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Prevention Health Series Part 1: Newborn

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 our topic today is preventive health for newborns. Joining me is Dr. Cory Kercher. She’s an Assistant Professor of Pediatrics at Weill Cornell Medicine and an Assistant Attending Pediatrician at New York Presbyterian Weill Cornell Medical Center. Dr. Kercher, it’s such a pleasure to have you join us today. As far as infants, we know we come in for these well visits. But what do you address and counsel at the first visit for new parents?

Cory Kercher, MD (Guest):  Thanks so much for having me. Yeah, so that’s a really good question. Because having a brand new baby is super exciting but also can be pretty scary and when you get home with the baby; you are not quite sure what to do and you don’t know what is normal and what’s not normal. And you hear so many different things from about what you should do and shouldn’t do. So, at our first visit, really, it’s a lot about making sure not only that the baby is healthy but also that you’re comfortable with what’s going on with the baby at home.

The first thing is, is the baby feeding okay and growing okay. We always tell patients in the hospital that their babies are going to lose weight after they are born but we want to make sure that they haven’t lost too much weight and that the feeding is going well enough that they are not getting dehydrated. So, we’ll go over the feeding. If you’re breastfeeding, we’ll make sure that’s going well. If your milk is coming in and make sure that the baby is peeing properly. That’s going to be our most important indication that the baby is getting enough fluid. And checking a weight on the baby. Babies can lose weight like I just said but we don’t want them to lose too much weight. And we want them to start regaining within a few days of after they go home.

So, we’re going to spend a lot of time talking about what’s normal feeding. Babies do need to feed very frequently at first on demand but no longer than every three hours. Making sure that the baby is peeing regularly and then going over some basic safety issues that the baby is sleeping properly, sleeping on his or her back only on a nice firm mattress. Making sure that everyone around the baby is washing their hands and being safe and just making sure you are overall comfortable with having your baby at home.

Host:  New parents never realize how much they are going to talk about peeing and pooping until they visit you for the first time. And while you mentioned safety, illness prevention in the newborn is so important especially this time of year. People are concerned with keeping their newborn from getting sick. What’s your recommendation for that?

Dr. Kercher:  That’s a big topic that we talk about at the beginning. Because a big concern is making sure that the baby can stay healthy and their biggest risks and exposures are the people around them. So, their parents, other family members, visitors, their siblings in particular. So, we first and foremost want to make sure that everyone knows to have good handwashing. Handwashing is the best way to prevent illness whether you wash in the sink with soap and water or use Purell and have it all over your house so that people can sanitize their hands. That’s the best way to prevent illness. And teaching the older siblings to do that routinely is super important.

The other thing is vaccines. Making sure that the close contacts of the baby are properly vaccinated against things like the flu, this time of year in the dead of winter where everyone seems to have the flu and some of the other routine vaccines that we want to make sure that the caregivers have like the whooping cough vaccine. These are things that a baby cannot have and is especially vulnerable to so we want to make sure that any close contact with the baby is properly vaccinated.

Host:  As long as you mentioned vaccines, when do they begin with infants?

Dr. Kercher:  So, the babies will be offered their first vaccine in the hospital, that’s the hepatitis B vaccine. Then after that one single vaccine, we don’t start giving the routine ones until babies are two months old. So, that leaves them vulnerable from their immune standpoint in the first two months. That’s why it’s critically important to keep them protected from exposures from people who are ill from crowded spaces in those first two months and then once the two month mark happens, we start immunizing the babies so they can get their own level of protection.

Host:  Well I’d like to talk a little bit about breastfeeding support and for the listeners; we do have a podcast with Carolyn Migliore and she’s an internationally recognized and certified childbirth educator and lactation consultant and she’s discussing all the details you need to know about breastfeeding. So, please be sure to check that one out as well. But while we’re on that topic, Dr. Kercher, whose the best person to help with that and can the pediatrician help or guide us to the person that can help?

Dr. Kercher:  Absolutely. Like I mentioned, in the first visits, what’s critically important is making sure that the baby is feeding and growing appropriately. And that can happen in a lot of different ways. Whether it’s breastfeeding or bottle feeding or formula, whatever is safest and works best for the baby and the family. And the pediatrician is really there to help make sure that not only do you have the support you need for whatever you want to be doing, it’s also going well enough so that the baby is healthy. Meaning if for some reason, breastfeeding isn’t going as expected and the baby is not gaining weight or getting dehydrated; that there are other options and we’re there to help make sure you can accomplish your goal and keep the baby safe at the same time.

So, the pediatrician is a very good resource to help with that.

Host:  Well certainly that is and what great information. Now for the mother, postpartum depression screening. Is that done at your office with the pediatrician or is that something that they visit their gynecologist about?

Dr. Kercher:  So, at our office, we do do the screening because obviously the mother’s health and parent’s health is as important to us as the baby’s to help the baby thrive. So, we do do postpartum screening. We have a questionnaire that we give out in particular at the one and two month visit, because that is when we see it peak for women. Initially, right after birth, usually there’s a nice adrenaline surge when you have a new baby and then some of the symptoms of postpartum depression start to set in around that one month mark. And so we do give a questionnaire at the one and two month mark to try and see how – check in with women and see how they’re doing.

Host:  How do you monitor our children’s growth as an infant? What do you do?

Dr. Kercher:  So, at every visit, particularly every well visit, we weigh babies, we measure their length and we measure their head circumference. And then we are plotting those on a growth curve, a standardized curve to make sure that the babies are growing appropriately. Obviously, parents are always very concerned with what the numbers are, what is the weight, what is the percentile, but frankly, from a medical standpoint; what we care most about is that the baby is growing at the appropriate rate. So, when we’re putting these on the curves and we’re giving you percentiles; the actual number actually is not so important. What’s important is where your baby has been and where they are going and are, they staying on the same curve? Even if they are at the fifth percentile and you think you’re concerned because that’s so tiny; if they’ve always been there; then that’s okay.

If they are at the 90^th percentile so, they’re bigger, if they’ve always been there; that’s okay. So, again, we’re looking at trends and making sure that the rate is appropriate. And the way the visits are scheduled or so that we can make sure we’re checking in frequently enough so we’re not missing anything that might be going wrong.

Host:  Thank you for that answer. Because that’s a great answer and parents do worry about that whether it’s fifth or 90^th but as you say, the trend is what you’re looking for and following that trend is the most important thing. So, thank you for that. And as parents worry, as we all do about developmental milestones, but not every child’s the same Dr. Kercher, so tell us a little bit about screening for milestones or any red flags you’d like parents to know about.

Dr. Kercher:  Absolutely. So, part of when we do the well visits, one of the biggest parts is not only the feeding, not only the growth; but how your baby and child is developing. The schedule of the well visits is thought out not only because of when we need to give vaccinations but when we should see some of the major milestones. So, we have it spaced out in a way so that we can be following along to make sure that the baby is appropriately developing and is doing the things we expect them to do at that age.

Now, but it’s also not set in stone. If you read in a book that a baby needs to be crawling at nine months; on average, maybe babies do, but your baby may or may not be and we want to make sure that the baby is starting to show signs that they’re going towards that end. That they are progressing appropriately. So, in the first year of life; the well visits are at after initial newborn visit, and the one month visit, then they are at two months, four months, six months, nine months and 12 months. And all along those ways are where we see some of the more typical milestones. For example, at two months, we want to see the baby smiling socially. At six months, we want to see the baby being able to sit in a supported way. But like I said, what we’re really looking for is progress.

So, even if the baby is not doing something exactly that the textbook says at that minute, are they getting close to it? Are they doing more than they were at the visit before? If they’re losing milestones or doing less than they were; that’s a red flag. Or if they are not progressing. They’ve been sitting up since they were eight months old and haven’t started trying to crawl and haven’t started to pull themselves up to stand and now, they are a year old. Well now the baby isn’t progressing and that’s a more concerning picture. And so, we just sort of look at the bigger overall trend is the baby making progress and moving towards what we want them to be doing.

Host:  Is there any routine lab testing that you do at a child’s well visit?

Dr. Kercher:  The only routine lab testing we do is at either nine months or a year depending on the practice and our we tend to do it at nine months, but you can also do it at one year. We check for lead levels and we do a screen of anemia. We check a hemoglobin level. That’s really the only recommended screening to do in the first year of life.

Host:  So, before we wrap up, one of the most important things to parents, new parents, and baby is sleep. Can our pediatrician give us good recommendations on how to get the little guy to sleep so that we can get a decent night’s sleep so that everybody’s happier?

Dr. Kercher:  Absolutely. The pediatrician is a very good resource for that. Again, like everything else with having kids, you’ll hear a million different words of wisdom and pieces of advice and what worked for this person and you have to do this because it’s the best. But not every baby is the same. So, really what a pediatrician can help guide you especially since they have a relationship and know how things are going at home. Where can you tweak the routine and the schedule to help the babies become better sleepers? And learning to be a good sleeper starts really from early on in life, setting and instilling good habits and good routines about how you put your baby down at night and how to prevent from holding too long and not holding them all night when they sleep and as they get older, letting them have some time to work out and falling asleep on their own. And knowing what stage of development they’re at so what’s appropriate to let them do depending on what stage of development they are in.

There’s many different methods to help your baby become a better sleeper. And we’re here to help work out whatever the particular issue is and see if we can help your baby become a better sleeper because again, one size doesn’t fit all and what your issue might not be what your best friend’s issue was and so their method might not work for you.

Host:  Please conclude for us Dr. Kercher, what an important topic and for new parents; what would you like them to know about the importance of those well visits with their pediatrician and to make sure that they ask all the questions that they want because that’s what you’re there for to answer them and help them through that most exciting time.

Dr. Kercher:  I think what’s most important is exactly what you just said. For parents to come in with whatever questions that they have and to hear from the medical perspective what’s safe and what we think is best for your child or your baby. You are hearing so many different things between family, friends and the internet, some of which may or may not be safe, much of it may have changed since your friend or family had a baby and no longer is a good idea or a safe idea. So, really, we are here to make sure that what’s going on at home, not to tell you what to do; but to guide you in what is safe and what we’ve seen be effective and try and be helpful and sort through all the different advice and things that you might have heard. And that’s really what your pediatrician is a good resource for.

Host:  Thank you so much Dr. Cory Kercher for that great information and to our listeners. This concludes today’s episode of Kids Health Cast. Please remember to subscribe, rate and review this podcast and all the other Weill Cornell Medicine podcasts. For more health tips and updates on the latest medical advancements and breakthroughs please follow us on your social channels. I’m Melanie Cole.