From Birth to Four Months

Congratulations on the arrival of your baby! Your new family member isa special, one-of-a-kind little person who is probably making big changes

in your life. You may feel emotions ranging from extreme joy to overwhelmingresponsibility. But don’t feel alone. Most parents share these same feelings. The

purpose of the Baby Your Baby Newsletters is to give you important information that willhelp you and your baby grow together as you develop your new and special relationship. Eachnewsletter is designed to cover topics of interest to most parents as their children grow anddevelop through various stages of infancy and early childhood. You will want to keep all fivenewsletters and refer back to them.

You and Your BabyEach baby is an individual with a uniquepersonality, temperament, and group oftalents. Every baby needs affection andencouragement from his family. Yours isno exception!

The following helpful ideas can makeyour life, and your baby’s, easier andhappier.

• Start a baby book! Records of well child care visits, immunizations, anddevelopment can all be kept in a healthrecord. The Baby Your Baby HealthKeepsake has been created just for thispurpose. You may have received onewhile you were pregnant. If you don’thave one, please call 1-800-826-9662 foryour free copy.

• Set aside some private time for yourself and don’t feel guilty about it. It’s important to take time out now andthen.

• The “Baby Blues” — feelingdiscouraged, tired, overwhelmed —can happen after any big change in life.If time, extra rest, and patience don’tseem to help, ask your health careprovider, family or friends for help.

• It may be hard to find time foreveryone in the family. If you haveother children, they also need yourlove, care, and attention. Try to givethem some special time with you. Letthem know that their feelings andneeds are important to you.

Remember that your baby is yours to loveand enjoy. He depends on you as a sourceof joy and understanding in his world.

Your DevelopingBaby

Not all babies sit, smile, or reach out atexactly the same age, but they do developin a predictable way. Every baby developsat his own rate with his own style.

GENERAL DEVELOPMENTYour baby’s first task is to adjust to hisnew world. He needs to feel that there issome consistency and order to his daysand nights. He also needs to learn thatwhen he cries you will come to take careof his needs.

DEVELOPMENT OFLARGE MUSCLES A newborn’s neck and back muscles aren’tstrong enough to support his head, so youneed to provide that support when liftingyour baby. At 3 to 4 months of age, yourbaby may hold his head steady whilesupported in a sitting position. When onhis stomach, he may lift his head andsupport himself on his forearms.

DEVELOPMENT OFSMALL MUSCLES The small muscles that young babies learnto control first are those around their eyes.Your baby will enjoy seeing new thingsand will soon turn his head towardsounds.

SeeingAt birth, babies can only focus onobjects that are 8 to 15 inches away, aboutthe distance from his eyes to yours as younurse or feed your baby. Things that arefarther away are blurred.

Although newborns are able to payattention to patterns and shapes, they likelooking at faces best.

As the first weeks go by, give your baby acolorful mobile and other toys to look at.

Take time to talk to your new baby, face toface. Before your baby is 2 months of agehe will reward you with his first smile.

SleepThe usual pattern of sleep for newborns isone of short “cat naps” during the day andnight. You can expect periods of sleep to bebroken up by crying and fussing.

Newborns sleep between 8 and 20 hours aday. The older your baby becomes, thefewer naps he needs, and the longer hewill sleep at one time.

Many parents worry about SIDS or SuddenInfant Death Syndrome. Even though SIDSdoesn’t happen very often, health careproviders now recommend ways to reducethe risk to your baby.

Schedule visits forwell child care andimmunizations at

2 weeks, 2 months,and 4 months of age

• Baby should sleep on his back (napstoo), unless your health care provider has given you other advice.

• Be sure that baby’s mattress is firm with no more than a thin covering, such as a special fitted sheet, on it.

• Don’t let baby get too warm whilesleeping. Keep the temperature in baby’sroom so that it feels comfortable for you. Don’t overdress or bundle baby.

• Don’t use fluffy blankets or comforters.Baby should never sleep on a sheepskin,waterbed, soft couch or chair cushions,pillow or other soft material.

• Do not place pillows, stuffed toys or extra bedding in baby’s crib. This can causeyour baby to be smothered or suffocate. Ifa baby takes naps or sleeps with someoneelse, such as a parent or older sibling,make the bed the same way as a crib witha firm mattress and thin sheets.

Remember, SIDS is rare. Don’t let the fear ofSIDS spoil the enjoyment of having a newbaby.

Also, remember to give baby plenty of“tummy time.” Even though he sleeps on hisback, he needs time to play on his stomachand develop those large muscles that helphim lift his head now and crawl when he getsa few months older.

Hearing andSpeech

Your baby’s most important learning takesplace between birth and 4 years of age.During this time, he will learn tocommunicate — first to understand whatpeople say, and then to talk. This is a goodtime for mom and dad to start reading tohim for 15 to 20 minutes every day.

Your baby was born with the ability tomake sound. Around 1 month of age babiesmake cooing and gurgling sounds alongwith crying. By 3 months of age babiesbegin to babble.

In order to develop normal speech andlanguage patterns, your baby must be able tohear. If you think your baby cannot hear, askyour health care provider to refer you to alicensed audiologist who can test his hearing.Tell your health care provider if other familymembers have had hearing or speechproblems. Hearing can be tested any timeafter birth. The earlier that hearing loss isfound, the better. Your baby’s hearing wasprobably tested in the hospital before hecame home.

The following checklist is a guide to normalhearing development for a baby from birthto 4 months of age. Check to see if yourbaby does most of the things listed below:

• Is startled by loud sounds

• Is soothed by mother’s voice

• When sleeping in a quiet room, begins to move, wakes up, or cries when someone talks or when there is a noise.

Handle With Care!Certain types of activities can seriouslyhurt a baby. One such activity is shaking orjarring. Some parents have unintentionallyinjured their baby during rough playactivities, such as throwing the baby in theair and catching him suddenly.

This sudden jarring can tear fragile bloodvessels in the head and cause internalbleeding. Bouncing a baby on your kneetoo hard or not restraining him in a carsafety seat can have the same effect.

Young infants are especially vulnerable toinjury from shaking and jarring due to theirlack of head, neck and back control.Support your baby’s head and neck andavoid activities and behaviors that mightharm him. Remember, even older babieswith good head and neck control can beinjured by shaking or jarring.

NutritionBreast milk is the best food for your babyduring the first year. Breast milk containsan ideal balance of nutrients for your babyand antibodies that help protect your babyfrom certain illnesses.

When a mother cannot or chooses not tobreastfeed, formula can be substituted. Cow’smilk — whole, 2% or skim — should not begiven to babies until they are at least 1 yearold.

Babies are usually ready for solid foods(baby foods) around 6 months of age whilestill breast or formula feeding. Before youstart using baby foods, talk to your healthcare provider.

Many women are able to breastfeed evenwhen they are working full-time. This takessome planning. Breastfeed your baby solelyfor at least 4 to 6 weeks before you go backto work. This helps to get your milk supplywell-established. Bottles of your breast milkor infant formula can be used for feedingswhen you are away from your baby.

Whether you breast or bottle-feed, feedingtimes will be more enjoyable andrewarding when you hold your baby. Ifyou have questions or concerns about howyour baby is feeding, check with yourhealth care provider.

CryingCrying is your baby’s first form ofcommunication. Babies cry for a lot ofreasons like hunger, discomfort, and stress.As you get to know your baby’s cries youwill be able to know what he needs.

If your baby continues to cry after you havefed and changed him, he might be tired,bored, lonely, or need to be held. Avoidfeeding your baby every time he cries.

When your baby cries, there are manyways to comfort and soothe him, including:

• Rock and cuddle baby.• Give him a pacifier.• Change baby’s position.• Hold baby on your shoulder.• Play soft music.• Sing to baby.• Move baby to a different room.• Let someone else hold baby.

It is important that you respond to yourbaby when he cries. A prompt responseteaches your baby that help is nearby and

Your baby’s mostimportant learningtakes place between

birth and 4 years of age.

makes him feel comfortable and loved.However, it is okay for your baby to cryfor a few minutes while he is falling asleepafter you have taken care of all his needs.

Between 3 and 4 weeks of age, somebabies begin to display vigorous crying that cannot be soothed by feeding,rocking or other comforting measures.These crying spells usually occur in theevening. They often increase in length andintensity after 4 weeks of age and continueuntil 6 to 10 weeks of age.

Here are some suggestions to help parentsget through this difficult time:

• Begin with a medical evaluation byyour baby’s health care provider to make sure your baby isn’t sick.

• Ask about formula changes or colicmedicines; these may or may not beeffective.

• Because crying periods frequentlyhappen in the evening, try to reduceyour stress and keep things calm at thistime. You might have to rearrange yourschedule so you can better attend toyour baby.

• Wrap your baby snugly in a thinblanket and place him in a quiet, dimlylit room.

• Activities like rocking or a ride in a carseat can help.

• When all else fails, take a break. Askgrandparents, a babysitter, or someoneelse you trust to give you help.

• It is okay to put your baby down in thecrib and take a few minutes by yourselfif you are losing patience.

• Never shake your baby!

ImmunizationsNewborn babies get special substancescalled antibodies from their mothers.These antibodies protect children againstmany diseases. But this protection doesnot last forever. It usually wears off in thefirst year of life. You can keep your childprotected by getting him vaccinated.

Vaccines help your child’s body prepare tofight deadly diseases by making protectiveantibodies. These antibodies know how todestroy disease germs before they invadethe child’s body so that your child will notbecome ill. If your child is not vaccinatedand is exposed to a disease, the child’sbody may not be strong enough to fightthe disease.

You might not think that diseases likerubella or mumps are a serious threattoday because you don’t see or hear muchabout them. But they are still around. Ifwe stop vaccinating against these diseases,many more people will become infected.Vaccinating your child will keep himhealthy.

Newborn TestsWhen your baby is 2 to 4 weeks of age,you need to take him back to your healthcare provider for the second newbornscreening test. Be sure to take with you thenewborn screening form and envelopeyou received in the hospital. This is also agood time to share your baby’s familyhealth history with your health careprovider. Find out if birth defects,learning, speech, or hearing problems, the“baby blues,” and other chronic healthproblems tend to run in your family.

It is important to have your baby testedfor certain disorders that can cause mentalretardation if untreated. When foundearly, treatment can allow a baby to growand develop more normally.

If a baby’s test is abnormal, the health careprovider is notified and he will contactyou to arrange more tests.

Well Child Care and ImmunizationsWell child care refers to routine checkups at specific intervals. The following schedule for well child care and immunizations isrecommended by the American Academy of Pediatrics and the Advisory Committee on Immunization Practices (ACIP). Each baby andfamily is unique and your baby’s health care provider may want to see him more often. This schedule and the recommended tests mayvary depending on your baby’s needs and his health care provider.

BIRTH- 1-4 2 4 6 6-18 12-15 12-18 15-18 24 MO- 4-6 11-162 MOS MOS MOS MOS MOS MOS MOS MOS MOS 18 YRS YRS YRS

x

AgeVaccine

Hepatitis A(2 doses 6 months apart)

Hepatitis B

DTaP

Hib

Pneumococcal

Td

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Chickenpox

Influenza(yearly for children

≥ 6 months with certainrisk factors)

MMR

Polio

Well Child Visit

xx

x

x x x x x x x x xx

x x x x xxx

xx

xx

xxx

xxx

xx

x

x

x

SecondhandSmoke

Do not smoke around your baby! Whenyour baby breathes in cigarette smokefrom the air, things happen that you can’tsee. The baby’s heartbeat speeds up, bloodpressure rises, and dangerous carbonmonoxide seeps into his blood. Sincebabies breathe faster than adults, theybreathe in 2-3 times more polluted air perunit of body weight.

Babies of parents who smoke at homehave more ear infections and runny noses,and may develop lung diseases, likebronchitis and pneumonia. They are alsoat higher risk of SIDS. Cigarette smoke isalso very harmful to babies with asthma.

If someone smokes around your baby, askthem to go outside to smoke and then towash their hands. If you or someone youknow would like to stop smoking, you cancall 1-888-567-TRUTH for help.

SafetyIN THE CARParents spend a lot of time keeping theirbaby healthy, well cared-for and protected.But, too many parents, grandparents, andothers allow infants to ride unprotected incars and trucks. Make sure your babyalways rides in an approved car safety seat.Teach grandparents and others how to useyour car seat properly.

Here are some helpful hints:

• Infants should ride in rear-facing safetyseats as long as possible, until they are atleast one year old AND 20 pounds.

• Always put baby in the back seat. Thisis especially important in cars with apassenger air bag. The impact of an airbag hitting the back of the safety seatcan cause injury or death.

• Install the car seat at a 45 degree angle.If baby slumps to one side or the other,roll up two small blankets and placethem on either side of baby to addsupport. Never place the blanketaround the top of baby’s head.

• Always put the infant seat’s carryinghandle in the down position whiledriving.

• Adjust the safety seat’s retainer clip tounderarm level.

You can also protect your baby by bucklingup yourself and other passengers. A babycan be seriously hurt in car crashes frombeing hit or crushed by an unrestrainedadult.

Car seats can reduce traffic deaths amongyoung children by up to 80 percent — if theseats are used correctly. If you don’t have acar safety seat for your baby, get one today.You can buy one from any number of stores.If you need help installing your car seat, callyour local health department.

IN THE CRIBHere are a few guidelines to make sure

your crib is safe for your baby:

• Spaces between crib slats should be 2 3/8 inches or less so that baby’s head or body will not slip through. Cribsthat have wider spaces between slatsshould not be used.

• Keep the sides of baby’s crib up andsecurely latched.

• The mattress must be the right size for the crib. A mattress is too small if youcan fit more than two fingers between itand the crib sides.

• Never prop a bottle in baby’s mouthand leave him; he may spit up andbreathe in the fluid. The sugars in milkand juices can also lead to tooth decay.

• Keep window blind and electrical cordsaway from cribs.

Family HealthHistory

Learning about your family health historyis one of the best things you can do foryour baby. This is because health problemsthat run in your family (like asthma ordiabetes) can increase your baby’s risk ofdeveloping the same problem. But the goodnews is, by knowing your family healthhistory, you can make lifestyle andscreening choices to keep you and yourbaby healthy. Talk to close family members(parents, siblings, grandparents, and auntsand uncles) about:• health problems they have had• age when the problem started• lifestyle habits (diet, weight, exercise

and smoking habits)

• age and cause of death for familymembers who have died.

And don’t forget to share what you learnwith your baby’s health care provider.

Postpartum Healthfor Moms

Getting back into “regular” clothes isexciting yet challenging for most newmoms. But don’t expect to be able to getinto your favorite pair of jeans for severalmonths, at least. Keep in mind that it took9 months to gain your pregnancy weightso it will take time to lose it.

PHYSICAL ACTIVITYStart out slowly. You need to conserveyour energy to recover from labor anddelivery. Many health care providersadvise waiting until after your firstpostpartum checkup (usually six weeksafter delivery) to resume an exerciseprogram.

After those first six weeks, you can beginwalking to increase circulation and getsome general exercise. Do what you canhandle, even if it’s only 10 to 15 minutes,and increase your time as you getstronger. Walk with a normal stride and letyour arms swing naturally by your sides.Warm up with five to 10 minutes ofrhythmic activity such as marching, side-to-side lunges, shoulder rolls, andarm circles.

NUTRITIONIt was important for you to eat rightduring your pregnancy. It is just asimportant to take care of yourself now thatyou have had your baby - especially if youare breastfeeding. Eat plenty of healthyfood. It’s the raw material for the milkyou’ll be making for baby. Avoid alcohol,tobacco, caffeine and other drugs. They’llget into your breast milk and into yourbaby.Try to include the following in your dietevery day:• 3 cups of vegetables - variety is

important• 2 cups of fruit - easy on the juice• 7 ounces of bread, cereals, rice or pasta -

make 1/2 whole grain• 3 cups of milk, yogurt or cheese- go

low-fat or fat-free• 6 ounces of low-fat meat, poultry, fish,

dried beans, eggs or nuts - low-fat orlean meats

The information contained in this newsletter is not a substitute for personal medical, psychiatric, or psychological advice.Readers are urged to consult their health care providers concerning specific questions or problems.