The first weeks with baby tend to pass by in a blur of emotions, new love, and bouts of exhaustion in varying degrees. Doing your research before baby arrives and selecting a pediatrician you feel comfortable with helps you avoid unnecessary worry. Reading up on what to expect from your newborn and communicating any concerns with your pediatrician also sets you off to a good start.
Having served children for the past fifteen years, Doctor Jarret discusses with Dreaming of Baby what parents need to know about newborn health markers and what to look out for when selecting a pediatrician.
Daniela: Good afternoon, Doctor Jarret, and welcome to Dreaming of Baby. It’s a pleasure to be able to discuss with you today all that parents-to-be need to know before the baby is born. Before we start with our discussion, it would be great if you could introduce yourself to our readers.
“Doctor Jarret” Patton MD FAAP: Good afternoon, I’m “Doctor Jarret” Patton MD and I have served thousands of children in eastern Pennsylvania for over 15 years. Throughout my career as a pediatrician and Medical Director, I have remained an advocate for children’s health issues. Over time, my servant leadership style led me to curtail clinical practice to become a change agent in the healthcare system. I have published in the medical literature and contributed to books primarily in the areas of general pediatrics, cultural competency and health equity. I am also the founder and CEO of DoctorJarret, PLLC, a coaching and consulting firm which helps educate, enlighten, and improve healthcare.
How to select a pediatrician
Daniela: Great, thank you for this introduction, Doctor Jarret. With the aim of assisting parents-to-be in their journey, what should they be considering when selecting a pediatrician for their baby and how early should this be done?
“Doctor Jarret” Patton MD FAAP: It may take some time to find the perfect pediatrician for you and your baby. You can start by asking your obstetrician, friends and family. From there, you can call the office and ask to have a “meet and greet” with the pediatrician. This will give you a face to face opportunity to meet the pediatrician and ask about some of her ideals and office policies. You will get a better feel for them in person versus a website. You should also be sure that they accept your insurance, or have a cash payment option in writing. This will help you avoid unnecessary bills. In addition, you can determine if they are licensed in your state and have board certification by the American Board of Pediatrics.
“Doctor Jarret” Patton MD FAAP: You can start this process anytime during your last trimester if you are expected to go full term.
Daniela: Thank you for this overview, Doctor Jarret. Moving to the birth, would the baby be seen by a pediatrician immediately at birth or this is something that happens later given that no complications arise? And would this usually be the same pediatrician as selected prior by the parents?
“Doctor Jarret” Patton MD FAAP: Typically, the pediatrician will see your baby at some time during the first 24 hours of life if there are no complications. It depends on what time of day your baby is born and the time the physician does rounds in the hospital. The pediatrician could be your same pediatrician, however, if that is important to you, you should also ask that question while screening new pediatricians. If the doctor is a part of a large practice, it may be one of the partners that sees you in the hospital, but they will make sure you see your preferred pediatrician in the office. Some pediatricians do not go to the hospital at all.
Doctor Jarret: “Typically, the pediatrician will see your baby at some time during the first 24 hours of life if there are no complications.”
What do pediatricians look for when baby is born?
Daniela: That is very good to know. And what do pediatricians specifically examine/look for in a newborn?
“Doctor Jarret” Patton MD FAAP: We perform an overall assessment of your baby at birth. We check the basic functioning of the baby like the heartbeat, breathing, feeding patterns, stooling, urination, and activity level. We also look for any birth defects that we may discover. We pay particular attention for jaundice, which is the temporary yellow color of the eyes or skin in the first few days after birth.
Daniela: You mention jaundice – how common is it and at which point does this become worrying?
“Doctor Jarret” Patton MD FAAP: Jaundice is very common in the newborn period. This is because the substance that causes jaundice, bilirubin, does not get eliminated well by the baby in the first few days. Bilirubin is a natural substance in our blood. However, a baby’s liver takes a few days before it can eliminate it properly. Until then, the baby has to rely on stooling to eliminate the substance. Your baby’s doctor may take a blood test to determine the level, at which point we determine if it is at a dangerous level or not. Most babies do not need treatment for this condition; it gets better on its own. If treatment is needed, painless, ultraviolet lights can be placed on or over your baby to help reduce the substance.
Daniela: Thank you for elaborating on this subject. On a different note, are there any immunizations given immediately at birth?
“Doctor Jarret” Patton MD FAAP: Typically, your baby will get one immunization during the hospital stay: hepatitis B.
Newborn health: what’s normal and what isn’t?
Daniela: Proceeding to the taking baby home stage: Life with a newborn can be quite a haze so it’s important for parents to know what should be reason for worry and what shouldn’t. In this regard, what should parents be on the alert for and what should they expect that may seem worrying but is in fact normal?
“Doctor Jarret” Patton MD FAAP: As a new parent, it is natural to worry about every sound, hiccup or gas bubble your baby has. However, there are a few warning signs that you should be aware of. If your baby has a fever (temperature at or above 100.4 F), poor feeding, excessive sleepiness, decreased diaper wetting or excessive vomiting, you should contact your doctor right away.
Doctor Jarret: “There are a few warning signs that you should be aware of. If your baby has a fever (temperature at or above 100.4 F), poor feeding, excessive sleepiness, decreased diaper wetting or excessive vomiting, you should contact your doctor right away.”
Daniela: In terms of diaper-wetting, what should be normal for a newborn? Would this differ between breastfed and formula-fed babies?
“Doctor Jarret” Patton MD FAAP: They should have at least 5 soaking wet diapers a day. Don’t be surprised if it is closer to 8-10 in the first few days. It may be slightly less in breastfed babies in the beginning, but this increases as the mother’s milk supply increases during the first few days.
For how long should newborns sleep?
Daniela: You also mention excessive sleepiness – parents-to-be might be thinking, ‘but newborns sleep a lot’. When would a lot of sleep be too much?
“Doctor Jarret” Patton MD FAAP: Newborns do sleep a lot. They may sleep close to 18-20 hours per 24 hours in the initial few days. It is more based on the period of time they stay asleep. They should wake at least every 3-4 hours to feed. If they sleep longer than that, they should be awoken to feed. If they have difficulty awakening to feed, that is when you should contact your doctor.
Doctor Jarret: “[Babies] should wake at least every 3-4 hours to feed. If they sleep longer than that, they should be awoken to feed. If they have difficulty awakening to feed, that is when you should contact your doctor.”
Daniela: Many thanks for clarifying. Based on your experience working in pediatrics, what are new parents usually most worried about and how could this be addressed?
“Doctor Jarret” Patton MD FAAP: Parents are most frequently concerned about their baby being “normal.” The best way to alleviate that concern is to attend the doctor visits. The first year of life may have as many as 7 or 8 well baby visits even if everything is going well. It is fine to keep a journal of questions so that you have them handy for the doctor’s visits.
What to expect at well-baby visits
Daniela: Speaking of doctor’s visits; what kind of questions should parents expect at well-baby visits? (As this would also help them stay on the alert for these factors.)
“Doctor Jarret” Patton MD FAAP: We are interested in how your baby sleeps, how many wet and dirty diapers and feeding schedules and amounts, if known. This helps us correlate the baby’s activity to the growth that we follow on the growth charts. We will also ask you about any concerns that you may have as a parent.
Daniela: As you shared with us then, keeping a journal will come in handy. In terms of newborn breathing; what’s normal and what’s not?
“Doctor Jarret” Patton MD FAAP: Newborns have the unique property of having varying respiratory rates. Unlike older children and adults that may breathe around 16 breaths per minute, a newborn breathes between 30 and 60 breaths per minute. You may notice a brief pause in between breaths (particularly while sleeping) and this is normal, they usually catch up by breathing faster during other periods.
Daniela: Excellent, thank you for sharing this insight. On a final note, what would be that one piece of take-home advice that you’d give parents-to-be as they prepare for their baby’s arrival?
“Doctor Jarret” Patton MD FAAP: It never hurts to start reading about what to expect from your baby. There are many resources to learn about your baby and parenting. Although your baby won’t fit perfectly with what you read (no baby does), you will be better prepared on what to expect or how to react.
Daniela: Thank you, Dr. Jarret, the information you have shared with us today will be helpful to many on their journey towards parenthood. Thank you for your time today, it’s been a pleasure speaking with you!
“Doctor Jarret” Patton MD FAAP: Thank you, Daniela. I hope this will be helpful as I know it is a very nerve-wracking time leading up to having a baby.
Daniela: It is indeed, we’re sure this insight will help many!