Guide you in anticipating your child’s needs from newborn to 21.
Experience
As part of their extensive training, pediatricians are experienced in the physical, emotional, and social development of children. Children may be too young or shy to talk so pediatricians understand the importance of listening carefully to your child, and to you. Pediatricians answer your questions, helping you to understand and promote your child’s healthy development. Pediatricians also address issues affecting a child’s family and home environment.
Pediatricians understand that children are not simply small adults.
They often present different symptoms from adults. They may need different prescriptions or treatments than adults. Pediatricians are specially trained to recognize the importance of these differences, especially with young children and newborns.
The American Academy of Pediatrics believes that circumcision has potential medical benefits and advantages, as well as risks. Evaluation of current evidence indicates that the health benefits of newborn male circumcision outweigh the risks and that the procedure’s benefits justify access to this procedure for families who choose it, however, existing scientific evidence is not sufficient to recommend routine circumcision. Therefore, because the procedure is not essential to a child’s current well-being, we recommend that the decision to circumcise is one best made by parents in consultation with their pediatrician, taking into account what is in the best interests of the child, including medical, religious, cultural, and ethnic traditions.
Your pediatrician (or your obstetrician if he or she would be performing the circumcision) should discuss the benefits and risks of circumcision with you and the forms of analgesia that are available.
Walk into any baby store and you probably will be overwhelmed by the selection of equipment available. A few items are essential, but most things, while enticing, are not necessary. In fact, some are not even useful.
To help you sort through the options, here is a list of the basic necessities you should have on hand when your baby arrives:
A crib that meets all safety specifications. New cribs sold today must meet these standards, but if you’re looking at used cribs, check them carefully to make sure they meet the same standards and have not been recalled. Unless you have money to spare, don’t bother with a bassinet. Your baby will outgrow it in just a few weeks.
Bedding for the crib, including a flannel-backed, waterproof mattress cover (which is cooler and more comfortable for your baby than plain plastic or rubber covers), and tight fitted sheets. Never use infant cushions that have soft fabric coverings and are loosely filled with plastic foam beads or pellets. Remove all pillows, quilts, comforters, sheepskins, and other pillow like soft products. Remember that the safest position for a baby to sleep in is on her back.
A changing table that meets all safety specifications. It should be placed on a carpet or padded mat and against a wall, not a window, so there is no danger of your child falling out the window. Put shelves or tables to hold diapers, wipes, and other changing equipment within immediate reach (but away from the baby’s reach), so you will not have to step away from the table—even for a second—to get anything.
A diaper pail. Keep the pail securely closed. If you are going to wash your own diapers, you’ll need a second pail so you can separate wet diapers from “soiled” ones.
A large plastic washtub for bathing the baby. As an alternative to the washtub, you can use the kitchen sink to bathe your newborn, provided the faucet swings out of the way and the dishwasher is off. (The water from the dishwasher could dump into the sink, resulting in scalding.) After the first month, it’s safer to switch to a separate tub, because the baby will be able to reach and turn on the faucet from the sink. Always make sure the bathing area is very clean before bathing your baby. Also, be sure the hottest temperature at the faucet is no more than 120 degrees Fahrenheit (48.9 degrees Celsius) to avoid burns. In most cases, you can adjust your water heater.
Keep Everything Clean
Everything in the nursery should be kept clean and dust-free. All surfaces, including window and floor coverings, should be washable. So should all toys that are left out. Although stuffed animals look cute around newborns (they seem to be a favorite shower gift), they tend to collect dust and may contribute to stuffy noses. Since your baby won’t actively play with them for many months, you might consider storing them until she’s ready for them.
Cool Mist Humidifiers
If the air in the nursery is extremely dry, your pediatrician may recommend using a cool mist humidifier. This also may help clear your child’s stuffy nose when she has a cold. If you do use a humidifier, clean it frequently as directed in the package instructions and empty it when not in use. Otherwise, bacteria and molds may grow in the still water. Steam vaporizers are not recommended because of the danger of scalding.
Mobiles
One object that your baby is sure to enjoy is a mobile. Look for one with bright colors (the first color she’ll see is red) and varied shapes. Some also play music. When shopping for a mobile, look at it from below so that you’ll know how it appears from your baby’s point of view. Avoid the models that look good only from the side or above—they were designed more for your enjoyment than for the infant’s. Make sure you remove the mobile at five months of age or as soon as your baby can sit up, because that’s when she’ll be able to pull it down and risk injury.
Other Useful Equipment
Other useful additions to the nursery may include a rocking chair or glider, a music box or musical toy and a tape, CD, or MP3 player. The rocking motion of the chair will increase the soothing effect your baby feels when you hold her. Playing soft music for your baby will comfort her when you’re not nearby and will help her fall asleep.
Lighting
You will want to keep the lights in the nursery soft once your newborn has arrived and leave a night-light on after dark. The night-light will allow you to check on the baby more easily, and as she gets older, it will reassure her when she awakens at night. Make sure all lights and cords are kept safely out of the baby’s reach.
If you have a boy, you’ll need to decide whether to have him circumcised. Unless you are sure you’re having a girl, it’s a good idea to make a decision about circumcision ahead of time, so you don’t have to struggle with it amid the fatigue and excitement following delivery.
Circumcision has been practiced as a religious rite for thousands of years. In the United States, most boys are circumcised for religious or social reasons. At present, there is discussion over whether circumcision is advisable from a medical standpoint. There are potential medical benefits to circumcision as well as risks. A recent analysis by the American Academy of Pediatrics concluded that the medical benefits of circumcision outweigh the risks. Studies have concluded that circumcised infants have a slightly lower risk of urinary tract infections, although these are not common in boys and occur less often in circumcised boys mostly in the first year of life. Neonatal circumcision also provides some protection from penile cancer, a very rare condition.Some research also suggests a reduced likelihood of developing sexually transmitted diseases and HIV infections in circumcised men, and possibly a reduced risk for cervical cancer in female partners of circumcised men. However, while there are potential medical benefits, these data are not sufficient to recommend routine neonatal circumcision of all boys. We recommend that the decision to circumcise is one best made by parents in consultation with their pediatrician, taking into account what is in the best interests of the child, including medical, religious, cultural, and ethnic traditions and personal beliefs.
Circumcision does, however, pose certain risks, such bleeding and swelling. While they may occur, however, bleeding and swelling are rare.
Although the evidence also is clear that infants experience pain, there are several safe and effective ways to reduce the pain. If the baby is born prematurely, has an illness at birth, or has congenital abnormalities or blood problems, he should not be circumcised immediately. For example, if a condition called hypospadiasis present, in which the infant’s urinary opening has not formed normally, your doctor will probably recommend that your baby boy not be circumcised at birth. In fact, circumcision should be performed only on stable, healthy infants.
Circumcision
At birth, most boys have skin that completely covers, or almost covers, the end of the penis. Circumcision removes some of this foreskin so that the tip of the penis (glans) and the opening of the urethra, through which the baby urinates, are exposed to air. Routine circumcisions are performed in the hospital within a few days of birth. When done by an experienced physician, circumcision takes only a few minutes and is rarely complicated. After consultation with you, your doctor will provide local anesthesia to reduce the pain the baby experiences during the procedure; the doctor should inform you in advance about the type of anesthesia she recommends.
Before your baby arrives, you’ll want to consider whether you’re going to breastfeed or use formula. The American Academy of Pediatrics advocates breastfeeding as the optimal form of infant feeding. Even though formula feeding is not identical to breastfeeding, formulas do provide appropriate nutrition. Both approaches are safe and healthy for your baby, and each has its advantages.
The most practical benefits of breastfeeding are convenience and cost, but there are some real medical benefits, too. Breastmilk provides your baby with natural antibodies that help her resist some types of infections (including ear, respiratory, and intestinal infections). Breastfed babies also are less likely to suffer from allergies that occasionally occur in babies fed cow’s milk formulas. Breastfed infants also may be less likely to develop asthma and diabetes, or become overweight, than those who are bottle-fed.
Mothers who nurse their babies feel there are many emotional rewards. Once the milk supply is established and the baby is nursing well, both mother and child experience a tremendous sense of closeness and comfort, a bond that continues throughout infancy. The first week or two can be challenging for some, but most pediatricians can offer guidance or refer you to a certified lactation consultant for assistance if needed.
If there is a medical reason you cannot breastfeed or you choose not to do so, you still can achieve similar feelings of closeness during bottle-feedings. Rocking, cuddling, stroking, and gazing into your baby’s eyes will enhance the experience for both of you, regardless of the milk source.
Before making your decision on this issue, be sure you thoroughly understand the advantages and disadvantages of breastfeeding and bottle-feeding, and you are aware of all the options available to you. If you decide upon breastfeeding, there are classes available in many communities to help you plan for breastfeeding and get your questions about it answered. Ask your doctor for a referral.
As your due date nears, you’ll need a basic collection of baby clothes and accessories that will get your newborn through his first few weeks.
A suggested starting list to register for includes:
3 or 4 sleepwear sets
6 to 8 T- shirts
3 newborn sleep sacks
2 sweaters
2 caps/hats
4 pairs of socks or booties
4 to 6 receiving/swaddle blankets
1 set of baby washcloths and towels (look for towels with hoods)
3 to 4 dozen newborn-size diapers
3 to 4 onesies/T- shirts with snaps between legs
Guidelines on Making Baby Clothes Choices
Here are some suggestions to keep in mind when selecting clothing for your newborn:
Buy big. Unless your baby is born prematurely or is very small, they probably will outgrow “newborn” sizes in a matter of days—if theyever fits into them at all! Even three-month sizes may be outgrown within the first month. Your baby won’t mind roomier clothes for a while.
To avoid injury from a garment that catches fire, all children should wear flame-retardant sleepwear and clothing. Make sure the label indicates this. These garments should be washed in laundry detergents, not soap, because soap washes out the flame retardant. Check garment labels and product information to determine which detergents to use.
Make sure the diaper area of clothing has snaps or access to be able to change diapers.
Avoid any clothing that pulls tightly around the neck, arms, or legs or has ties or cords. These clothes are not only safety hazards, but are also uncomfortable.
Check washing instructions. Clothing for all children of all ages should be washable and require little or no ironing.
Do not put shoes on a newborn’s feet. Shoes are not necessary until after they start to walk. Take care that socks are not too tight around your baby’s feet and ankles.
You will find that we tend to refer to babies’ health care providers as pediatricians as a matter of convenience, and the American Academy of Pediatrics (AAP) does believe that pediatric health care is optimally delivered by a pediatrician. There are also, however, non-physician clinicians who are important members of the pediatric health care team and who also care for babies and children.
MD and DO. If doctors have an MD after their names, it simply tells you that they attended a “traditional” medical school. Others have the initials DO after their names—a designation that tells you they are graduates of osteopathic medical schools. MD and DO medical schools train physicians, and both types of doctors can go on to do pediatric residency training specializing in the care of children. While there are some differences between these 2 types of physicians, both are educated about normal human health and disease conditions.
Board-certified pediatrician. Board-certified pediatricians are physicians who have graduated college, completed 4 years of medical school, and have at least 3 years of “on-the-job” training (residency) in pediatrics. To become board certified, pediatricians must also pass a rigorous examination given by the American Board of Pediatrics (ABP). To remain board certified, pediatricians have to maintain ongoing education in pediatrics, demonstrate quality patient care, and hold a valid medical license. These certification requirements help ensure that certified pediatricians (including specialists) have sufficient knowledge and skills to provide quality care for children of all ages.
Family physician. Family practice doctors can be either MDs or DOs and, like pediatricians, also complete medical school and at least 3 years of “on-the-job” training (in a family medicine residency). Like pediatricians, family physicians must also pass an examination and meet several criteria to become board certified and then renew their certification. Unlike pediatricians, however, family physicians do not limit their practice to the care of children from birth through adolescence. As their titles imply, they care for patients of all ages.
Nurse practitioner. In some instances, you may find that your baby is scheduled to see a pediatric or family nurse practitioner. These health care providers are registered nurses with additional education. Those who specialize in pediatrics generally have specific advanced training in caring for children. Nurse practitioners may work in your doctor’s office as part of a physician-led team.
Whomever you choose, you’ll want to make sure that they have the training and/or experience to offer guidance on the health- and illness-related matters you may encounter—many of which are unique to childhood.
Use our Find a Pediatrician tool to search for an AAP member pediatrician, pediatric sub-specialist, or pediatric surgical specialist near you.
By: Mitchell S. Cairo, MD, FAAP & Allyson Flower, MD
Many parents have questions about umbilical cord blood banking and donation.
The American Academy of Pediatrics policy statement, “Cord Blood Banking for Potential Future Transplantation” calls for renewed emphasis and education about the advantages and need for public cord blood banking.
Stem Cell Transplants
A stem cell transplant can be used to treat children with cancer and other life-threatening diseases including metabolic, immune, and blood disorders. As more newborns are screened for potentially fatal diseases, the number of stem cell transplants has increased as well. Using cord blood for stem cell transplants instead of bone marrow or peripheral blood stem cells is less invasive and expands the number of possible donors. The primary purpose of storing cord blood is so that a child with a potentially fatal disease can receive the banked cord blood from an unrelated matched donor.
Other uses of stored cord blood include:
Directed donation: When a child with a known disorder has a matched sibling donor. Upon delivery, the newborn sibling’s cord blood can be stored and later used for a stem cell transplant.
Personal use: The use of a child’s own banked cord blood is limited. For example, if a child develops leukemia, that child’s stored cord blood will likely have the potential to progress to leukemia and cannot be used. Although the future use of a child’s own banked cord blood for regenerative purposes in some chronic diseases is promising, further research is needed.
Public vs. Private Banking
There is a difference between public cord blood banks and private, for-profit cord blood banks.
Public cord blood banking is preferred, here’s why:
Frequency of use: Cord blood from public blood banks is used more often than privately banked cord blood. Thirty times more publicly banked cord blood units are used for transplants compared to privately banked cord blood.
Quality: Collection, evaluation and preservation of publicly banked cord blood is highly regulated by accrediting institutions such as the NetCord/Foundation for Accreditation of Cell Therapy, the FACT/Joint Accreditation Committee, and the American Association of Blood Banks. Private cord blood banks may or may not choose to meet these standards. This is why publicly stored cord blood has been shown to be of higher quality—increasing the potential for a successful stem cell transplant. Parents who are thinking about private cord blood banking are encouraged to ask these facilities about accreditation, costs, failure rates of their stored cord blood to achieve successful transplantation, and method of backup electrical systems in case of storage equipment failure. Conflicts of interest and financial disclosures should be provided.
Cost: There is no cost to the donor family with public cord blood banking. Private cord blood banking requires a processing fee of $1350-$2350 and an annual maintenance fee of $100-175.
Ethical considerations: Publicly banked cord blood is available to anyone. National and international public cord blood banks are searchable for children with life-threatening diseases throughout the world who need a stem cell donor. Private banking serves the needs of only one family.
Closing the Diversity Gap
Ethnic minorities are encouraged to consider public cord blood donation, as the need is great. Public donation is free and builds up the supply of cord blood that can then serve the needs of others in these populations.
How You Can Donate to a Public Cord Blood Bank
Donating cord blood is safe for the baby and doesn’t interfere with labor and delivery. Because families must register ahead of time—so a collection kit can be sent and used after the baby is born—parents should talk about cord blood banking with your obstetrician, pediatrician, or other medical personnel at the first prenatal visit. Cord blood donation should be arranged by the 34th week of pregnancy.
Does every hospital collect cord blood for public donation?
No. There is legislation in some states to support more funding for public cord banking, which is usually recovered when a patient’s insurance is billed for a transplant. Check if your hospital is on the Be the Match list of participating cord blood collection hospitals. The Parent’s Guide to Cord Blood Foundation guide to USA Donation Hospitals includes additional donation programs that may not be listed with Be the Match.
If my hospital doesn’t work with a public cord bank, can I still donate?
If the hospital where you plan to have your baby does not work directly with a public cord blood bank, you can still donate by enrolling in a mail-in donation program. The Parent’s Guide to Cord Blood lists public banks that accept cord blood donations by mail. Talk with your doctor or midwife to make sure he or she is trained to collect the cord blood.
Parents now have the option of using the latest in audio and video baby monitoring to listen to and watch their baby from afar. Many parents find that this type of technological surveillance buys them peace of mind, by allowing them to roam freely around the house while they are still keeping tabs on their baby. If you choose to use a monitoring device, camera, and/or app, you may want to keep the following considerations in mind:
Nothing beats the real thing. First and foremost, never let baby-monitoring technology substitute for direct supervision and taking sensible safety measures. Also, be aware there is unfortunately no evidence that using a monitor decreases the chance of SIDS.
Range. Baby monitors themselves are only as good as their technological limitations, so we suggest you take a look at what kind of listening range, clarity of view, and data they each offer. The kind that sync with some of the baby-monitoring apps, of course, have solved what used to be a more common range limitation by making use of cloud-based access.
It works both ways. There are steps you can take to minimize the potential for interference, hacking, or fuzzy reception, starting with simply following the product instructions. This typically includes recommended security precautions such as setting a strong password for the monitor and your home’s wireless network, updating software regularly, and keeping other electronic devices away from the monitoring unit as necessary.
Disrupting the peace. Some of you may find that leaving the monitor on at night significantly disturbs whatever limited sleep you stand to get, causing you to be wide awake in response to your slumbering baby’s every twitch or snort.
Channel surfing. In this age of modern electronics, there’s more than enough to interfere with your monitor, including cordless phones, cell phones, radio stations, and other monitors. Try to find a monitor with good reception and more than one channel to decrease the likelihood of interference. We also suggest holding onto your receipt in case you run into any unforeseen technological conflicts that become apparent only once you put the monitor to use at home.
Bells and whistles. Give some thought to which bells and whistles you really want and which simply serve to raise the price. Some of the available added features include a portable receiver with a belt clip, two-way walkie-talkie radio capability, night vision, a room-temperature sensor, a receiver that vibrates or flashes lights so you can leave the sound turned off, the ability to watch your baby on your computer or other devices using your wireless network, and the possibility of purchasing multiple portable receivers that can accompany a single base station.
Safety reminders. All monitor bases and additional units should be wireless or, if they have a cord, must be well out of baby’s reach.
The best way to start looking for a pediatrician is by asking other parents you know and trust. They are likely to know you, your style and your needs. You also should consider asking your obstetrician for advice. They will know local pediatricians who are competent and respected within the medical community. If you’re new to the community, you may decide to contact a nearby hospital, medical school, or county medical society for a list of local pediatricians. If you are a member of a managed care plan, you probably will be required to choose a pediatrician from among their approved network of doctors.
What to consider
Once you have the names of several pediatricians to consider, start by contacting and arranging a personal interview with each of them during the final months of your pregnancy. Many pediatricians are happy to fit such preliminary interviews into their busy schedules.
Before meeting with the pediatrician, the office staff should be able to answer some of your more basic questions:
Is the pediatrician accepting new patients with my insurance or managed care plan?
What are the office hours? Do they include weekends and holidays?
What is the best time to call with routine questions?
Do the doctors answer secure e-mail or other HIPAA compliant electronic communications?
Who answers the phone if my baby has an issue after the office has closed?
How does the office handle billing and insurance claims? Is payment due at the time of the visit?
Both parents should attend the interviews with pediatricians, if possible, to be sure you both agree with the pediatrician’s policies and philosophy about child rearing. Don’t be afraid or embarrassed to ask any questions.
Here are a few suggestions to get you started:
How soon after birth will the pediatrician see your baby?
Most hospitals ask for the name of your pediatrician when you’re admitted to deliver your baby. The delivery nurse will then phone that pediatrician or her associate on call as soon as your baby is born. If you had any complications during your pregnancy or delivery, your baby should be examined at birth. This exam may be conducted by a staff pediatrician or neonatologist at the hospital if your pediatrician is not there at the time of delivery. Otherwise, the routine newborn examination can take place anytime during the first 24 hours after birth.
Ask the pediatrician if you can be present during that initial examination. This will give you an opportunity to learn more about your baby and get answers to any questions you may have. Your baby will undergo routine newborn tests that will screen for hearing and jaundice levels as well as thyroid and other metabolic disorders.
Other tests may be needed if your baby develops any problems after birth or to follow up on findings on your prenatal sonograms.
When will your baby’s next exams take place?
Pediatricians routinely examine newborns and talk with parents before the babies are discharged from the hospital. Many pediatricians will check the baby daily in the hospital, and then conduct a thorough exam on the day of discharge. During these exams, the doctor identifies any problems, while also giving you a chance to ask questions. Your pediatrician also will let you know when to schedule the first office visit for your baby and how to reach them if a medical problem develops before then.
All babies also should begin their immunizations before leaving the hospital. The first and most important “immunization” is starting to breastfeed your baby as soon as possible after birth. This provides some early disease protection for your baby. The second recommended immunization is the first dose of the hepatitis B vaccine, which is given as a shot in the baby’s thigh. Your baby will receive the next series of vaccinations when they are eight weeks old, including the second dose of hepatitis B.
When is the doctor available by phone? Email?
Some pediatricians have a specific call-in period each day for questions, while others will return calls as they come in. If office staff routinely answer these calls, consider asking what their training is. Also ask your pediatrician for guidelines to help you determine which questions can be resolved via phone and which require an office visit. Some pediatricians prefer using secure electronic messaging, usually through an online portal. You both may find this more convenient. It may also help foster a relationship with the doctor. Some doctors also offer electronic visits via telemedicine.
Which hospital does the doctor prefer to use?
Ask the pediatrician where to go if your child becomes seriously ill or is injured. If the hospital is a teaching hospital with interns and residents, find out who would actually care for your child if they were admitted.
What happens if there is an after-hours (nighttime or weekend) concern or emergency?
Find out if the pediatrician takes their own emergency calls at night. If not, how are such calls handled? Also, ask if the pediatrician takes office visits after hours, or if you must take your child to an emergency department or urgent care center. When possible, it’s easier and more efficient to see the doctor in their office, because hospitals often require lengthy paperwork and extended waits. However, serious medical problems usually are better handled at the hospital, where staff and medical equipment are always available.
Who covers the practice when your pediatrician is unavailable?
If your physician is in a group practice, it’s wise to meet the other doctors in the practice, since they may treat your child in your pediatrician’s absence. If your pediatrician practices alone, they probably will have an arrangement for coverage with other doctors in the community. Usually your pediatrician’s answering service will refer you to the doctor on call, but it’s still a good idea to ask for the names and phone numbers of all the doctors who take these calls—just in case you have trouble getting through to your own physician.
If your child is seen by another doctor at night or on the weekend, you should check in by phone with your own pediatrician the next morning (or first thing Monday, after the weekend). Your doctor probably will already know the situation, but this contact will give you a chance to bring them up to date and let them reassure you that everything is being handled as they would recommend.
How often will the pediatrician see your baby for checkups and immunizations?
The American Academy of Pediatrics (AAP) recommends a checkup within 48 to 72 hours after your newborn is discharged from the hospital. This is especially important in breastfed babies to evaluate feeding, weight gain and any yellow discoloration of skin (jaundice). Your pediatrician may adjust this feeding schedule, particularly in the first weeks after birth, depending on how your newborn is doing.
During your baby’s first year after birth, additional visits to your doctor’s office should take place at about two to four weeks of age, and then at two, four, six, nine and 12 months of age as well. During your baby’s second year of life, they should be seen by your pediatrician at ages 15, 18, and 24 and 30 months, followed by annual visits from three to five years of age. If the doctor routinely schedules examinations more or less frequently than the AAP’s guidelines, discuss the differences with them. Additional appointments can be scheduled any time that you have a concern or if your child is ill.
What are the costs of care?
Your pediatrician should have a standard fee structure for hospital and office visits as well as after-hours visits and home visits (if they make them). Find out if the charges for routine visits include immunizations. Be sure to familiarize yourself with the scope of your insurance coverage before you actually need services.
After these interviews, ask yourself if you are comfortable with the pediatrician’s philosophy, policies and practice. You must feel that you can trust them and that your questions will be answered, and your concerns handled compassionately. You also should feel comfortable with the staff and the general atmosphere of the office.
Remember
Once your baby arrives, the most important test of the pediatrician is how they care for your child and responds to your concerns. If you are unhappy with any aspect of the treatment you and your child are receiving, you should talk to the pediatrician directly about the problem. If the response does not address your concerns, or if the problem simply cannot be resolved, seek out another physician.
