Dr. James Jewell, a pediatrician and internal medicine physician at Novant Medical in King answers his most often asked questions.
How well is my baby feeding?
I recommend breastfeeding, if possible. When breastfeeding the mother can’t directly measure how much milk her baby is taking in, but in a quiet room she can hear her baby swallowing milk. There should be at least six or more wet diapers a day.
With formula-fed babies we tend to not give parents a specific amount per feeding because each child is different but, again, there should be at least six wet diapers a day. And with both methods of feeding there should be consistent weight gain.
Most pediatricians will see your baby in the first week after coming home from the hospital and again in a month. In between those visits I like to see the newborn back about a week after the first visit just for a weight check. Most babies will gain between a half-ounce and 1 ounce a day following the first two weeks of life.
When to start solid foods?
When to start solids has been debated for many years. About 40, 50 years ago people were routinely starting infants on cereal at two months or even earlier (just ask your grandmother). Current recommendations are to introduce solids between 4 – 6 months. Most people start with the easy-to-feed and easy-to-digest cereals and then progress to vegetables, fruits and, later, meats. The only hard and fast rule I try to get my parents to observe is not introducing more than one food at a time.
When a new food is introduced parents should wait 3 – 4 days before introducing the next new food. If a child has had a reaction to a food (fortunately this is uncommon) and you have tried three new foods that day, it can be difficult and time consuming to figure out the offending food.
When it comes to sleep, what are best practices?
Sleep can be a tough one. The first consideration for a newborn is safety. The American Academy of Pediatrics Task Force on Sudden Infant Death Syndrome (SIDS) released updated recommendations in 2016. No real new ground was broken. The main points can be summarized by the following: Infants should always be placed on their back to sleep on a firm surface; no bed sharing; no soft objects (pillows, bumper pads) or loose bedding in the sleep area; offer a pacifier at naps and bedtime; and avoid overheating and head-covering during sleep.
Most kids sleep fine and my biggest problem is parents thinking their baby should be sleeping uninterrupted through the night a lot earlier than is developmentally possible for a child of that age. Most babies can’t make it an 8-hour stretch until 6 months of age at the earliest – often later than that based on individual needs, temperament and the amount of daytime sleep.
People are often amazed by the amount of sleep a baby requires. Newborns will sleep as much as 16 hours a day. That decreases to about 14 hours by 4 – 6 months and 13 hours by a year old. Of course every child is different and these are not hard and fast rules.
Do you have any book recommendations for new parents?
A few years ago I joined with two other pediatricians to review several childcare books to see which of the current selections available were best to recommend to our patients. The unanimous favorite was “The Focus on the Family Complete Book of Baby and Child Care” by James C. Dobson. It is well written, easy to read and reference and packed with good advice from birth through the teen years.
Two other excellent books that we also liked were “Caring for Your Baby and Young Child – Birth to age 5” by the American Academy of Pediatrics and “What to Expect the First Year” by Arlene Eisenberg and Heidi Murkoff, which has an especially good section on breastfeeding. Lastly, a good reference for questions about sleep-specific problems is “Solve Your Child’s Sleep Problems” by Richard Ferber.