in the first few days of life, the baby may be very sleepy as you are, I'm sure as well. So it's important to note that you may have to wake the baby to feed at least every three hours is what we recommend. On the first day of life, babies may only take a few milliliters per feed or maybe a few drops of colostrum, but this will gradually increase to about one to two ounces, every two to three hours in the first few days of life. But it's important to remember that every baby is a little bit different.

And so we will talk about in a little bit about looking for hunger cues as well. And then I get a lot of questions regarding how do we know if the baby has had enough milk? So, monitoring the number of daily wet diapers can be helpful. There's a general rule for this. So, typically we would like to see one wet diaper in the first day of life. Two wet diapers on the second day, three wet diapers on the third, four on the fourth, five on the fifth, and then a minimum of five going forward from there.

Host: That's great information. So usable for parents. So, I hope you can, rewind and listen to what she just said again. So Dr. Wawrin, let's hit some of these points that new parents ask you about. Let's start with cord care because that's one of those things I didn't know what the heck to do. And then when you see it not sitting there, you're looking around in the blankets. What are we supposed to do about the cord? What are we supposed to do to take care of it?

Dr. Wawrin: The most important thing with the umbilical cord is to just leave it alone, actually. A lot of parents are attempted to touch it or put different oils or lotions on it. And that is actually not very safe to do. So, it's best to just leave it alone. It tends to fall off by the third week of life. Even if it falls off within the first few days, that's not a problem. But things to monitor for would be, if you notice any redness, a circle of redness around the umbilical stump that could be concerning for an infection. And that's definitely a time to get in touch with your pediatrician. Otherwise, when it falls off, I always like to let parents know that there can definitely be some discharge. There might even be a little bit of bleeding and sometimes they can even smell a little bit as well. Those are all normal. And it's important to realize that, however, if there's anything that you're concerned about, we would just always err on the side of caution with you getting in touch with us.

And then once the umbilical stump is off, it's completely dry. The belly button looks like a normal belly button, that's when you can start bathing the baby normally and getting that area wet. Up until that time, it's best to do just sponge baths, avoiding that area.

Host: Dr. Austin, you mentioned that we talk about hunger cues. So, why don't you give us a few of your best bits of advice for breastfeeding or formula feeding, if that's what the mother has to do and cues that the baby is hungry.

Dr. Austin: The best advice is kind of just looking towards your baby and letting them kind of drive the ship as far as feeding. So, if they're showing any signs of lip smacking or sucking or looking around and kind of what we call rooting, so moving their head side to side, that would indicate that the baby is hungry and looking for food. And so you can always offer the breasts, or if you're doing formula, you can give the bottle. Sometimes it's nice to pace it by about 10 to 15 milliliters at a time. Sit the baby up, maybe burp the baby a little bit to see if the baby could take an additional 10 to 15 mls. It's normal for babies to sometimes split up maybe one or two mouthfuls after a feed, if you notice that the baby spit up, like the whole feed, maybe an ounce or two ounces, then that might be a sign that perhaps that was a little bit too big of a feed, but just some things to keep in mind.

Host: Dr. Wawrin, and why don't you expand on bathing and diapering for us? Do we use powder? Are we not using powder? Do we use the smelly pink stuff? What are we doing?

Dr. Wawrin: So, for bathing, one of the good things, and you, you mentioned that bathing can be terrifying one of the good things with newborns is they really don't need to be bathed all that often. Usually just recommend once a week. Some babies hate baths, and luckily like you get it over with once a week, because the dirtiest part of them is constantly being cleaned. So, just doing like those sponge baths, and once the umbilical stump has fallen off, you could do a bath where they're being more exposed to the water. If your baby really likes being bathed and it's relaxing, you could always make it more of a part of your routine. But in general, I would just do it three times a week, max at the beginning, because it could lead to some drying out of the skin.

And it's always best if you are using any soap to use an unfragranced baby soap, since their skin is so delicate. Fragrances can be very irritating to the skin and you might end up with some rashes that you can certainly always contact your pediatrician for. For diapering, I mentioned that the skin is very sensitive. You're going to notice that your baby is peeing and pooping a lot in the beginning and really that's great news to the pediatrician. It means that the baby's being fed well. But some things to consider is checking out the baby's diaper, at least with every feed to see if there's any stool or any urine. It's good to do those frequent diaper changes just because, as a stool and the urine is coming into contact with the skin, it can cause some irritation. If you wanted to stay ahead of that, you could always use a nice barrier creams, such as a Desitin, also known as zinc oxide, Aquafor, A and D ointment that creates once again, a nice barrier so the stool and the urine isn't coming directly in contact with the skin. And always making sure to, we discussed the umbilical stump before, but it's best to fold down the diaper while the baby has the umbilical stump, so it's not catching on the umbilical stump, which I'm sure you could imagine would be uncomfortable for the baby.

Host: What great advice. I remember those days and Dr. Austin, the next one. So important, well, they're all important, but sleeping. Tell us about Back To Sleep, the importance of putting our babies to sleep on their back. Swaddling recommendations. Anything you'd like to talk about getting sleep because wow, as a new parent that's so, so vital.

Dr. Austin: Yeah, this is a question that we definitely get a lot. Initially in the first couple days of life, sometimes the baby sleep cycles are a little bit reversed, so they may be more awake at night and more sleepy during the day. And they're just kind of jet lagged essentially. And so that does take a couple of days, sometimes a couple of weeks to fully reverse.

As you can imagine, in the first couple of days, first couple of weeks of life, it's pretty exhausting with this routine of feeding every three hours and the constant diapering as Dr. Wawrin was describing. And so it's very tempting to sort of want to co-sleep with a baby or have the baby sleep on you while you're kind of dozing off. But as we know, that's just very dangerous. And so we always recommend that babies are alone in their crib or bassinet, always on their back, with nothing else in the crib or bassinet, and this helps prevent the risk of sudden infant death syndrome. And the first couple of weeks, babies sometimes have a startle reflux and they can jump or startle themselves out of sleep. And so it can be helpful to actually swaddle them in a blanket or use one of those Velcro or zipper swaddlers to sort of prevent this and help them kind of sleep for longer stretches.

Host: And when we're looking at cribs, Dr. Austin, is there anything you want parents to know about things that should or shouldn't be in the crib?

Dr. Austin: Yes, nothing except for the baby swaddled. So, no bumpers, no pillows. The cribs often have a mattress that is a firm mattress that is safe for infants to sleep on. So, nothing else in the crib.

Host: Dr. Wawrin, as we're interacting with our newborn, how important is cooing, talking to them? Because some people say, oh, you know, babies don't understand, but all of that communication really helps development. And that's what we're talking about today is encouraging that development.

Dr. Wawrin: A lot of parents will bring up the fact that they actually feel like they're not doing enough within the first month. And I understand that, that can be a huge cause for concern, but really talking to the baby as much as possible, reading. The baby's never too young for you to read to him or her, playing music. All of that will be really helpful not only in terms of the baby's growth and development, but also in just creating a nurturing, loving environment as well. It's not unexpected though, that the baby, as Dr. Austin had mentioned previously, the baby's going to sleep a lot within the first month. So, I recommend taking advantage of the few wake hours that the baby has, to read and talk as much as possible.

You will start to notice some of those little cooing sounds, which are vowel noises, and kind of talking back to the baby who knows exactly what you're talking about, but it's always nice for them to have that communication coming back, that positive reinforcement. And it's also important to just, to remind yourself that you can't spoil a baby. So, holding them, loving them, a lot of skin to skin contact, is all the better for the relationship going forward.

Dr. Austin: Another thing you can do with your baby, because I was talking about Back to Sleep, you actually can put your baby on his or her belly and we actually do recommend to do some tummy time. So, we would recommend at least 15 minutes a day, but it can be broken up, however, the baby tolerates it. Maybe a few minutes here and there. Always supervised on a firm surface and this kind of helps the baby learn how to use his or her neck muscles and kind of look around and also prevents flattening of the back of the head. So, tummy time is something you can do as part of a routine during the day and important developmental stimulation along with talking with your baby and just loving them like Dr. Wawrin said.

Host: I would love to give you each a final thought here. So, Dr. Austin, I'd like to start with you. I'd like you to speak to the parents now, to new moms specifically, what are some of the important aspects and while you're a pediatrician, you're dealing with this new family in the medical home, give us some of your best advice about self-care for the new parents in this very scary, but such exciting time. And if there are any red flags of postpartum depression that maybe the pediatrician might notice or anything you would like the new parents to know.

Dr. Austin: It is so important that parents take time for themselves during this busy and hectic time. Make sure that you're getting your rest, make sure that you're eating and drinking enough water and staying hydrated. If you're planning to breastfeed, all of those things are so important for your milk production, but also just for you to kind of provide all of the things that your baby needs throughout the day. I would just say to use your resources, recruit a family member, a trusted friend who may be able to come over and kind of hang out with the baby, so that you can get some sleep. And just really use your resources. I would say that if you're feeling very sad or anxious or feel like you've lost interest in certain things, or of course have ever have feelings of wanting to hurt yourself, then definitely talk to us about that. We have some resources for you and nobody should be alone feeling those things. And we always talk about postpartum depression for moms, but for dads and other partners as well. It's such a major life change you know. Please come to us if you're feeling any of those things,

Host: Well, as you said, support is so important for new parents and Dr. Wawrin last word to you. What would you like new parents to know about when they get baby home, the exciting time, the things they should watch out for and why it is so important. And as someone who loves her pediatrician, why it is so important that we rely on our pediatricians when we have any questions and that we shouldn't be afraid to call you and ask, because that's why you're there.

Dr. Wawrin: First of all, we love our babies. We understand that it can be really intimidating to arrive home with a small little human being. A lot of our parents have never had any experience with a baby before. So, it's very foreign territory. So luckily we have a lot of experience with that. I think the one thing that I would really just recommend parents keep in mind is that time flies. Enjoy your baby as much as you possibly can. The first few months you might feel like you're not getting much sleep, but it will get better. So, just really soak up that time with your baby because before you know it, they're going to be walking around and doing all of these other really cool things, but they won't be babies anymore. If you do have any questions or any concerns, I think most of the pediatricians would prefer that you just err on the side of caution and let us know.

Obviously the pediatricians have a lot of great advice when it comes to rashes which pop up all the time, to feeding issues, to pooping problems. But we also have wonderful nurses too who are available throughout the day and are happy to get in touch with you and discuss whether or not some of the things that you're going through or some of the symptoms your baby is experiencing are normal.

It would really make me sad to know that one of my parents was at home stressing about something when you could easily call or contact us through the medical portal. And hopefully we could just ease your mind. We also have a lot of Telemedicine as well, given the pandemic.

So, there are video visits that are available all days of the week, even on the weekends, where somebody, if it's not convenient for you to travel to the office, one of the pediatricians could take a peek and discuss your concerns through video and always look at any findings on physical exam that we could give you guidance towards. During the first month of life, the number of visits in the office are pretty variable based on the concerns that you have and the baby's weight gain.

However, from there, the well-visits are typically every two months up until six months of age. And then they are three months. Following that, in between six to 12 months, as you can imagine, during that time, there are a lot of immunizations that take place. And at each of those visits, we go over the vaccines that your child will receive. If you have any questions about immunizations, feel free to contact us and let us know.

Host: And that's why we love our pediatricians because you all are helping us to raise our children and parents that's what it's all about. We want to raise them to be happy and most of all safe. So, it's so important that you reach out to your pediatrician if you have any questions. Doctors, thank you so much for joining us today.

I love these kinds of episodes, so informative. Thank you, both. And Weill Cornell Medicine continues to see our patients in person as well as through video visits. And you can be confident of the safety of your appointments at Weill Cornell Medicine. That concludes today's episode of Kids Health cast. We'd like to invite our audience to download subscribe, rate, and review Kids Health Cast on Apple podcasts, Spotify and Google podcast. For more health tips, you can always go to weillcornell.org and search podcasts. We have so many really great podcasts in our library, and don't forget to check out Back to Health. I'm Melanie Cole.