Congratulations on your expected arrival! We understand that choosing a pediatrician is a very important decision to you. We hope that this website gives you a brief introduction to our practice. We also welcome you to come and meet us in the office.
We offer the courtesy of prenatal consultations to allow expecting parents the opportunity to meet the physician(s) one-on-one, see the office and ask any questions you may have. Please call the office at (914) 235-3800 to schedule an appointment.
We recommend that you schedule the baby’s 1st appointment within 2-3 days of discharge from the hospital or sooner as needed. At that visit, we will measure the baby’s length, weight, and head circumference, do a complete physical exam, review your prenatal and the baby’s postnatal history, discuss newborn care and development, as well as answer any questions you may have.
Following your child’s first appointment, the baby will be seen for routine check-ups according to the schedule below to ensure proper growth and development as well as to receive immunizations to protect against disease. All routine office visits are by appointment only. Please try to be on time. Should you be unable to keep an appointment, please notify us at least 24 hours in advance, if possible.
• 1 week
• 2 weeks (as needed)
• 1 month
• 2 months
• 4 months
• 6 months
• 9 months
• 12 months
• 15 months
• 18 months
• 2 years, and yearly thereafter
If at any time you have any questions, please do not hesitate to call us – we are available! For routine questions or problems that are not urgent, we would prefer that you call during office hours. Of course, if there is an emergency, regardless of the time, day or night, call right away. During office hours, if your call is urgent, the doctor will be interrupted to take your call. For non-urgent matters, if the doctor is not readily available to talk, our receptionist will take a message, and your call will be returned as soon as possible.
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More than half of women experience postpartum blues on the third or fourth day after delivery. The symptoms may include tearfulness, tiredness, sadness and difficulty thinking clearly. This temporary reaction is thought to be a result of sudden changes in maternal hormone levels. Also, since these symptoms often appear around the time that you are going home from the hospital, the realization of having total responsibility for this helpless newborn baby may also compound these feelings. It is not uncommon for women to feel guilty about these feelings, as they have been led to believe that this is a time for pure joy. But rest assured that this is very common and normal, and symptoms usually resolve in 1 to 3 weeks.
There are several steps that you can take to help cope with postpartum blues. First, it is important to acknowledge these feelings and discuss them with your partner or loved ones. Don’t feel that you have to suppress crying or put on a “supermom” show for everyone. Second, try to get adequate rest. Third, get help with your work or house duties. Fourth, get out – mix with other people, get together with a friend, go to a movie, etc. By the third week, try to set aside one evening a week for “date night” or time for adults only to enjoy some time together without the baby. If your symptoms continue beyond a month, please talk to your physician for further guidance.
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Breastfeeding is encouraged for everyone, as it provides many health benefits, including protection from infection, which cannot be matched in formulas. However, some women are unable to breastfeed for various reasons, and that’s alright (free yourself of any guilt if this applies to you).
While babies do have a natural reflex to suck, they are not born knowing how to breastfeed – it is a learned behavior and takes practice. But with patience, it can be a wonderful experience for both you and your baby.
Sometimes, it takes a while to catch on. Correct positioning, or “latch-on,” is the key to successful breastfeeding. If the feeding is painful, the baby is probably not correctly positioned. Try to get the baby to open his or her mouth widely, and push the baby straight onto the nipple and areola – the baby’s mouth and lips should be around most or all of the areola, not just the nipple. Be patient, the baby will soon get the idea. But if you have problems, call us and we’ll be happy to assist you further.
All too often, in the first day or two, the baby will be too sleepy to feed. This is quite normal. To wake the baby simply unbundle him or her. The baby won’t get cold and the cool air will serve as a wake up. You can also rub the bottoms of the feet, or along the baby’s spine, to help wake him or her up.
In the beginning, you will feed the baby on demand; that is, whenever your baby is hungry. On average, that will be about every 1 to 3 hours. How long should you nurse? In the first few days in the hospital, start slowly, i.e. 5-10 minutes on each side. Then, gradually add another minute or two each day, feeding frequently throughout the day in order to stimulate your milk production. Nursing too long at the beginning may contribute to sore nipples. In time, you can expect feedings to take no longer than 30-40 minutes. And as the baby becomes more efficient at feeding, he or she will get everything he or she needs in 5-10 minutes. There are a lot of good calories in the “hind” milk – that is, the last part of the milk that comes out from each breast. Therefore, it is always a better idea to ‘finish’ one breast, than to do a little on each side.
Almost all women report some degree of nipple soreness in the beginning. Don’t let this temporary discomfort stop you from nursing. The pain will go away as your nipples get accustomed to your baby’s suck. Should you develop any breast tenderness, feed the baby more frequently and consult your obstetrician as you may be getting an infection.
Newborns do not normally require any fluids other than breast milk (or formula) in the first few days. The exceptions are infants with particular health concerns. Babies do not need any water or juice. Hold off on any other liquids, as your baby’s digestive and urinary systems are not mature enough to handle them. Juices may also lead to allergies or diarrhea. In fact, you can forgo the juice altogether even when your baby is ready for a more varied diet, as infants and toddlers have no nutritional need for juice.
Many breastfeeding mothers wonder, “is my child getting enough?” The baby’s urine output and growth are the best indicators of a child’s adequate fluid/nutrition intake. Your baby should make approximately 6-8 wet diapers a day. If this is happening, and he or she is growing well, you can be assured that your breast milk is doing its job and your baby is getting everything he or she needs.
If you feel you would like to introduce a bottle – you may offer the baby either expressed breast milk or formula in a bottle at approximately one month of age. Doing so earlier may confuse your baby as he or she is learning to breastfeed and may also decrease your own milk supply. Any of the breast simulated formulas are well suited for this purpose. If you express breast milk, proper storage is important to prevent contamination or spoilage. Refrigerated breast milk should be used within 72 hours; frozen breast milk is good for at least one month (3-6 months if kept in a 0? freezer).
After you leave the hospital you will want to continue to rest, drink plenty of fluids, eat a well balanced diet and take your prenatal vitamins. Consult us or your obstetrician before taking any medication.
Exclusively breastfed infants should receive vitamin D supplementation, such as Tri-Vi-Sol vitamin drops, for as long as breast milk is their primary source of nutrition.
Initially, your baby may be given water by the nurse for the first feeding. Thereafter you will be able to feed the baby formula if you choose. At first, the baby will take only a small amount – probably ¼ or ½ an ounce. Don’t worry – as the baby becomes accustomed to feeding, he or she will drink more. Most newborns take only about 1 to 2 ounces for the first few weeks. As the baby grows, the amount of milk will increase. Let the baby determine how much he or she needs. Avoid overfeeding.
The formula you are feeding is an excellent milk which is fortified with vitamins and iron. Thus you will not need additional vitamins. After leaving the hospital you will want to purchase formula for your baby. There are a number of formulas that come in a variety of forms to suit all needs and budgets. We suggest breast simulated formulas with iron (unless otherwise specified). Whether you desire the convenience of ‘Ready to Feed’ or the economy of concentrate is strictly a matter of preference. Babies fed exclusively with ‘Ready to Feed’ formula, however, will need fluoride supplementation after 6 months of age. Formula feeding works best on a modified demand schedule. That is, you will feed your baby when he or she is hungry – about every 3-4 hours (don’t let the baby sleep longer than four hours during the daytime). During the night, let the baby sleep as long as he or she will. The bottle may be at room temperature or warmed (do not boil or microwave).
Sterilization according to the instructions on the bottle label may be used although it is not required, provided that you wash and rinse the bottle and nipple well in hot water.
Although many parents and most grandparents encourage early introduction of solids, most infants, in general, do not require the extra calories in the first few months of life. Contrary to popular opinion, early addition of solids will not make a baby sleep through the night. We usually recommend adding solids between four and six months of age, once the baby has developed adequate head control. If there are any questions about solids, please ask us.
A Few Other Basics
Many parents expect their babies to look like the pretty pictures in the magazine. However, those babies are what your infant will look like in about six months. The red-skinned, dry, peeling, often bruised baby with misshapen head and blue hands and feet that you have been holding is the normal appearing healthy newborn. Give him or her a few months and he or she will be just like those in the pictures.
Despite their small size, babies are not fragile – they don’t break. They will cough, sneeze, hiccup and even spit up from time to time. Some infants will actually bring up an ounce or more after a feeding. This usually occurs during burping, but may happen at any time. Don’t worry, this is often normal. However, if vomiting becomes persistent or occurs with most or all feedings, give us a call.
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Unlike adults, infants vary in their needs for sleep. Some newborns require 16-20 hours of sleep a day, while others are content with 4-8 hours. Babies should sleep on their backs, to reduce the chance of SIDS (sudden infant death syndrome). The baby’s room should be kept a comfortable temperature (if it’s comfortable for you, it will be okay for your baby). Despite popular opinion, your infant does not need to be in an overly heated room. In summer, air conditioners, fans and open windows are fine; avoid drafts.
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During your hospital stay, the nurses may have given you instruction on how to bathe and dress your baby, or other useful information. Here, again, are some main points that we think will help you to care for your baby once you’re at home.
You should sponge bathe your baby using a mild soap until the cord falls off; thereafter, a tub bath in warm water is fine. Using a baby shampoo, wash the baby’s hair as often as needed. Babies do not necessarily need to be bathed daily.
At first, most babies’ skin is quite dry, particularly the hands and feet. This will improve on its own in a few days and does not require any special care.
Commonly, babies will have a variety of rashes during the first few months. Most of these will simply come and go and do not require treatment. However, sometimes a rash will persist. Should you find a rash that doesn’t clear after a day or two, give us a call as we may wish to examine the baby. In the diaper area, A & D ointment or petroleum jelly will protect your baby’s delicate skin. (Packaged cleansing wipes are okay when you are away from home.) Baby powders and oils are not necessary. [If you do use powder, though, use corn starch powder only, NOT talcum powder.]
In the hospital a special blue medicine may be applied to the cord to protect the baby from skin infection. By the time you are ready to leave, the cord will have become quite dry and will subsequently fall off. Apply a small amount of rubbing alcohol with a Q-tip to the base of the cord (where the cord touches the skin) with each diaper change until it does fall off. You may notice a small amount of blood oozing from the navel after the cord has dried. This is normal and to be expected. Once the cord is off, don’t be afraid to clean the inside of the navel with a moistened Q-tip. If any swelling or redness develops around the navel do notify us so that we can examine the baby.
If your baby is circumcised, you can expect the penis to be red and swollen for the first few days. This is normal and requires no care except applying a little petroleum jelly at each diaper change. You may sponge bathe the baby until his penis has healed; thereafter a tub bath is fine.
Baby girls frequently have a discharge which is either clear mucus or blood tinged. This is normal and requires no treatment.
Eyes, Ears and Noses
You may have already noticed that your baby’s eyes may have been quite puffy in the first couple of days of life. This swelling may be a result of the protective antibiotic ointment placed in the eye when your baby was born. This should disappear. A discharge from the eye during the first week or two is also common. A clean cotton ball soaked with warm water can be used to wash away this fluid. However, if pus is noted or if the eye becomes red on either the outer lids or on the inside, give us a call.
Ears don’t require any specific care except to remind you not to put anything in them that is smaller than your elbow! (Washing the outer ear with a wash cloth or moistened Q-tip to remove debris is okay.) The same advice goes for the nose as well. You may notice that your baby’s nose is stuffy particularly in the morning. This is not unusual (he or she does not have a cold) and requires no treatment. Sometimes a baby might get a little congested. If so, a mild salt water (saline) nose drop will suffice to rid the nose of the extra mucus.
It is no wonder with all the advertisements emphasizing ‘regularity’ that new parents become quite concerned over their baby’s bowel habits. Infants’ stool patterns are anything but regular. Your baby may have as many as 6 to 8 yellow to yellow-green to brown soft, loose or pasty stools a day. But it is just as likely that he or she will have only one or two. Furthermore, there are many babies that only have a stool every other day and, believe it or not, a normal healthy breastfed baby might have one movement a week. As long as the stool is soft, it is normal (do not expect your baby’s B.M.s to look like an adult’s). Also, your baby will most likely get red in the face, will cry or grunt and draw up his or her legs while passing a soft stool. This, too, is normal. Should the stool be watery (except for breast fed babies in the first few weeks), rock hard or bloody, it is then abnormal and you should notify us.
Fussiness and Crying
Babies have only one way to communicate with us – by crying. Your baby will cry if he or she is hungry, soiled, too hot or too cold, or if he or she wants to be held or, all too often, for no reason at all. The difficulty for each of us is to know which cry means what. Surprisingly, after a few weeks at home, you will begin to recognize each of your baby’s cries. Until then, you simply have to go by trial and error. Don’t be afraid to just hold and love your baby when he or she is upset. You are not going to spoil him/her.
Most babies have a period of fussiness. Usually this occurs in the early evening, but can occur at any time. Many parents mistake this normal crying spell as ‘colic,’ but actually this is your baby’s way of letting off a little steam. The important thing to know is that it’s normal for babies to cry (as upsetting as this may be, especially if it is late at night or when you are very tired). Ordinarily after a few weeks, most infants settle down and the fussy periods cease. If you are having problems with these episodes, give us a call. Should your baby’s crying be persistent with signs of illness, please notify us.
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For many parents the first few days and weeks are the most overwhelming and exhausting. You may wonder if you will ever catch up on sleep or work. One important solution is asking for help. No one should be expected to do it all alone.
Keep in mind that it is natural for babies to wake several times a night. One way to avoid sleep deprivation is to split the total amount of sleep you need each day into several shorter naps. Go to bed earlier, and sleep when the baby sleeps! While you are napping, take the phone off the hook and put a sign on the door saying something like, “MOTHER AND BABY SLEEPING.” It is just as important to take care of yourself – if you’re not rested, you won’t be able to take care of your baby.
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Although everyone wants to see this new person, we suggest you discourage handling by too many visitors. Babies are not immune from illness even though they have some protection. Thus, anyone with a cold or other infection, especially skin infections, should not be with the baby. Anyone who does handle the baby should always wash their hands beforehand – good hand washing is the most important way to prevent infection.
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GOING OUT WITH THE BABY
Weather permitting, you may take the baby out after the first week. In the first 4-6 weeks, however, you should avoid exposing the baby to crowded places, such as airplanes, trains, stores, etc. in order to limit the risk of infection. Dress the baby appropriately, according to the temperature. Avoid overdressing as this may lead to dangerous over heating.
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When riding in a car (from the moment you leave the hospital), your baby should be placed in a protective car seat. Infant car seats should be rear-facing until the child is at least 12 months AND 20 pounds. Most police stations offer free infant car seat installation assistance. Police-installed infant seats provide the highest level of safety. Check with your local police department for more information.