Tina Manshadi, M.D. from Cook Children’s Pediatrics (Plano) shared this mother’s experience from a recent newborn class session:

“I remember a mom who came to class looking really worried about whether her baby would be getting enough milk in those early days,” Dr. Manshadi explained. “She kept saying, ‘How will I know?’ So, we sat together and walked through all the little clues we look for, such as how a baby feeds, how they’re gaining weight, monitoring diapers, and the signs that her milk supply was coming in just fine. As we talked, you could see her shoulders relax. By the end, we had a plan that matched her goals, and she knew she wouldn’t be figuring it all out alone. We were a team, and that made all the difference.”

The ‘team’ approach is how the pediatricians at Cook Children’s view newborn care. Below, four of our pediatricians leading these classes answer some of the big questions and help prepare parents for the classes.

Beyond the basics, what is the primary benefit parents gain from attending this class?

“It is a great chance to understand what to expect from a pediatrician’s office and to get a sense of the doctor who might be seeing you a whole bunch those first several years,” says Alison Hsu, M.D., from Cook Children’s Pediatrics (Parkwood). “There are no dumb questions,” she emphasizes.

Amy Stockhausen, M.D. from Cook Children’s Pediatrics (Carrollton) says “expectant parents who attend this class have the chance to really communicate with and get to know the physician teaching the class.” “They have the opportunity to ask questions they are particularly worried about and get answers from a physician instead of online,” Dr. Stockhausen continues.

For a new parent arriving feeling unsure or worried, what does a typical newborn class look like? What can they do to prepare beforehand?

Dr. Hsu encourages that since “these tend to be smaller classes; it can be structured in the way that works best for the parents attending.” “We have a presentation we can go over if you’re not sure what to ask or expect, but we can also spend extra time on topics of interest, skip past things that aren’t of interest, and have free and open discussion. To prepare, parents can certainly come with specific questions or considerations for their situation.”

What is one essential topic you cover that surprises parents the most, and why is it so critical for those first few weeks?

“One thing that always surprises parents is just how normal so many newborn behaviors really are,” says Dr. Manshadi. “Frequent feeding, quirky sleep patterns, sneezing, hiccups, and plenty of crying are all part of healthy development. Once parents learn this, you can almost see the relief—they realize their baby isn’t ‘difficult,’ they’re simply being a newborn. That reassurance can make those first few weeks feel a whole lot lighter,” she encourages.

What do you hope is the single biggest takeaway every parent carries home with them after their class?

Dr. Stockhausen reminds parents “that they have good instincts, even if they have little experience in caring for babies.” “There is a lot of information from friends, neighbors, family and the internet; I hope families learn that they are the best source of knowledge about what is right for their baby and their family. We are here to support them with education and scientific advice whenever they need us!”

“I want every parent to walk away knowing they’re never on this journey alone,” encourages Dr. Manshadi. “Welcoming a new baby is exciting, but it can also feel overwhelming—and that’s exactly why we’re here. Whether it’s a big worry or a small question that pops up, I want parents to feel comfortable reaching out anytime.”

How do these classes provide support for the parents as they navigate life with a newborn?

Diana Nguyen, D.O. from Cook Children’s Pediatrics (Parkwood) says “attending a class will give parents an introduction to the clinic and a chance to meet with the pediatrician. You may also get to meet and chat with other parents who are experiencing the same things you are or have the same questions as you do.”

The "team" approach doesn't end when the class is over; it’s the beginning of a lifelong partnership in your child’s health. If you’re expecting or have recently welcomed a newborn, we invite you to join us at one of our participating locations.

Below is a list of all clinics offering these newborn classes and the links to sign up. We look forward to being a part of your journey!

• Cook Children’s Pediatrics (Aubrey)
• Cook Children's Pediatrics (Collin County)
• Cook Children’s Pediatrics (Keller Parkway)
• Cook Children’s Pediatrics (Lake Worth)
• Cook Children’s Pediatrics (Parkwood)
• Cook Children’s Pediatrics (Plano)
• Cook Children’s Pediatrics (Windhaven)

Being a new parent is hard.

Being a new parent today is even harder.

With the limitation of visitors, changes to doctor’s offices, and lack of ability to get out of the house (among many other challenges), being a parent in COVID-times is causing new parents to feel even more isolated and ill-equipped.

But, when can you have visitors over to meet your newborn?

Like most things COVID-related, it’s not a simple question.

It’s also a decision that, given all the same information, two families might make very different choices.

Even in “normal” times, I believe that babies under 2 months should have a pretty tight circle drawn around them, which can relax more with each round of shots at 4 and 6 months. COVID has just heightened my desire to protect them even more.

It appears that infants less than 1 year are at a higher risk of severe illness than other kids.. Because of the upfront, face-to-face nature of caring for them, they may be at higher risk for exposure from a caregiver. When considering this decision, it’s essential to keep in mind the reverse (and perhaps more significant) risk to the person entering the house. Many grandparents and other family members might fall into higher-risk categories based on age or medical conditions.

But that doesn’t mean you have to go it alone.

Here are three factors to consider:

1. The purpose of the visit.
2. The behavior of the visitor.
3. The activity at the visit.

The purpose of the visit.

The first time this comes up is at the time of delivery. If you have an older child at home, they need to be taken care, of and you should have the opportunity to have someone to support you at delivery. This one is easy. Ask the grandparent or other caregiver to take caution with social distancing, masking and other precautions around 36 weeks so that they can be as safe as possible entering the home.

After the initial delivery phase, some parents may need ongoing support from a close family member. When a parent has to go back to work or doesn't have a lot of experience with babies, they may need ongoing support. The safest way to do this is to ensure that the person entering your home has been following guidelines for at least 2 weeks before the visit. If possible, they should plan to come and stay as much as possible rather than coming and going frequently. Staying put limits their number of contacts and lowers the risk for everyone.

Purely social visits are probably the riskiest. Having any number of visitors drop in to say hi significantly increases the baby's risk because of the number of possible contacts and the lack of control over their behavior and exposures. Some parents might feel comfortable with a very close friend or family member. Still, we all must recognize the risk of doing so.

The behavior of the visitor.

There are many different approaches and mindsets concerning coronavirus. While I wish everyone took a cautious approach, that’s not the case. And while you may have family members who argue they have the right to make their own decisions regarding social distancing, mask-wearing and the like not everyone has the right to make their own decisions AND get to spend time with your baby.

If you have a close friend or family member you trust is taking an extremely cautious approach, you may feel more comfortable inviting them come over to meet your baby. Remember that you get to make your own decisions about what makes you comfortable. If you decide to take a more conservative route than your family appreciates, feel free to blame your pediatrician (especially if it's me). I promise we’re cool with that.

The activity at the visit

Once you’ve decided you’re going to see family, there are still questions about what will happen at the visit. Of course, at a baseline, we’re going to do all the usual things we would ask anyone to do when visiting a newborn.

1. No one comes over who has possible symptoms, such as a cough, runny nose, (obviously) fever, etc.
2. No one holds the baby without washing hands first.
3. No one kisses the baby period.

Extra precautions you might consider in the context of COVID would be (in decreasing order of safety): drive-by only visits, patio/outside visit, no-holding/across the room visit or a masked visitor visit.

Be gracious with yourself and others

Remember again that every parent and family will make different decisions and have different comfort levels. Be kind to yourself and your fears. Consider the impact of not having visitors vs. having visitors and what that means for your level of stress because it might affect each parent differently. If you are the potential visitor, be kind, and understand if the new parents in your life ask you to stay away

We're all in this together for the long haul, and they are dealing with enough stress as it is.

Newborn Notes From a Pediatrician:

1. The hiccups are normal.
2. The sneezing is normal. It’s not allergies.
3. The booty is going to get red (baby's, not yours). This is from the constant wiping and moisture. If ulcers start to form, be more gentle with the wiping or even run that tushy under some warm water in the sink rather than wiping, and apply a barrier cream with each diaper change (Desitin, A&D, Boudreaux). Air dry booty often.
4. No amount of lotion will help that peeling, flakey skin in the first few weeks. They're like snakes - they shed that first layer after they're born.
5. No need for lotion, unless your pedi tells you so.
6. After they lay down for awhile, they often sound congested. This is usually because of reflux, which all infants experience at some point or another. I wrote a couple of articles on reflux you may find helpful: "Let's Learn About ... Infant Reflux" and "3 Important Questions Answered About Your Baby's Reflux Answered."
7. If you’ve chosen to breastfeed - congratulations on a great way to feed and nourish your child!
8. If you’ve chosen to formula feed - congratulations on a great way to feed and nourish your child!
9. Spitting up is normal now and then. Sometimes it comes out of the nose, yes. That’s okay. It’s just another hole in the head.
10. Putting the baby on a schedule is hard at first. They really need to eat as much as their brains are telling them to - and that often seems sporadic and chaotic, but it needs to happen. You can start some simple sleep training steps from day one, though. Start waking your baby at the same time every morning. And put her in the living room during the day for the first month - make sure there’s lots of light and noise in the area. Even if she’s sleeping through it, this will start to “set” the circadian rhythms - which tell her when to be awake and when to sleep. At the same time each night, turn lights low and put baby in a quiet room.
11. During the day, feed your baby at least every 3 hours. They’ll want to eat more often than that sometimes, and that’s okay. But if it’s been 3 hours, go ahead and wake her up. We want to get as many “daytime calories” in them as possible!
12. There is a very common, very gassy/grumpy phase they start around week 3. It is called the Period of PURPLE Crying. Often, during a certain part of the day (i.e., evening), they will cry, grunt, and generally look uncomfortable.You can read more about my thoughts on it here. 
13. Some babies poop with every feed. Some babies poop once a week. Both are normal.
14. It’s common for the hands and feet to be purple sometimes, especially if their leg is squeezed or they’re cold. This is called acrocyanosis and goes away with time. Always call us or an ambulance if you’re noticing any difficulty breathing, or if the tongue or gums look dusky or purple - this is different.
15. You don't have to clip the finger and toenails. You can peel or file them down.
16. Belly buttons are weird. Umbilical cords are weird. They ooze a little now and then and sometimes there’s a spot of blood on the diaper as they’re drying up and falling off. Let your pedi know if the skin around the cord is red and if that redness is spreading. Or if you feel like yellow goo oozing from it is excessive or soaks into clothes.

I know you feel alone, but know that you're not alone in your isolation these days, and there are still ways to connect. Create a safe "pod" of help and support and if you're my patient, know that I am in it with you.

It's OK to feel weird, and "off" those first few weeks or months - I did.

It's OK if you don't feel connected to your baby at first - I didn't. It was like a loud elephant was suddenly in the room.

If your feelings overwhelm you or worry you, PLEASE ask for help.

The picture you see above is of me and my first baby the night he was born. I was anxious, scared, exhausted, in pain, and I had no idea what I was in for.

Book smarts are nothing compared to experience, my friends. You will know more every minute, hour, and day.

Hugs,

Dr. Diane

Related Articles You May Be Interested In:

• During COVID-19 Pandemic, When Can You Have Visitors Over to Meet Your Newborn?
• Let's Learn About ... Infant Reflux
• 3 Important Questions About Your Baby's Reflux Answered
• Social Isolation and COVID-19 Causing More Anxiety for New Moms
• Should I Breastfeed During COVID-19 Pandemic?

As a pediatrician, I’ve been privileged to teach a newborn class since 2016, sharing important information and getting to know expectant parents. It’s my first opportunity to step in and give you the information you need to have a happy and healthy journey with your little one.

But like everything else right now, things have changed how we normally do things. It’s so fun for me to offer these parent classes virtually. These classes are available to you and now from the comfort of your own home! Click here to view them.

Live classes are a great opportunity to meet other expectant parents and to ask questions, but if your time does not allow for this, we have videos posted on our website you can view at your leisure.

Here is the information from my video in regard to infant safety and CPR. Be sure to take a child and adult CPR class once it becomes available, as this information is for babies 0-12 months.

Order a CPR kit to practice at home. 

Infant safety

1. Sick contact precautions
   • Newborns should not be exposed to anyone with sick symptoms.
   • Limit visitors.
   • If caretakers become ill they should wear a mask around the baby. 
2. Rear facing car seat 
   • Install correctly and go for a car seat check if it is available.
   • Rear facing until at least 2 years of age and until they outgrow the height and weight specifications for rear facing in the car seat (to keep your baby safe keep rear facing as long as possible)
3. Safe sleep - avoid sudden unexpected infant death - SUID
   • Babies should sleep on their back in their own bed - no blankets, swaddling or positioners. Side sleeping is not recommended.
   • No tobacco exposure (this increases risk of SUID).
   • In your room but not in your bed until 12 months old, nothing else in the bed. 
   • See video safebabysleep.org cookchildrens.org.

Infant CPR (less than 12 months of age)

1. Take a full CPR class.
2. Practice often. The more you practice CPR the more effective it will be.
3. Perform CPR on a firm flat surface.
4.  Tap and shout - if baby is not responsive call 911 and start CPR
5.  Chest compressions
   1. Fingers right below the imaginary line between the nipples
   2. Compress 1.5 inches
   3. Hard and fast 100-120 per minute
   4. Allow complete recoil (allows the heart to fill back up with blood and maximizes your chest compressions)
   5. 30 chest compressions to 2 breaths
6. Rescue breaths
   1. Head tilt chin lift
   2. Mouth covers baby's nose and mouth
   3. Turn your head a little to watch the baby's chest rise
   4. 1 breath over 1 second. Give 2 breaths.

Continue CPR until baby becomes responsive or help arrives.

Infant Choking

1.  No blind sweeps - this can push the object in further. It is ok to grab the object if you can see it and get it without pushing it further into the airway.
2. 5 back blows between the shoulder blades using the heel of the hand
3. Follow with 5 chest thrusts with fingers on the chest like you would for CPR
4. Support the baby’s head below the baby’s body
5. Avoid covering the baby's face or neck with your other hand
6. Continue to alternate 5 back blows with 5 chest thrusts until the object comes out or the baby becomes unresponsive
7. If infant becomes unresponsive call 911 and start CPR

Please watch the infant safety and CPR video and buy the American Heart Association instructional video with mannequin so you can see demonstrations of above information and practice CPR. Once available, please take a CPR class.

Congratulations! We are here to help you on your upcoming journey as a parent!

At Home

• Don’t put blankets or other loose bedding in your infant’s sleeping environment. Instead, babies should wear one-piece sleepers or sleep sacks to keep warm while avoiding the risk of suffocation. For more information on SIDS, suffocation and co-sleeping dangers, click here.
• Make sure your home has working carbon monoxide detectors on every level, especially near bedrooms. They should be located at least 15 feet away from fuel-burning appliances. You can find more information about carbon monoxide dangers in this Checkup Newsroom story from 2015.
• Have a fire escape plan ready in case of a house fire. Make sure the whole family knows what to do if the unimaginable happens.

In the Car

• Don’t put your child in a car seat with a heavy coat on. In a crash, padding from a coat or thick layers will flatten out, leaving room under the car seat harness. This increases the risk of a child slipping through the straps and being thrown from the car seat. Instead, dress your child in thin layers. Once buckled up, slip the coat on backwards with the sleeves on the child’s arms. This way, the coat acts as a blanket and doesn’t affect the fit of the harness.
• If using a blanket over a newborn in a car seat, tuck it several inches below the child’s chin to ensure it won’t become a source of suffocation.
• Be mindful of road conditions which may increase the risk of a collision. 
• Pack an emergency bag for your car. It’s a good idea to have blankets, warm clothing, hats and gloves available in case you become stuck in winter weather. You’ll also want to have non-perishable snacks packed away.

When Outside

• Make sure newborns are dressed appropriately. "A good rule of thumb is to dress newborns in as many layers as you're wearing," said Diane Arnaout, M.D., FAAP, a Cook Children's pediatrician in Willow Park. "That includes covering their heads, hands and feet. Those areas can lose a lot of heat and be harder to keep warm."
• For the most warmth, dress your little ones in wool instead of cotton. Essential winter items include hats and gloves, as well as sweatshirts or T-shirts that can be layered under overcoats or jackets. “Infants have the same temperature intolerance as adults, but they lose more heat through their heads,” said Frank McGehee, M.D., a Cook Children’s pediatrician at Fort Worth (Magnolia). “A hat is one of the most important pieces of winter clothing for infants.”
• Blue skin, shivering and a cool chest and stomach are signs that children may be dangerously cold. If you see these signs, take action immediately to get kids out of the cold. Seek immediate medical attention if you're not able to warm the body.

Recognizing Hypothermia

According to the Centers for Disease Control and Prevention (CDC), hypothermia, or abnormally low body temperature, "is a dangerous condition that can occur when a person is exposed to extremely cold temperatures. Stay safe this winter by learning more about hypothermia, including who is most at risk, signs and symptoms, and what to do if someone develops hypothermia." To learn more about the warning signs of hypothermia, click on this site from the Centers for Disease Control and Prevention (CDC).

Warning signs for adults include:

• Shivering, exhaustion
• Confusion, fumbling hands
• Memory loss, slurred speech drowsiness

Infants:

• Bright red, cold skin
• Very low energy

Victims of hypothermia can include babies sleeping cold rooms.

So before your child arrives, it’s important try to be as prepared as possible.

Prior to Delivery

1. Every mother should get a Tdap vaccine in the third trimester of pregnancy to protect her baby against whooping cough. Any other family members who will be spending time with your newborn should also get a Tdap vaccination. If it’s flu season, family members should also receive the flu vaccine to protect your child from getting the flu, since babies are unable to receive the flu vaccine themselves until they are 6 months old.
2. Pack a to-go bag for the hospital with clothes, toiletries, and a camera (or at least have your phone charged and ready to go), as well as anything that you may want to have during delivery such as soothing music. Formula, diapers and wipes are readily available in the hospital and do not need to be packed. Don’t forget to bring your baby’s car seat, as your family won’t be allowed to leave the hospital without having one.
3. If possible, before delivery, ensure that car seat/car seat base is installed tightly. If it can be moved more than an inch side to side or front to back, it’s not tight enough. All infants and toddlers should ride in a rear-facing car seat for as long as possible, until they reach the highest weight or height allowed by the car seat manufacturer, which is usually about 40 pounds. Most children can stay rear-facing until after 2 years old. Rear-facing is the safest way for babies/toddlers to ride.
4. Make sure your baby has a safe sleeping space at home. This may be a crib or bassinet with a firm, flat surface for your baby to sleep on. Besides a tight-fitting sheet over a mattress, there should not be anything else in the crib/bassinet. No loose blankets, stuffed animals/toys, pillows or bumpers in the sleep space. It’s recommended that babies share a room with parents. The bassinet or crib should be close to your bed for at least the first 6 months of life, but preferably the first year of life. This has been shown to decrease the risk of SIDS.

After Delivery

1. After delivery, your child will be examined by a pediatrician within the first 24 hours of life, and then each day your baby is in the hospital.
2. Every baby will receive a vitamin K shot and erythromycin eye ointment soon after they are born.
3. After your baby is born, he or she should be fed on demand, which is usually every 2-3 hours. Every baby loses weight in the first week of life, and then usually gains back to their birth weight by about 2 weeks of life. Until that time moms, be prepared to feed at least every 3 hours.
4. Breastfeeding: In the first few days after birth, a mother’s body will produce nutrient rich colostrum for her baby. Breast milk usually comes in 3-5 days after the birth. It’s helpful to breastfeed often to stimulate milk production. Breastfeeding is a learning process for both mother and baby. It’s very helpful to utilize lactation consultants in the hospital. They are a wonderful resource for parents.
5. Babies should receive their first hepatitis B vaccine prior to discharge from the hospital. Babies will also have a hearing screen, congenital heart screen, and newborn screen done prior to discharge from the hospital.
6. When placing your baby in the car seat after leaving hospital: Harnesses should be at or below the baby’s shoulders. When testing the harness strap over your baby’s shoulders, you should not be able to pinch any slack between your fingers. The harness chest clip should be at the center of the chest, even with your baby’s armpits.
7. Your baby should have a follow-up appointment with your pediatrician 2-3 days after discharge from the hospital, or sooner if needed.
8. Keep the umbilical cord clean and dry. Only give sponge baths until the umbilical cord has fallen off. If there is any redness/swelling or foul smelling discharge, call your pediatrician.
9. Try to keep yourself and your baby away from people who are sick. Wash your hands with soap and warm water often. If you are not near water, use an alcohol-based hand cleaner. Call your pediatrician if your baby has a fever, which is 100.4 degrees F. The most accurate way to check a baby’s temperature is rectally.

Argh! I know. It seems like a lot. But by taking a few precautionary steps now, you will have more time to enjoy your baby and this exciting time in your lives!

But when it comes to newborns, forget everything I’ve always taught you about fever. If an infant has a fever, it is a sign something is wrong and a serious cause for concern

In older children, fever is almost never an emergency, the exact degree of the temperature doesn't really concern me and unless there are other reasons to do so, a workup isn't indicated.

In babies up to 3 months of age, the opposites are true.

Fever in a newborn is an emergency. When a newborn has a fever, parents should have a sense of urgency.

An accurate temperature really matters for newborns. You don't need to go around checking your baby for fever randomly. But if they feel warm, are not eating well or you're otherwise worried, we recommend taking a rectal temperature. Rectal temperature is important because it's the most accurate way to determine the temperature and the studies that tell us what to do with your baby are based on rectal temperatures.

Once you have an accurate temperature, I recommend that you call your doctor with any temperature over 100 degrees. Technically fever is anything over 100.4, but it's good to let us know so we can coach you on what you should be looking for. It also helps us decide what should prompt a visit to the emergency room if it rises overnight.

Fever is such an emergency in babies because they can be an early sign of serious, even life threatening infections and babies can't tell us if something hurts. Babies can have blood stream infections, meningitis or urinary tract infections with little other symptoms. They also can get all the other things that older kids get too like stomach bugs, flu and other viruses but we would rather be safe than sorry.

Because of these risks, babies with fever will typically receive some type of lab work to determine if infection is present. This can include blood work, urine test and possibly a spinal tap to rule out meningitis.

While it's scary and no one wants to think of your baby needing this work-up, the fear of missing one of these serious infections or leaving them untreated, even for a short period, is even scarier.

Most babies with fever will be started on antibiotics while we wait in results from the test. This prevents babies from getting worse while we wait for results to come back.

So, as you can see, fever in newborns is a LOT different.

But, the important thing to remember is to call your doctor if the fever is over 100 and we'll help you keep your baby safe from there.

Related Topics:

• My Child's Fever Isn't Going Away. Should I Be Worried?
• 7 Types of Thermometers and to what Degree You Should Trust Them
• My Child has a Fever. Should We Go to The ER?
• 5 Days of Fever. Now What Should I Do?
• When It Comes to Your Kids It's Never Just a Virus
• Let's Learn About Fevers
• 4 Reasons Why This Pediatrician Doesn't Alternate Tylenol and Motrin for His Kids

They were doing great, breastfeeding or taking a bottle and eating some solids but now what?!??! You're expected to change everything. First off, remember that if you plan to continue to breastfeed (which is awesome if that’s your choice!), some of this won’t apply to you but some of it will.

With everything else going on, I’m here to tell you it doesn’t have to be that complicated.

Here are my 5 simple rules for transitioning to milk at 1 year of age (and only two low-stress choices for you to make):

1. Remember that there’s nothing magical about milk.

Cow’s milk is an easy source of calcium, calories, and protein but if they are eating those things then they actually don’t have to drink milk at all. Especially keep that in mind when you make the change if their milk intake falls off. It’s OK. I generally recommend 18-24 ounces per day. This should be enough to get your baby some extra calories, but not be so much that it can lead to constipation. Also remember that yogurt and cheese have similar nutritional content so they can be included in the total as well.

2. Transition to a cup before 15 months.

The closer to 1 year that you can transition to a cup, the better. Hopefully you’ve been offering some water at meal times with a cup for a while. Don’t buy any large quantities of a cup until you find out what your baby likes. Put the cup in front of them, they’ll eventually drink.

3. Decide on a milk. You have some choices.

Remembering rule  No. 1, it’s OK to give yourself some flexibility in the milk that you choose. I’m not worried about cow’s milk or dairy intake as a general rule. Depending on baby’s weight, I am Ok with either whole milk or 2% milk. Talk to your doctor about which might work for your child. There are a few milk alternatives that closely resemble cow’s milk in nutritional content (pea and soy milk are examples) but there are others that are basically water (almond milk). I don’t routinely recommend toddler formula unless medical indicated or recommended by your doctor.

4. Decide on a plan for your transition.

I’ve seen families make the change cold turkey the first day it was possible. I’ve seen families slowly transition by adding in milk alternating bottles with formula. I’ve also seen families mix some formula and some milk in individual cups. I haven’t seen any one particular strategy work better than another. I think most babies would do fine with a quick transition or cold turkey swap…but every baby is different.

5. Try not to stress too much about this.

There are plenty of things to worry about in parenting. Deciding what to give them to eat and drink shouldn’t add to your stress. Provide them plenty of fruits and vegetables. Decide on your milk choice and your method of transition and don’t stress the rest.

They will have good days and bad days (just like us).

But, I promise everything is going to be OK in the end.

But, does your child have a cold or allergies?

After all, the mountain cedar pollen count is the highest it's been all season in North Texas and is in the "very high" category for the first time since January 2017. 

We're also in the middle of the cold and flu season. 

Determining the difference between colds and allergies can be very difficult, but knowing which it is can be helpful for treatment, expectations for how long it should last and for determining if your child is contagious.

Colds are caused by viral infections which are spread from person to person. They can occur year round but are going to be more common in winter months. Symptoms usually last 3 days to 2 weeks but remember that kids can get several colds per year so it’s possible for them to be sick for long periods if they catch a few colds back to back.

Allergies are caused by an overreaction of the immune system to allergens. Dust, pollen or molds can all be potential triggers. Allergies can occur year-round depending on what your child is sensitive to. Usually fall and spring are busy allergy seasons but pollen counts were moderate to high many days in December.

So, how can you tell the difference?

Symptoms with a cold usually build up over a few days but allergic symptoms can start quickly after the child is exposed to the substance they are allergic to.

Here are some of the symptoms that can be present and whether they are more likely a cold or allergies:

This time of year, if your child has cold symptoms but also have significant body aches or high fever, you should also consider if they might have flu (because they probably do).

Treatment for colds is treating the symptoms. Nasal saline and suction for babies. Honey for kids over 1. Make sure they are drinking plenty of fluids and getting rest.

Treatment for allergies should usually start with a long acting antihistamine like Zyrtec or Claritin. If that doesn’t seem to be helping, talk with your doctor.

ENOUGH MILK ON DAY ONE?

Many parents worry their baby is not getting enough milk. Did you know a baby’s stomach is the size of a cherry when first born? And the drops of milk you are making the first day or two are normal! The milk you make these first days is called “colostrum” and is highly concentrated, yellow, and sticky, full of easy to digest carbohydrates and proteins that help your baby fight off infections.

SUPPLY AND DEMAND:

The more you breastfeed, the more your brain will make hormones that increase your milk supply and switch it over from drops of colostrum to larger volumes of mature milk. The larger the “demand” for milk, the larger the supply you will make. That is why frequent breastfeeding in those first days after birth are crucial! A general goal is 8-12 feeds during a 24 hour period. Watch the baby for hunger cues like opening their mouth, putting their hands to their face, sucking on their hands, or moving their head around as if they are searching for something. Your baby might even begin to cluster feed, where the baby will want to feed seemingly right after you just fed them! This is their way of getting your milk supply to come in. They cannot overfeed at this stage. Sometimes pumping during this stage can be beneficial to the supply/demand effect. The more you stimulate the breasts, by direct breastfeeding with the baby, and by using a pump, the more milk you will produce. To get an idea of what amount is typical, see the chart below for average volumes of milk intake.

MILK COMING IN

Mature milk usually will come in around day 3-4 of life and will be creamy, fatty, and white. Your breasts will likely feel firm, warm, tender, and full. But remember it can take up to four days for this to happen. If your milk has not come in by day 4, see your pediatrician and your OBGYN in addition to optimizing breastfeeding techniques with a lactation consultant.

LOSING WEIGHT (For baby, not mom!)

Some weight loss in the first days of life is normal. Your pediatrician will check the baby every day in the hospital and again a few days after leaving the hospital to make sure the baby’s weight loss is in a safe range. It is normal to lose up to 10 percent of birthweight in the first week, so for a 7 pound baby that means losing up to 11 ounces. Once the milk is in, the weight should start going up, and babies are expected to be back up to original birthweight when they are 2 weeks old. In addition to weighing, a good way to gauge if the baby is hydrated and getting enough from feeds is to check the number of wet diapers. Lots of full wet diapers means your baby is staying hydrated from feeds. If weight loss is beyond the normal range, your pediatrician will guide you through ways to help, which can include supplementing and/or pumping.

IT HURTS!

The most common cause of discomfort with breastfeeding is not having the right latch onto the breast. Try to make sure that the baby is opening up wide to get the entire areola and not just the nipple. You may need to take the baby off the breast and try again if the latch is not right. Both lips should be open wide and curled outwards if the latch is ideal. Lactation consultants in the hospital can help you each day to make sure you and your baby have a good latch. You can also try to use Lanolin creams to help soothe your nipples after feedings. With the proper latch onto the breast, your discomfort should be a temporary issue that gets better with time.

PACIFIER USE

Sleep deprivation combined with a crying infant can make pacifiers a tempting choice in the first days of life. However, studies show that pacifiers are best introduced AFTER breastfeeding is “established” meaning it is going very well, typically at 3 weeks of life, to prevent the baby from being confused between the pacifier and the nipple. Many parents don’t know this, but pacifiers are actually recommended because in the long run they reduce the risk of sudden infant death syndrome. So DO use a pacifier, but try to wait until feedings are going well first.

PRACTICE MAKES PERFECT

I always grew up hearing my dad say “practice makes perfect!” I wonder if that’s why I ended up becoming a doctor. I got used to practicing new things over and over again until it felt like second nature. The same can be said about breastfeeding. It is a skill, and it takes practice and most importantly, patience, but sleep deprivation added into the mix can make this easier said than done! If you are looking for further breastfeeding support from other parents, more resources, lactation consultant recommendations, or free breastfeeding classes, check out the following resources:

• Breastfeeding Tarrant County Coalition website
• Mobile app LatchMe
• Mobile app LactMed - information about safety of medications and their effect on babies through breastmilk

Happy feeding!

Dr. Rachel Hamilton

About the author

Rachel Hamilton, M.D., is a pediatrician at the Henderson Clinic. To make an appointment, call 817-783-4109. Dr. Henderson grew up in the Dallas/Fort Worth area. She obtained her bachelor’s degrees in chemistry and biology and graduated as a president scholar from Southern Methodist University. She completed medical school at the University of Texas – Southwestern Medical Center in Dallas and pediatric residency at the University of Texas at Austin – Dell Medical School. She is a member of the medical honor society Alpha Omega Alpha, and has been recognized for humanism in medicine. She is married to David Hamilton and enjoys traveling, SCUBA diving, bass fishing and other outdoor activities. Her favorite aspects of being a doctor include life-long learning and the joy of helping children live fulfilled, healthy and happy lives.

Here are four reasons I don't recommend putting a breastfed newborn on a feeding schedule:

1. They need comfort and bonding. Imagine being thrown into a brand new, anxiety-provoking environment with no skills for calming yourself and no way of escape. Plus, the person who can give you comfort is right there. Sure, you can cuddle them to help, but sometimes they just need to nurse.
2. They are hungry. I can't wait three hours to eat. I'm pretty sure if I could only eat 1-2 ounces of a liquid meal, I'd be starving before three hours came up again as well.
3. Scheduling can hurt your milk supply. Frequent feeds help your milk come in. I've seen too many babies who've been on a rigid schedule come in at 1 week with lower weight gain. Then we are scrambling to get mom's milk supply up so that they can maintain breastfeeding.
4. They will find their own schedule. Implementing a rigid schedule out of the nursery is not necessary. By paying attention, you can discover an ideal schedule for you and your child and help them keep to that without having a rigid schedule.

There, I said it.

Those of you who insist that every child can do so, comment away.

Those of you who tried and started a knock-down-drag-out weekend of fighting in your house, only to quit and come back to it later with a different strategy that was much more successful, you may stand up and applaud.

The three-day potty training method has several different flavors but all of them involve some of the following ingredients:

• Draw a hard line in the sand - no more diapers.
• Let the child go naked for the weekend (or longer).
• Give the child lots of fluids and salty snacks (I’ve seen some recommend soda. I mean, just … NO!)
• Put the child on the potty frequently.
• Celebrate successful pees and poops.

I know that these methods work some of the time, with some kids. The posts about the strategy wouldn’t be so popular if they didn’t. Problem is, I don’t hear much about it when it works. But, I do hear about it when it becomes a disaster. I hear about it when everyone is in tears and tensions are through the roof.

Any of you with more than one child can confirm that kids are different. They do things on their own time and in their own way. Potty training is the same way. To assume that every child can potty train by age 3 and in three days is unfair. Each child may need a different strategy.

Here is my potty training guide:

Readiness

I usually give two signs for potty training readiness:

1.Knowledge of wet and dirty. If a child doesn’t understand what pee and poop is, good luck.

2.Ability to sit still on the toilet. Unless you want to be forcing your child to sit down on the seat every time, they have to be patient enough to wait for the action to happen.

But guess who ultimately decides when your child (and you) are ready to potty train? You and your child! Not grandma, nor your judgy friend or the blog post they shared. So, take your time if you want or go ahead, it’s up to you.

Method

I only have one rule when it comes to your method for potty training. Be patient!

Be patient with your child. Some kids have legitimate fear about the part of their body that they are flushing down the drain. It can be the same to them as flushing an arm. Some kids will get it right away, some won’t. Give them the chance to fail without punishment.

Also, be patient with yourself. You will get frustrated at some point during the process. Pick some fun things to do with your child and alone to recharge. It’s OK if it doesn’t go perfectly.

Pick a method that you think fits well with your child and stick with it for a bit. Don’t change after one day. But, it’s also ok to step back and make a change after a bit if things are going well. It’s even ok to decide that you tried to early and wait to start again in a few months.

Potty training is a necessary step in development. It might not be as fun as the first word or first step but it is just as monumental. So maybe it’s not always a “happy” time but at least it can lead to joy. Don’t let unreasonable expectations steal that.