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Newborns and Infants
Questions and Answers
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Thanks to Mark D. Widome, M.D. a general pediatrician and professor of pediatrics at Penn State College of Medicine in Hershey, Pennsylvania.
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How much sleep do babies need?
Newborns need about twice as much sleep as adults: 17 hours versus 8 1/2 hours. Babies get that sleep in rather short segments throughout the 24-hour day. By the time kids are a year old, they get about 14 hours of sleep divided into 10-12 hours at night and the rest divided into a morning and afternoon nap. Kids will usually give up one nap in the second year and the second nap as preschoolers. I tell parents that these sleep guidelines are averages and that there is a lot of individual variation from child to child. Pediatricians are a lot more concerned about the amount of sleep that the parents are getting than the amount of sleep the infant is getting
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When can I introduce baby foods?
Most parents introduce baby foods some time between four and six months of age. A reasonable rule is to wait until your baby has good head control and has at least doubled his birthweight. If the bottle-fed baby is taking more than a quart of formula a day that is another good sign of readiness. Starting baby foods before four months is unnecessary and there is a risk of overfeeding, because the baby is unable to adequately communicate that she has had enough. Starting baby foods much after six months is sometimes problematic because babies often get into a stubborn streak and are less willing to try new things. Breast milk or formula is nutritionally adequate in the first six months, but in the second six months, babies benefit from the added calories, protein, and iron in solid foods.
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Can cereal help sleep through the night?
Baby foods are unlikely to be the thing that determines whether your baby sleeps through the night. Sleeping through the night has more to do with maturation of normal body rhythms. Most babies can be expected to begin sleeping through the night sometime between two and four months of age.
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How long should infants sleep on backs?
Most of the risk of SIDS is in the first six months of life, especially between one and five months. By the time an infant is six months old, he or she will be rolling over and will assume the position of greatest comfort. So, it seems reasonable to put the baby to sleep on the back for at least the first six months, but you don't need to keep checking to see if he or she has rolled over onto the stomach. The slight increased risk of SIDS if a younger infant occasionally rolls onto his stomach is not sufficient to outweigh the disruption to parents of constantly checking the infant's sleeping position. If you happen to find that your younger infant has rolled onto his stomach, you can gently roll him over onto his back.
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When should we move from crib to a bed?
Move from a crib to a bed when it seems that your child will soon be able to climb out by himself. When the mattress is placed on its lowest setting and your child is standing at the crib, if the top of the rail is below nipple height, or he is about 35 inches tall, then it's about time. For most kids this will happen around the second birthday, but for some tall ones, it may happen at 19 or 20 months.
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When can the car seat be turned forward?
At 20 pounds or one year of age, whichever comeslast. Rear facing is always safer, so don’t turn the car seat around any sooner than you absolutely have to. It is better to go into a crash rear-facing so that the forces are distributed over a large surface of your child's body-his back-and so that the neck cannot be thrown forward, possibly resulting in serious neck injury. This is a particular problem in infants facing forward, because infants have relatively weak neck muscles. Note that some car seats are now labeled for use rear facing up to 22, 25, or even 30 pounds. These seats are a good choice especially for the larger baby, and these kinds of seats will become increasingly popular in the next few years.
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Can immunizations be given when sick?
Mild illnesses, with or without low-grade fever, are no reason to delay immunizations. Many children remain incompletely immunized, and therefore susceptible to preventable diseases because of the mistaken belief that a cough, cold, upset stomach, sore throat, or mild fever is a reason to delay immunizations.
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Why do children get many ear infections?
Most children have gotten more than one ear infection by the time they reach their third birthdays. Children are prone to ear infections because the middle ear space (the space behind the ear drum) can easily become congested and fluid-filled when children catch colds and become congested. When fluid accumulates it is very prone to getting infected, resulting in ear pain and fever. Some children are more prone to infection than others, based on genetics and circumstances. While you can't change genetics, some things that you can do to reduce the likelihood of ear infections include breast feeding, avoidance of tobacco smoke, and choosing smaller childcare settings rather than larger ones in the first several years of life. It is likely that a new experimental vaccine aimed at preventing pneumonia and serious infections due to the pneumococcus bacteria will also have the beneficial effect of preventing ear infections. We should be seeing these new vaccines in the next couple of years, maybe sooner.
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When should a child give up a pacifier?
There are lots of different opinions on pacifiers, and the best that I can do is to give you my personal opinion. Pacifiers are fine for the young infants who seem to need something to soothe them and satisfy their need to suck beyond the point that their hunger is satisfied. However, there is no need to encourage the use of a pacifier in an infant who seems not to need one (a baby who is easily soothed by rocking or seems to soothe himself.) In breastfed babies, I would stay away from the pacifier for the first few weeks, until nursing is well established. The pacifier may confuse the baby and discourage the frequent nursing that is essential to stimulate a good milk supply. When a baby is 3-4 months old, that is a good time to make the pacifier less available, and to let the baby find his own fingers and thumbs, if necessary for soothing. It is harder to get rid of the pacifier if you wait until later in the first year when, too often, it becomes a necessary piece of equipment to get to sleep at night. But even if a child does seem attached to a pacifier, do not to worry too much. There are lots of habits much worse than using a pacifier.
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How much juice driking is too much?
Try to limit to no more than 4 ounces a day before the first birthday and no more than 8 ounces per day after the first birthday. Juice is not a nutritionally important part of the diets of children. It should not replace formula or breast milk. Juice has no iron, no protein, and no calcium. It lacks most vitamins and minerals. Kids who drink excessive juice tend to grow more slowly, probably because the juice is replacing more nutritious foods. Also too much juice can sometimes be the cause of chronically loose stools, because of the large amounts of sugar that the juice is delivering to the intestinal tract.
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Do babies need shoes?
No. Shoes really serve only two purposes in young children: to keep their feet warm and to protect their feet from what might be on the ground. Shoes do not help a child to walk early or straight, they are not necessary for normal foot development, and they have nothing to do with the development of normal arches or strong ankles. A baby doesn't need shoes until she is walking. A first pair of shoes should be flexible (you need to bend your feet to walk) and have plenty of room for the toes to wiggle around. High tops are not necessary, unless a low-cut shoe will not stay on your child's foot. Don't spend a lot of money on shoes, as you will be buying a new pair every 2-3 months at first. But do make sure you get a good fit. Tight shoes will hurt and loose shoes will not stay on the feet and make it difficult to walk. Leather has no particular advantage over canvas.
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