Well Care || Immunizations ||
After Hours Care and Advice || Circumcision Care ||
Umbilical Cord Care || Newborn Jaundice ||
Newborn Screening || Bottle-feeding ||
Formula Storage and Preparation || Breast-feeding
|| Postpartum Depression
Alpine Pediatrics is excited for you and your growing family! We want to give you and your family some
resources to help and support your care for your newborn and growing family.
When should I see my Pediatrician for Well Care?
Caring for a new baby can be a rewarding and overwhelming experience, but it can also come with many questions and your Pediatrician is here to help you navigate this new experience. Your first visit to your Pediatrician should be 2-5 days after being released form the hospital, unless you have been directed otherwise by a doctor. Topics covered in this visit can be found at this here. More information about what you can expect during the first month with your new baby can be found here.
After this visit you should expect the following visits in the first year of life: 2-week, 2-month, 4-month, 6-month, 9-month, and 12-month. Although this may feel like a lot of visit in the first year of life, these visits are necessary to ensure your baby is growing and developing normally. These visits can also serve as a check in for your family to ensure all of the needs of your family are being met.
These appointments can be scheduled over the phone by calling any of our offices, in person after another visit, or with the self-scheduling tool.
Immunizations
Alpine Pediatrics requires all patients to vaccinate in order to be patients of the Practice. Alpine Pediatrics also strongly encourages fact-based vaccine education.
The Alpine Pediatrics Vaccine Policy states: "Alpine Pediatrics, PC follows the current immunization guidelines established by the AAP (American Academy of Pediatrics) and ACIP (The Advisory Committee on Immunization Practices). Any desire to follow a modified schedule must be discussed with a Provider. If I refuse or delay immunizations, I understand the following:
- 1. I may be dismissed from Alpine Pediatrics.
- 2. If my child does not receive the vaccine(s) according to the medically accepted schedule, the
consequences may include:
a. Contracting the illness the vaccine is designed to prevent. The outcomes of these illnesses may include one ore more of the following: certain types of cancer, pneumonia, illness requiring hospitalization, death, brain damage, paralysis, meningitis, seizures, and deafness; other severe and/or permanent effects from these vaccine-preventable diseases are possible as well.
b. Transmitting the disease to others, including those too young to be vaccinated or those with immune problems.
Information about each vaccine, what they prevent against, and links to additional vaccine information can be found here.
After Hours Care and Advice
Alpine Pediatrics offers After Hours clinics in both the Pleasant Grove and Saratoga Springs offices. After Hours clinics run Monday - Friday from 6 pm to 9 pm in both the Pleasant Grove and Saratoga Springs office, and Saturdays from 9 am to 5 pm in the Pleasant Grove office and 9 am to 1 pm in the Saratoga Springs office. The After Hours clinics can accommodate urgent care and will also accommodate a limited number of well visits each night or Saturday.
If you find that you need care after 9 pm on a week night, or 5 pm on a Saturday, we also offer a comprehensive symptom checker online. This symptom checker gives clear directions about when to see your Pediatrician or when you need to go to the emergency room. The symptom checker can be found here.
A triage nurse can also be reached for access to live medical advice by calling any of our office numbers and choosing the option for the nurses line. This option is available 24 hours a day, 7 days a week.
Circumcision Care
The Procedure:
Alpine Pediatrics Providers use the Gomco clamp method for circumcisions. A Gomco clamp is a medical device that has the advantages of a steel bell which protects the penile head during the procedure and the absence of a foreign body remaining at the site afterward. During a circumcision, the infant is given sugar water from a syringe to help pacify and soothe them during the procedure. Numbing shots are given at the base of the penis, so your baby does not feel the procedure.
After the Procedure:
Following a circumcision, after each diaper change, you can apply a large amount of petroleum jelly or over-the-counter antibiotic ointment with a gauze pad over the penis head and the incision for four days. Doing this will keep it soft, prevent it from sticking to the diaper and help prevent bleeding. A few drops of blood following the circumcision is normal from friction from the diaper. If it is actively bleeding and will not stop on its own, then apply gentle, direct pressure to the site. If the bleeding does not stop after a few minutes of direct pressure, please call our office to make an appointment to be seen. Avoid tub baths for seven days following the circumcision. You can sponge-bathe your infant instead.
Watch for adhesions which can be common following circumcision. Adhesion is when the healing skin where the foreskin was removed begins to attach itself to the base of the penile head while it is healing. Once a day, when changing your infant’s diaper, pull back on the ring at the base of the penile head, where the foreskin was removed. This will prevent adhesions from occurring. If you notice new adhesions, pull back gently on the adhesion to see if you can un-adhere it. If that does not work or you are concerned, call our office to make an appointment.
Umbilical Cord Care
An infant’s umbilical cord generally will fall off between 1 to 3 weeks. If an umbilical cord has not fallen off within six weeks, you should call to schedule an appointment. There is no special treatment or cleaning of the cord. You want to keep the cord dry so it will dry up and fall off. Folding the diaper down in the front so it is not rubbing on the cord and allowing air to the cord is helpful. Do not routinely use rubbing alcohol to clean the cord or the navel, as it can interfere with healing. If the umbilical cord and navel get poop on them, clean the area with soap and a warm washcloth. Avoid submerging the cord and navel in water until the cord has fallen off and the navel has healed over. You can sponge-bathe the infant instead.
Some drops of blood from the navel when a dry cord has snagged and pulled away from the navel are normal. Just clean it out with a wet Q tip. If the cord has fallen off, the navel may have clear or slightly blood-tinged secretions for a few days while it is healing. If you see redness, swelling, red streaks around the navel, cloudy discharge or pus from the navel, or the infant develops a fever, this may indicate an infection, and you should have the infant seen. Infections of the navel are uncommon but can occur. If an umbilical cord smells bad or drains, clean the skin around the base of the cord two times per day with a wet cotton swab. You will need to push down the skin around the cord to get to some areas.
Newborn Jaundice
Jaundice means the skin has turned yellow. Bilirubin is the pigment that turns the skin yellow. Bilirubin comes from the normal breakdown of older red blood cells. The liver normally gets rid of bilirubin, but at birth, the liver may be immature. The Infant’s bilirubin levels need to be checked to ensure they are not getting too high. High levels need to be treated with bili-lights. Your baby will have a bilirubin blood test in the hospital before discharge, around 24 hours of age. Depending on what that first bilirubin result was before discharge, the hospital doctor would have instructed you whether a repeat bilirubin blood test is indicated again or not. We do not draw blood for bilirubin blood tests in our office. If a recheck is needed, the doctor will provide the hospital outpatient lab with the order, and you take your infant there to have the test performed. Our office will then follow up on the bilirubin results by phone or at an office visit if you have an appointment.
It is recommended that all newborns be seen in our office within the first 2-3 days of birth. If you have had a bilirubin test done through the outpatient lab and have not heard from our office within 2-3 hours, please call our office. Jaundice starts on the face, moves downward, and resolves similarly. Jaundice that is only on the face is less concerning. If jaundice moves to the abdomen (stomach area) or legs, this is more concerning, and a bilirubin level needs to be checked. Bilirubin is excreted through the infant’s poop, so ensuring your infant is eating well and having regular wet and messy diapers is essential. This can be hard sometimes because when an infant's bilirubin is elevated, they tend to be drowsier and less interested in eating. If your infant’s jaundice has become worse, especially during the first seven days of life, feeding poorly, has gone over 8 hours without a wet diaper, more than 24 hours without a messy diaper or jaundice is not gone by 14 days of age, please call to schedule an appointment.
Newborn Screening
Infants born in Utah have blood for a newborn screen test collected twice. Once at 24-48 hours after birth and again at the two-week child care appointment, preferably between 7-16 days after birth. Completing both tests is critical to correctly identifying these treatable disorders. A small heel prick obtains blood. The blood is collected on a screening card sent to the Utah Department of Health’s Public Health Laboratory. You will be given a screening card when your infant is discharged from the hospital. Please remember to bring this screening card to your two-week child care appointment. The newborn screen tests for several disorders have been shown to have treatments that minimize or completely prevent disabilities and, in some cases, even death if started early in life.
To learn more about the Newborn Screening requirement please visit the Utah Newborn Screening website.
Bottle-feeding
There are several types of infant formulas available. The following are some examples:
- Cow's Milk Formula: Enfamil, Similac
- Soy Formula (these formulas do not contain lactose or cow's milk): ProSobee, Isomil, Goodstart Soy
- Partially Hydrolyzed Formula (these formulas have already broken down proteins): Goodstart, Gentlease
- Extremely Hydrolyzed Formula: Nutramigen, Pregestimil, Alimentum, Gerber ExtensiveHA
- Free Amino Acid Formula: Neocate, Elecare
Whole cow's milk should not be given to infants until around 10 - 12 months of age. However, with the formula shortage, if you cannot find a formula for your baby, whole cow's milk can be given as young as six months of age as a short-term alternative, but whole cow's milk should not be used for more than a week. For more information about the formula shortage and what you can do, please visit this page.
Formula Storage and Preparation
Most city water supplies are safe for mixing with formula. Infants do not routinely need extra water. Infants usually start solids at around six months of age, this is also the age where you can introduce more water. Follow the instructions provided on the formula container when mixing the formula. Do not add more water than is instructed. Prepared formulas should be stored in the refrigerator and must be used within 24 hours. Open ready-to-feed cans of formula should be kept covered in the refrigerator and must be used within 24 hours. Prepared formulas left at room temperature for more than 1 hour should be discarded. Leftover used formula should be discarded because it is contaminated.
If you would like more information on the amount or frequency of formula feedings, please visit this page.
Breast-feeding
You should expect your infant to feed every 1 to 3 hours for the first month of age. During the day, wake your infant up, if more than 3 hours have passed since the last feeding. During the night, wake them up if more than 4 hours pass, without feeding. After one month of age, and if your infant is gaining adequate weight, you can allow them to sleep longer without waking up to feed. If breast feedings and the infant is gaining adequate weight, it is recommended that you try not to supplement with formula before 4 weeks of age. It can interfere with establishing a good milk supply. However, if your infant is jaundice with a high bilirubin level, breast feedings not going well, your milk has not come in by day 2 or 3 of life, your baby has gone over 8 hours without urine output or over 24 hours without a messy diaper, then it is medically indicated that you supplement with formula. Unless instructed otherwise by your doctor, you can try to breastfeed first but then supplement after every feeding. Another option is to pump and give formula or expressed breast-milk, instead of offering breast. If you choose to supplement with formula but want to breastfeed later, you need to ensure that you are pumping or that the infant is feeding before supplementing with formula at least every 3-4 hours during the first month of age. This will help you to not lose your milk supply. Offer the first breast for 10-15 minutes and then move to the second breast and allow the infant to nurse from that side until the infant acts satisfied.
When they are more than 1 month of age, the infant is gaining adequate weight, breast feedings are going well and your breast-milk is fully established, it is encouraged that you try infant-led feedings. This means you are watching for and following the infants’ feeding cues that they are hungry, and you are feeding on demand. Alternate which breast you start with. Start with the breast that they did not nurse as long from the previous feeding. Infants become soothed and sleepy while at breast, especially newborns. Try to change their diaper, rub their back and chest, or move them from lying to sitting on your lap, to try to awaken them, before a feeding. If they fall asleep while at the breast or are only sucking off and on, then remove them from the breast. Try to awaken them again and then try to relatch. Rubbing the infant’s head, hand, feet, back, or cheek, while at the breast, can keep the infant awake and actively sucking. It is very important that your infant latches correctly to get the milk. Look and listen for consistent swallowing. It may seem like the baby is sucking but if you are not hearing swallowing they may not be feeding effectively. You want to try to get as much of the areola, and not just the nipple in your infant's mouth when the infant opens to latch. This will help the baby to get a deep enough latch. Support the infant’s head and neck and hold the infant’s nose right up close to the breast to keep a steady deep latch. Some infants want to pull back on the latch down to the nipple.
Sucking on the nipple alone not only interferes with the let-down and transfer of milk, but can make the mother’s nipples really tender, blistered, or cracked. The amount of wet and messy diapers will be one of the best indications that your infant is getting enough to eat. Expect a steady increase in the number of wet diapers for each day of life. Day one, at least 1 wet diaper. Day two, at least 2 wet diapers. Day three, at least 3 wet diapers. By day five they should have 6 or more wet diapers. Messy diapers should increase in quantity and change from black to green to yellow-mustard, in color. This transition usually means that your milk is in, and the infant is getting breast-milk. In the first few days of life, the infant should have at least one messy daily diaper. By day 4 or 5, until 1 month of life, infants should have at least 3 messy diapers per day. Your infant should act satisfied after breast feedings. Your breasts should feel full before a feeding and softer after a feeding. If your infant goes over 8 hours without urine output, more than 24 hours without a messy diaper, is not breastfeeding well, struggling to latch, or jaundice spreads from the face to the arms and chest then call and schedule an appointment with your doctor. We do have lactation consultants that can help with breastfeeding. Please call our office if you would like to schedule a lactation consult appointment. If you have other questions regarding breastfeeding then the best information can be found at the following link.
Postpartum Depression
Postpartum depression is not your fault; it is real, treatable, and a common thing to experience. Around 1 in 7 women develop postpartum depression (PPD). It is not uncommon for this to be the first episode of depression. PPD is the first episode of depression experienced by nearly half of the women who experience PPD. Symptoms of PPD can start during pregnancy; it is never too late or too early to get help for PPD or any other type of depression.
Resources for postpartum depression:
Postpartum depression helpline: 1-800-944-4773
American Psychological Association
healthychildren.org
The Emily Effect
Postpartum Utah
Serenity Recovery and Wellness
Balance Health and Healing
The Sad Moms Club Podcast