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Newborn Visits
Dr. Hira Ahmed discusses newborn visits, safe sleep, feeding tips for parents, and newborn milestones.
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Learn more about Hira Ahmed, DO
Hira Ahmed, DO
Hira Ahmed, DO is a Pediatrician with Reid Health.Learn more about Hira Ahmed, DO
Transcription:
Deborah Howell (Host): Welcome to Right Beside You, a Reid Health podcast. I'm Deborah Howell, and I invite you to listen as we discuss newborn visits and milestones today. Joining me is Dr. Hira Ahmed, a Pediatrician and Doctor of Osteopathic Medicine with Reid Health. Dr. Ahmed, it's a pleasure to have you with us today.
Hira Ahmed, DO (Guest): Thank you. I appreciate coming in today and discussing important information for parents about their newborns.
Host: Important it is. And let's jump right in, you know, Safe Sleep is always one of the most important things we need to ensure for our newborns and the guidelines have changed a bit over the years. Can you speak to this?
Dr. Ahmed: Yes, of course. In 2016, the American Academy of Pediatrics and that's our governing body, so to speak, set out a policy statement, updating safe sleep practices for infants. The basic recommendations that the AAP came up with is one, breastfeeding is recommended to reduce the risk of SIDS, which is sudden infant death syndrome and to enhance the health and wellbeing of the infant and mother, they recommend exclusive breastfeeding for six months. Research demonstrates that exclusive breastfeeding can reduce the risk of this sudden infant death syndrome by 70%. So, that's pretty significant. Number two, they recommend skin to skin care for at least an hour after birth, regardless of feeding or delivery method. Three, room sharing with the infant, but on a separate sleep surface is recommended.
Four, AAP recognizes that parents may fall asleep in bed after or during feeding their infant. So, it's recommended that they remove pillows, loose blankets, loose sheets, and move the bed away from walls to prevent entrapment. Five, avoid nighttime feeding on couches and armchairs, which are not considered safe sleep surfaces at any time for infants. Obviously there's risk of falling from those surfaces, which is why it's not recommended. Six, it's important that anyone who cares for an infant puts the baby to sleep on their back. Prone sleeping or sleeping on the stomach actually increases the risk of re-breathing the same air that is on the baby's face, which increases the levels of carbon dioxide, which then leads to decreased oxygen in the blood and can be potentially fatal and lead to this sudden infant death syndrome.
Seven, the AAP recommends a firm sleep surface, such as a mattress in a safety approved crib covered with a fitted sheet to reduce the risk of sudden infant death syndrome. Firm sleep surfaces should not have any other bedding or soft objects such as pillows, bumpers, toys on them. And appropriate surfaces can include cribs, bassinets, and portable play areas. Just make sure that their safety approved cribs and other surfaces.
Host: Sure. All makes good sense. And as you said, so very important. Do you have any feeding tips for newborns for us?
Dr. Ahmed: Yes. Feeding is a huge part of our newborn and infant visits for the first year of life. As I mentioned, prior, breastfeeding is best. It leads to the decreased risk of sudden infant death syndrome, asthma, type one diabetes, obesity, ear infections, GI infections, and lower respiratory disease. However we know breastfeeding isn't for every woman. In these circumstances, formula is a great alternative and safe option. Whichever feeding method is chosen, fed is best. Newborns have stomachs that are the size of a ping pong ball, which means that they only eat small amounts, but they pretty frequently. Feeding amounts change drastically from birth throughout the first year of life.
Newborns start feeds with as little as a few cc's of milk. And by one to two weeks of age, they're taking about two ounces per feeding. Most babies are feeding every three to four hours until the age of four to six months when solids are introduced. And at which point they start sleeping through the night. For breastfeeding babies, the American Academy of Pediatrics endorses exclusive breastfeeding until six months of age after which, solids can be introduced. At the six month mark, solids can be introduced in the form of purees if certain criteria are met. Babies have to be able to hold their head upright. And they have to lose their tongue thrust reflex. Practices differ in different parts of the world on what should or shouldn't be offered. But in the United States, you'll find most pediatricians will recommend starting with infant cereals or pureed vegetables and fruits. Pediatricians always recommend starting with one new food every three to five days, so that if there are any allergies, we can avoid them.
The important thing I like to tell parents at my visits is at age six to eight months or so formula or breast milk is still your baby's prime nutrition source. Ensure they're still obtaining a good amount of intake on this. By 12 months, this changes and most nutrition should come from solids. And at that point, milk is a supplement.
Lastly, I'd like to mention the AAP guidelines and holding off introduction of peanut butter until 12 months. That's changed, in 2015, there was a huge study worldwide that was done that showed the decreased risk of development of allergy if peanut butter was introduced early. In certain cases, we still hold off on introducing this, but most infants can start these at age six months. Talk to your pediatrician about this at your six month visit to ensure your child is a candidate to start peanut butter. Foods to absolutely avoid prior to 12 months include honey and raw or hard foods that are a choking hazard such as nuts, raw vegetables, grapes, seeds, popcorn and peanuts.
Host: Yeah, I'm not sure it'd be great to feed a kid, some caramel popcorn at that age. Yeah, probably wouldn't go too well. What you say makes so much sense and now I'd love you to make sense about development and newborn milestones. Let's start with development.
Dr. Ahmed: Sure. So development and milestones are another huge part of pediatrician visits. We discuss these that every well check. The first year of life there's a lot of changes that are happening and every parent is going to see their child flourish before their eyes. As a newborn, not much is happening. Most newborns just sleep, drink, pee, poop, and cry.
But by one month of age, infants are holding their gaze on their parents, startling to sounds and lifting their heads. By two months, they're actually smiling at you, cooing, following your face, a full 180 degrees and grasping things. By four months, they're rolling both ways, laughing out loud and squealing. They can hold their heads up well, and they're reaching for toys. I love four months because at that point, I like to mention that babies can squeal and laugh, but they're not moving too much. So, they're not really a safety hazard.
Host: Can I just stop you at four months? Because I understand that's when fathers usually finally really get that sense of bonding with their child.
Dr. Ahmed: Yes. And I think it's because your interaction with your baby at that point is really meaningful. They can actually respond back to you by cooing and some of them are even mimicking. So, I think that's the reason why that happens. So, by six months, most infants are sitting independently. They're babbling, they're turning to their names and they're becoming really active. At this point, I do start discussing baby proofing the home. A lot of babies do start to army crawl as well. So at this visit, I do start talking about that. By nine months, most infants are cruising. They're crawling, they're pulling to stand, they're finger feeding themselves. They're clapping, they're waving, shaking and banging and throwing toys.
I definitely reinforce baby proofing the house at this visit because most babies are getting into everything by this point. By 12 months, most infants are walking and they're starting to take their first steps and saying their first words. The other thing I like to mention about development is as a good rule of thumb by 12 months, an infant's weight has tripled from their birth weight and they've gained about 10 inches in height from when they were first born. And the last tidbit is by two years of life, a child has actually reached half of their adult height, so you can see how much growth actually happens in those first few years of life. That's why it's so important.
Host: That's truly an incredible statistic. Doctor, can you share any other safety tips with us?
Dr. Ahmed: Yeah, we have lots of safety tips. I won't be able to review all of them today, but I urge all parents to check out brightfutures.aap.org to get all the parent information. There's lots of good handouts available. And the handouts that I give out my visits are actually from this website. So, I highly urge everybody to look at them.
At the first visit, I typically discuss importance of feeding and ensuring frequent feeds. We discussed never hitting or shaking your baby. Instead, put your baby down in a safe place and walk away, if you get frustrated. This happens to all of us when there's a baby that's crying and you cannot calm them down. And you've done everything that you know of. It gets frustrating. So, I definitely discussed this at the first visit. Two, if something doesn't feel right or your child isn't acting normally take a temperature. A fever is over 100.4 degrees Fahrenheit, and it requires an ER visit as a fever is an emergency in a newborn. Three prior to vaccinations, it's important to wash your hands often, avoid crowds and keep others from touching your baby. Because your child isn't vaccinated yet they are easily exposed to every germ in the world that we all carry on our hands. So, it's especially important to make sure that you're washing your hands and avoiding crowds. The other thing I like to talk about is car seat and proper installation and making sure that the car seat is rear facing. Every a car seat comes with an installation manual and there are car seat check stations as well in every city and state.
So you can look for that if you're not sure how to install your car seat correctly. Never leave your child alone in the car. This is really important. And we have been hearing about this in the news very frequently, where a child dies in the car in the back seat from overheating because the parent forgot. Newer cars do have signals where they tell you to check the back seat, but not every car does.
So, this is really important to keep in mind. Always put your baby to sleep on his or her back in his, or her own crib. Water heaters are another thing I like to talk about. Make sure that you're setting the temperature to 120 degrees Fahrenheit to prevent any water related burns. Finally, I like to tell parents to learn infant CPR. It can be a lifesaver. There are courses available online that parents can sign up for and most hospitals actually offer them before parents get discharged from the nursery. So, definitely ask your local hospital about these as well.
Host: I think you should write a manual because there is a lot to remember.
Dr. Ahmed: There are books available as well, and lots of resources that your pediatrician will have. So, definitely, I always encourage parents to look at these websites, look at the handouts, and if they can't remember questions, write them down and bring them in with you so that we can review all of that information at the visit.
Host: That's a great idea. Well, this has been such an informative episode. Dr. Ahmed, as we wrap up any other advice for people who are bringing home a newborn?
Dr. Ahmed: I always tell my parents, but the first few weeks they are to focus solely on this new being that they've brought into the world and ensure that they themselves are getting adequate sleep and rest. I always talk about that laundry, chores, cooking, cleaning can always talk to him later. But this newborn that they have, and they themselves are the most important things right now.
In addition, parental wellbeing is as important as an infant's wellbeing. I always tell parents to ensure that they have enough help at home. I tell them to take an evening off or even a few hours, spend time on yourself, go to a movie, enjoy a spa day or heck, go to target, but ensure you have a few hours to yourself each week. Being a parent is a full-time job, but it doesn't mean you have to forget about yourself.
Host: That's right. And sanity is a good thing to keep. All great information again. Thank you so much for your time today. I hope you'll join us again soon.
Dr. Ahmed: Thank you so much, Deborah.
Host: And you can call (765) 966-5527 to schedule your appointment today, or for more information, you can always visit Reidhealth.org to get connected to one of our providers That concludes this episode of Right Beside You, a Reid Health podcast. Please remember to subscribe, rate and review this podcast and all the other Reid Health podcasts. And we thank you for that. I'm Deborah Howell. Have yourself a terrific day.
Deborah Howell (Host): Welcome to Right Beside You, a Reid Health podcast. I'm Deborah Howell, and I invite you to listen as we discuss newborn visits and milestones today. Joining me is Dr. Hira Ahmed, a Pediatrician and Doctor of Osteopathic Medicine with Reid Health. Dr. Ahmed, it's a pleasure to have you with us today.
Hira Ahmed, DO (Guest): Thank you. I appreciate coming in today and discussing important information for parents about their newborns.
Host: Important it is. And let's jump right in, you know, Safe Sleep is always one of the most important things we need to ensure for our newborns and the guidelines have changed a bit over the years. Can you speak to this?
Dr. Ahmed: Yes, of course. In 2016, the American Academy of Pediatrics and that's our governing body, so to speak, set out a policy statement, updating safe sleep practices for infants. The basic recommendations that the AAP came up with is one, breastfeeding is recommended to reduce the risk of SIDS, which is sudden infant death syndrome and to enhance the health and wellbeing of the infant and mother, they recommend exclusive breastfeeding for six months. Research demonstrates that exclusive breastfeeding can reduce the risk of this sudden infant death syndrome by 70%. So, that's pretty significant. Number two, they recommend skin to skin care for at least an hour after birth, regardless of feeding or delivery method. Three, room sharing with the infant, but on a separate sleep surface is recommended.
Four, AAP recognizes that parents may fall asleep in bed after or during feeding their infant. So, it's recommended that they remove pillows, loose blankets, loose sheets, and move the bed away from walls to prevent entrapment. Five, avoid nighttime feeding on couches and armchairs, which are not considered safe sleep surfaces at any time for infants. Obviously there's risk of falling from those surfaces, which is why it's not recommended. Six, it's important that anyone who cares for an infant puts the baby to sleep on their back. Prone sleeping or sleeping on the stomach actually increases the risk of re-breathing the same air that is on the baby's face, which increases the levels of carbon dioxide, which then leads to decreased oxygen in the blood and can be potentially fatal and lead to this sudden infant death syndrome.
Seven, the AAP recommends a firm sleep surface, such as a mattress in a safety approved crib covered with a fitted sheet to reduce the risk of sudden infant death syndrome. Firm sleep surfaces should not have any other bedding or soft objects such as pillows, bumpers, toys on them. And appropriate surfaces can include cribs, bassinets, and portable play areas. Just make sure that their safety approved cribs and other surfaces.
Host: Sure. All makes good sense. And as you said, so very important. Do you have any feeding tips for newborns for us?
Dr. Ahmed: Yes. Feeding is a huge part of our newborn and infant visits for the first year of life. As I mentioned, prior, breastfeeding is best. It leads to the decreased risk of sudden infant death syndrome, asthma, type one diabetes, obesity, ear infections, GI infections, and lower respiratory disease. However we know breastfeeding isn't for every woman. In these circumstances, formula is a great alternative and safe option. Whichever feeding method is chosen, fed is best. Newborns have stomachs that are the size of a ping pong ball, which means that they only eat small amounts, but they pretty frequently. Feeding amounts change drastically from birth throughout the first year of life.
Newborns start feeds with as little as a few cc's of milk. And by one to two weeks of age, they're taking about two ounces per feeding. Most babies are feeding every three to four hours until the age of four to six months when solids are introduced. And at which point they start sleeping through the night. For breastfeeding babies, the American Academy of Pediatrics endorses exclusive breastfeeding until six months of age after which, solids can be introduced. At the six month mark, solids can be introduced in the form of purees if certain criteria are met. Babies have to be able to hold their head upright. And they have to lose their tongue thrust reflex. Practices differ in different parts of the world on what should or shouldn't be offered. But in the United States, you'll find most pediatricians will recommend starting with infant cereals or pureed vegetables and fruits. Pediatricians always recommend starting with one new food every three to five days, so that if there are any allergies, we can avoid them.
The important thing I like to tell parents at my visits is at age six to eight months or so formula or breast milk is still your baby's prime nutrition source. Ensure they're still obtaining a good amount of intake on this. By 12 months, this changes and most nutrition should come from solids. And at that point, milk is a supplement.
Lastly, I'd like to mention the AAP guidelines and holding off introduction of peanut butter until 12 months. That's changed, in 2015, there was a huge study worldwide that was done that showed the decreased risk of development of allergy if peanut butter was introduced early. In certain cases, we still hold off on introducing this, but most infants can start these at age six months. Talk to your pediatrician about this at your six month visit to ensure your child is a candidate to start peanut butter. Foods to absolutely avoid prior to 12 months include honey and raw or hard foods that are a choking hazard such as nuts, raw vegetables, grapes, seeds, popcorn and peanuts.
Host: Yeah, I'm not sure it'd be great to feed a kid, some caramel popcorn at that age. Yeah, probably wouldn't go too well. What you say makes so much sense and now I'd love you to make sense about development and newborn milestones. Let's start with development.
Dr. Ahmed: Sure. So development and milestones are another huge part of pediatrician visits. We discuss these that every well check. The first year of life there's a lot of changes that are happening and every parent is going to see their child flourish before their eyes. As a newborn, not much is happening. Most newborns just sleep, drink, pee, poop, and cry.
But by one month of age, infants are holding their gaze on their parents, startling to sounds and lifting their heads. By two months, they're actually smiling at you, cooing, following your face, a full 180 degrees and grasping things. By four months, they're rolling both ways, laughing out loud and squealing. They can hold their heads up well, and they're reaching for toys. I love four months because at that point, I like to mention that babies can squeal and laugh, but they're not moving too much. So, they're not really a safety hazard.
Host: Can I just stop you at four months? Because I understand that's when fathers usually finally really get that sense of bonding with their child.
Dr. Ahmed: Yes. And I think it's because your interaction with your baby at that point is really meaningful. They can actually respond back to you by cooing and some of them are even mimicking. So, I think that's the reason why that happens. So, by six months, most infants are sitting independently. They're babbling, they're turning to their names and they're becoming really active. At this point, I do start discussing baby proofing the home. A lot of babies do start to army crawl as well. So at this visit, I do start talking about that. By nine months, most infants are cruising. They're crawling, they're pulling to stand, they're finger feeding themselves. They're clapping, they're waving, shaking and banging and throwing toys.
I definitely reinforce baby proofing the house at this visit because most babies are getting into everything by this point. By 12 months, most infants are walking and they're starting to take their first steps and saying their first words. The other thing I like to mention about development is as a good rule of thumb by 12 months, an infant's weight has tripled from their birth weight and they've gained about 10 inches in height from when they were first born. And the last tidbit is by two years of life, a child has actually reached half of their adult height, so you can see how much growth actually happens in those first few years of life. That's why it's so important.
Host: That's truly an incredible statistic. Doctor, can you share any other safety tips with us?
Dr. Ahmed: Yeah, we have lots of safety tips. I won't be able to review all of them today, but I urge all parents to check out brightfutures.aap.org to get all the parent information. There's lots of good handouts available. And the handouts that I give out my visits are actually from this website. So, I highly urge everybody to look at them.
At the first visit, I typically discuss importance of feeding and ensuring frequent feeds. We discussed never hitting or shaking your baby. Instead, put your baby down in a safe place and walk away, if you get frustrated. This happens to all of us when there's a baby that's crying and you cannot calm them down. And you've done everything that you know of. It gets frustrating. So, I definitely discussed this at the first visit. Two, if something doesn't feel right or your child isn't acting normally take a temperature. A fever is over 100.4 degrees Fahrenheit, and it requires an ER visit as a fever is an emergency in a newborn. Three prior to vaccinations, it's important to wash your hands often, avoid crowds and keep others from touching your baby. Because your child isn't vaccinated yet they are easily exposed to every germ in the world that we all carry on our hands. So, it's especially important to make sure that you're washing your hands and avoiding crowds. The other thing I like to talk about is car seat and proper installation and making sure that the car seat is rear facing. Every a car seat comes with an installation manual and there are car seat check stations as well in every city and state.
So you can look for that if you're not sure how to install your car seat correctly. Never leave your child alone in the car. This is really important. And we have been hearing about this in the news very frequently, where a child dies in the car in the back seat from overheating because the parent forgot. Newer cars do have signals where they tell you to check the back seat, but not every car does.
So, this is really important to keep in mind. Always put your baby to sleep on his or her back in his, or her own crib. Water heaters are another thing I like to talk about. Make sure that you're setting the temperature to 120 degrees Fahrenheit to prevent any water related burns. Finally, I like to tell parents to learn infant CPR. It can be a lifesaver. There are courses available online that parents can sign up for and most hospitals actually offer them before parents get discharged from the nursery. So, definitely ask your local hospital about these as well.
Host: I think you should write a manual because there is a lot to remember.
Dr. Ahmed: There are books available as well, and lots of resources that your pediatrician will have. So, definitely, I always encourage parents to look at these websites, look at the handouts, and if they can't remember questions, write them down and bring them in with you so that we can review all of that information at the visit.
Host: That's a great idea. Well, this has been such an informative episode. Dr. Ahmed, as we wrap up any other advice for people who are bringing home a newborn?
Dr. Ahmed: I always tell my parents, but the first few weeks they are to focus solely on this new being that they've brought into the world and ensure that they themselves are getting adequate sleep and rest. I always talk about that laundry, chores, cooking, cleaning can always talk to him later. But this newborn that they have, and they themselves are the most important things right now.
In addition, parental wellbeing is as important as an infant's wellbeing. I always tell parents to ensure that they have enough help at home. I tell them to take an evening off or even a few hours, spend time on yourself, go to a movie, enjoy a spa day or heck, go to target, but ensure you have a few hours to yourself each week. Being a parent is a full-time job, but it doesn't mean you have to forget about yourself.
Host: That's right. And sanity is a good thing to keep. All great information again. Thank you so much for your time today. I hope you'll join us again soon.
Dr. Ahmed: Thank you so much, Deborah.
Host: And you can call (765) 966-5527 to schedule your appointment today, or for more information, you can always visit Reidhealth.org to get connected to one of our providers That concludes this episode of Right Beside You, a Reid Health podcast. Please remember to subscribe, rate and review this podcast and all the other Reid Health podcasts. And we thank you for that. I'm Deborah Howell. Have yourself a terrific day.