BabyAndMe 2019 Book

I HAVE QUESTIONS ABOUT MY BABY: babyandme.love



Welcome and
Congratulations

Dear Parent,
On behalf of Kaweah Delta Medical Center’s Family Birth Center, we want
to welcome and congratulate you. We are so happy for you and know this
is a special time in your life. In addition to bringing you the highest levels of
care, we will do everything we can to make sure you and your little one have
a very good experience and enjoy your first days together at Kaweah Delta
Medical Center.
This is an exciting time and we know you will have questions prior to and
after your stay with us. While you are here, we encourage you to ask any
questions of your nurse. Additionally, we have compiled this book to serve as
a resource for you so that you will be ready for everything from the big day to
keeping your baby safe after leaving the hospital.
Here is a checklist you may find helpful as you prepare for this journey:
• Review the Baby & Me book
• Sign up for prenatal classes by your fifth or sixth month of pregnancy by
calling 559-624-6012.
• Preregister at the hospital by your eighth month of pregnancy. This will save
you the discomfort of answering many questions while you are in labor.
• Select an infant car seat and become familiar with it. Prior to your delivery,
we suggest you schedule an appointment to make sure it is installed properly
by calling 559-802-7520.
Thank you for choosing Kaweah Delta Medical Center to care for you and
your family. At Kaweah Delta, you are in good hands. The tireless work of
our medical team and hospital staff have earned us numerous honors and
high rankings – we are a Healthgrades’ five-star recipient for both vaginal
and C-section delivery. Whether you are reading this as you prepare for your
delivery or you’re getting ready to bring your little one home, we wish you the
very best.
One final thing, if you would like to nominate a nurse who made an Impact
during your stay, you can do so at: https://www.kaweahdelta.org/patients-
visitors/for-patients/the-daisy-award.aspx.
Sincerely,

-3-

Table of Contents

What to Expect in Labor and Delivery .............. 6

• Policy for visitors
• Diet-related information
• Cameras
• Use of cell phones
• During labor and delivery
• Medications used to assist in delivery
• Nursing shift timings

Mother-Baby Unit (Acequia Wing) .................... 8

• Visiting Hours
• Some tips for your hospital stay
• Breastfeeding
• Photography
• WIFI
• Leaving the hospital
• List of common medications
• Bedside shift report

Postpartum Depression ................................... 12

• Emotional changes
• Postpartum blues
• Postpartum clinical depression
• Postpartum psychosis

Calming Your Baby .......................................... 15

• Swaddling
• How to deal with frustration
• Skin-to-skin contact

How to Keep Your Baby Safe .......................... 18

• Follow these AAP recommendations to prevent SIDS

Breastfeeding.................................................... 20

• Newborn feeding pattern
• Keeping track of the stool
• Cluster feeding
• Signs your baby is getting enough to eat
• Benefits for the baby
• Benefits for the mother
• Expressing milk by hand
• When you go home

Formula Feeding............................................... 26
Baby’s Daily Breastfeeding Log...................... 36
Child Safety Seat Information ......................... 38
NICU Information .............................................. 42

-4-

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before you are discharged?

What to Expect in
Labor and Delivery

Getting ready for your labor and delivery? We have compiled a list of
information that will help you prepare well for your delivery.
Policy for visitors
• Three armbands will be issued to each patient. We will allow only those

visitors who have these armbands when the patient is in Labor and
Delivery. Switching of these armbands is not permitted.
• Once you are transferred to the Mother and Baby ward which could be two
hours post-delivery, other family members or friends are allowed to visit.
• As we place maximum importance on infant security and confidentiality of
patients, visitors or family members are not allowed to wait in the corridors
or hallways.
• These guidelines could change in the flu season between October to March
to ensure the additional safety of patients and infants.
Diet-related information
• The diet you will be on while in Labor and Delivery or after delivery will be
decided by your physician. During labor, patients are usually only allowed
to eat ice chips.
• Please note that the Cafeteria is open between 6:30am to 7pm as well as
between 12 midnight to 2am.
• Exclusively for patients, the Nutrition Room stocks sandwiches and snacks.
Cameras
During the delivery process or while a cesarean section surgery is being
carried out, pictures or videos are not permitted. Pictures or videos are allowed
after the delivery only when the infant is declared “stable” by the doctor.

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What to Expect in
Labor and Delivery

Use of cell phones
It is mandatory to turn the cell phones off in patient care areas. You can
use the cell phone in the lobby area if needed. The pocket phones that the
nursing staff use have a different type of frequency that does not interfere
with or impact the equipment we use in patient care areas.
During labor and delivery
• During labor and delivery process, to monitor the heart rate of the fetus

and to assess the strength of contractions, a monitor is attached to your
abdomen.
• Some degree of pain is to be expected during labor and delivery. We offer
options to help with pain relief during labor or delivery. These include
position changes, massage or warm packs to provide comfort. Epidurals, IV
narcotics or Doulas on request are available.
• A nurse will check on you every hour to check on pain, assist with bathroom
visits or any other requirements. There is also a call light available if
you wish assistance in between these hourly checks. With our focus on
excellent patient care, we are happy to provide any assistance at any time.
• We believe that babies who are directly in contact with the mother’s
chest immediately after birth bond better and are likely to feed well. We
encourage this ”Golden Hour” to promote the bonding between you and
your infant.
Medications used to assist in delivery
To help with a smoother delivery, we may use some common medications
including Cytotec, Prepidil or Cervidil.
Nursing shift timings
Please note that the day shift of nursing staff is between 6am to 6pm and the
night shift is between 6pm to 6am.

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Mother-Baby Unit
(Acequia Wing)

Patients will be transferred to the Mother-Baby unit approximately two hours
after the birth of a new baby. At that point, family and friends will be allowed
to come and visit, and should enter through the Acequia Wing entrance.
Visiting Hours
Visiting hours are 8 a.m. to 5:45pm and 6:45pm to 9 p.m. One designated
person, over the age of 18, is encouraged to stay overnight with the patient.
The front doors of the Acequia Wing are locked after 9 p.m.; after that
time, visitors can enter through the Emergency Room. Only the designated
support person with a special visitor armband will be allowed during non-
visiting hours. Siblings of the new baby are welcome to visit during visiting
hours. During flu season, visitors under the age of 13 who are not siblings of
the new baby are not allowed. Visitors who are ill are not allowed to visit the
new baby any time of the year.
Some tips for your hospital stay
• Ask your support person to stay overnight with you in the hospital
• As we place maximum importance on infant security and confidentiality of

patients, visitors or family members are not allowed to wait in the corridors
or hallways.
• Call your nurse if you need help calming your baby or help with breastfeeding
• Get rest when your baby sleeps
• Talk to family and friends about delaying visits until you get home or visit
only for brief periods of time
• Minimize interruptions by asking your nurse to help facilitate “Quiet Time” to
let your family rest
• Use skin to skin as often as possible to keep your baby calm and respond
to your baby’s earliest feeding cues
• Keep your baby safe by putting him/her in the crib if you start to get sleepy
Breastfeeding
We are dedicated in providing support and education for any mother who
feels she needs information on breastfeeding. We can provide these
services throughout your hospital stay, and even after you go home through
our lactation services at 559-624-2163. Breast pump rentals are available.
Photography
Professional photography services are available before you leave the
hospital through Blue Daisy Baby Photography. View the packages
available at www.bluedaisybabyphotography.com.

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Mother-Baby Unit
(Acequia Wing)

WIFI
Free Guest WIFI Available.
Username: guest
Password: guest
To Access WIFI Please Follow the Steps Below:
• Go to SETTINGS on your device
• Click on WIFI tab
• (if not automatically connected) Scan for networks and select guest
• (if GUEST does not pop up) Go to Add Network and type in guest; if asked

for password type guest or select none and it should automatically connect
• If you are unable to connect or need further assistance please call ISS at

624-2280.
Leaving the Hospital
Special care is given by our staff to educate new parents about taking care of
their new baby. Parents are instructed and provided materials to assure they
feel comfortable caring for their baby prior to discharge.

-9-

List of Common Medications

Norco is a narcotic medicine. This medicine is Dulcolax (also called Bisocodyl) is a laxative.
for pain. It can be called an analgesic. It can It stimulates the gut to make soft stools.
ease mild to bad pain. Norco has a mix of Possible side effects include: stomach pain,
acetaminophen (Tylenol) and hydrocodone. cramps, and diarrhea.
Possible side effects include: itching, rash,
upset stomach, and vomiting. Dizziness, Mylicon (also called Simethicone) is used
sleepiness and constipation are also possible. to treat the pressure and pain of gas in the
Take this with food to help with nausea. stomach and intestines. Side effects can
include: heartburn, nausea, vomiting, and mild
Tylenol #3 (also called Tylenol with codeine) diarrhea.
Codeine is a narcotic medicine. This medicine
is for pain. Acetaminophen (Tylenol) is pain Iron Supplements (also called ferrous sulfate/
medicine that is not as strong. It increases ferrous gluconate) help your body make red
the effects of codeine. It is used to ease mild blood cells. Possible side effects include: con-
to bad pain. Possible side effects include: stipation, nausea, and diarrhea. Take iron with
itching, rash, upset stomach, and vomiting. food to lessen nausea.
Dizziness, sleepiness and constipation are
also possible. Take this with food to help with Pitocin (also called Oxytocin) is used just
nausea. after a placenta (also called the “afterbirth”).
It is also used to control bleeding and to
Ibuprofen (also called Advil/Motrin) is a improve muscle tone in the womb after giving
non-steroidal anti-inflamatory drug (NSAID). birth. It can be given in the muscle or through
It reduces hormones that cause swelling and IV after birth. Rare side effects include: dizzi-
pain. It can reduce fever and treat pain or ness, headache, increased heartbeat, itching,
swelling due to menstrual cramps, stomach and skin rash.
surgery and vaginal lacerations. Possible side
effects include: itching dizziness, mild upset MMR (Measles, Mumps and Rubella) shot is
stomach, and stomach pain. Take this with a “3-in-1” shot that protects against measles,
food to help with nausea. mumps and rubella. Women should NOT get
this shot if they received a blood transfusion,
Toradol (also called Ketorolac) is also a are pregnant or are planning to become preg-
NSAID (see Ibuprofen). It is used for 5 nant within 3 months. effects include: fever,
days or less to treat mild to bad pain. It is mild rash, swollen glands, and joint stiffness.
often given after surgery. It is used alone Pain and redness at the place of shot are also
or together with other medicines. It can be possible.
given through IV or by mouth. Possible side
effects include: upset stomach, vomiting, Rh (D) immune globulin is used to prevent
and stomach pain. Sleepiness, dizziness, and an immune response to Rh positive blood
headache are also possible. in people with an Rh negative blood type. If
your blood is a negative type and your baby
Benadryl (also called Diphenhydramine) is positive, you will get giving birth. Rhogam
is an antihistamine given to ease itching. It has no effect on the baby. It is used to prevent
is used for allergic reactions. Possible side cross-matched blood in the future. It is given
effects include: dizziness, sleepiness, and in the muscle, in: the butt or upper arm. Possi-
headache. Dry mouth and blurred vision are ble side effects include: fever, redness and/or
also possible. soreness at the place of shot.

Zofran (also called Ondansetron) is used to IV antibiotics may be ordered by your doctor,
prevent or ease upset stomach or vomiting for many reasons. Talk to your nurse or doctor
after surgery. Side effects can include: if you would like to know why you are getting
headache, diarrhea, dizziness, feeling sleepy them. Possible side effects include: mild upset
and constipation. stomach, vomiting, and stomach cramps.
Vaginal itching from fungal (yeast) infection is
Phenergan (also called Promethazine) is also possible.
an anti-nausea, anti-motion sickness drug.
It also has a calming effect. Side effects
can include: rash itching, dizziness, upset
stomach and/or vomiting. Dry mouth and
sleepiness are also possible.

BEDSIDE SHIFT REPORT

What is nurse bedside shift report? • Talk with you about your health,
Nurse shift changes occur when including the reason you are in the
nurses who are going off duty share hospital and what is going on with
information about your care with your care. The nurses will look at your
nurses coming on duty. At Kaweah medical chart.
Delta Medical Center, we want you to
be involved in shift changes to make • Check the medicines you are taking.
sure you get high-quality care. Being a The nurses will look at your IVs,
partner in your care helps you get the injuries, and bandages. They will also
best care possible. Taking part in nurse follow up on any tests that were done
bedside shift report is one way you can or lab work that was ordered.
be a partner.
Nurse bedside shift report is when the • Ask you what could have gone better
nurses going off and coming on duty during the last shift and what you
meet by your bedside to talk about hope to do during the next shift. For
your care. This gives you a chance to example, you may want to get out of
meet the nurse taking over your care, bed or just sleep. The nurse will try to
ask questions, and share important help you meet this goal.
information with your nurses. Nurse
bedside shift report does not replace • Encourage you to ask questions and
the conversations you have with your share your concerns. If needed, the
doctor. nurse coming on duty may come back
You can invite a family member or after the bedside shift report to spend
friend to stay during nurse bedside shift more time discussing your concerns.
report. We will only talk about your
health with others when you say it is What should I do?
okay. • Listen. You are an important part of the
When is nurse bedside shift report?
Nurse bedside shift report happens health care team. We want to make
every day between 6 and 6:30 a.m. sure you have complete and timely
and 6 and 6:30 p.m. It usually lasts information about your care.
5 minutes. The unit will be closed to • Speak up. If you have questions or
visitors from 5:45 p.m. to 6:45 p.m. concerns, nurse bedside shift report is
What should I expect? the perfect time to raise them.
During nurse bedside shift report, the • Ask questions if something is
nurses going off and coming on duty confusing. If the nurses use any words
will: or share any information you don’t
• Introduce themselves to you and understand, feel free to ask them to
explain it.
anyone with you. The nurse coming • Kaweah Delta Medical Center wants
on duty will write his or her name to make sure that you get the best care
and phone number on the white possible. If you have any concerns
board in your room. about the quality or safety of your care
during your hospital stay, please let
your nurse or doctor know.

• Invite you to take part in the nurse • If you are still concerned or if nurse
bedside shift report. You should bedside shift report does not happen,
decide who else can take part with call the Mother Baby Nurse Manager
you. at 624-2186.

Postpartum Depression

Emotional Changes
Giving birth brings many emotions such as joy and relief, while some mothers
experience sadness. Some find themselves impatient, unable to manage
caring for themselves or their baby, crying, feeling a lack of confidence
or irritable. These changes can range from postpartum blues to clinical
depression to psychotic depression. The difference is in how long the feelings
last to the nature and intensity of them. Studies show that women might
develop these problems after giving birth versus any other time in their lives.
Postpartum Blues
New mothers might doubt their ability to be a mother and if they can take
care of their new baby.
They may:
• Wonder what is wrong with themselves.
• Be tearful or easily irritated.
• Be anxious or ultra-sensitive.
• Be exhausted
• Have trouble concentrating or sleeping
• Feel overwhelmed by their responsibilities.
Feeling like these and others, occur in 9 out of 10 women who have given
birth, regardless if this is their first or another child. These feelings are often

- 12 -

Postpartum Depression

referred to as the “blues” and begin around the third or fourth day after birth.
They can last a few hours to a week. Typically, these feelings fade away over
time, usually without any treatment.
Coping with Postpartum Blues
Remember that you just had a baby, keep your expectations realistic. It takes
time for your baby to learn about you and you about them.
• Rest as much as possible.
• Limit visitors.
• Allow others to do things for you.
• Let your partner know how you are feeling.
• If you are single, find and develop a good support system.
Postpartum Clinical Depression
If the blues last more than two weeks and are getting worse, you might have
postpartum depression. Many of the signs are present, but more severe or
intense. Postpartum depression happens in 1-2 of every 10 women with
postpartum. These depressive signs can happen at any time during the first
months to one year after the birth.
These experiences and signs could lead you to disengage from and avoid
your baby or become possessive or your baby. This poses a risk to the safety
of your baby. If untreated, these signs can last up to a year. There are many
treatment options and mothers usually respond extremely well.
Contact your healthcare provider if you have any of these signs or
symptoms:
• Loss of identity.
• Difficulty sleeping or sleeping too much.
• Complete loss of control.
• Lack of interest in yourself, baby or others.
• Feeling withdrawn, isolated and lonely.
• Overly concerned about cleanliness/germs and the health and safety of

your baby.
• Change in appetite (either undereating or overeating).
• Exhaustion, but unable to sleep.

- 13 -

Postpartum Depression

• The need to keep moving or pacing.
• Feelings of hopelessness, a sense of failure or guilt.
• Feeling the need to “jump out of your skin.”
• Mood swings.
• Thoughts of hurting your baby, yourself or others.
• Constant crying.
• Nightmares.
• Constant anxiety or doubt.
• Difficulty focusing or concentrating.
Postpartum Psychosis
The signs below are some of the signs of postpartum psychosis. These signs
can start within 3 to 14 days after giving birth. These signs can vary, change
quickly and you might not have all of them.
If you have any of these symptoms go to the nearest emergency
department:
• You can’t remember how to do things you have done in the past.
• Agitation.
• Rapid or nonsense speech.
• Feeling like you have a lot of energy.
• You don’t like how you feel and you are afraid.
• You can’t sleep because your mind keeps going.
• Have strange feelings, like something is crawling on you.
• Have thoughts of harming your baby or yourself. If you have these tell

someone and go to the nearest emergency room.
• Hearing or seeing things no one else does.
• Feeling like someone is controlling you.
Be open and honest about how you are feeling. You can get better with
professional help.

- 14 -

Calming Your Baby

Babies can cry a lot at times in the months after their birth. It is important
for parents to know how to calm the baby down and to respond by giving
prompt attention. In the initial days, the baby needs a lot of attention to
help him/her settle down.
Swaddling can be an effective way to calm the baby down when correctly
done according to the American Academy of Pediatrics (AAP). When not
done correctly, swaddling can be risky as well. These points given by AAP
helps you understand how to swaddle correctly to avoid injuries to the
baby.
Swaddling
• Fold one corner of a blanket after spreading it out flat on a firm surface.
• Now place the baby on the blanket so that his or her head is over and

above the corner that has been folded. The baby should be placed with the
head facing up on the blanket.
• Then wrap the blanket so that the left side of it is tucked in-between the
body’s right side and the baby’s right arm. Do the same with the right side
of the blanket to tuck it between the left side of the body and left arm of the
baby.
• Tuck the bottom side of the blanket under one of the sides of the baby.

- 15 -

Calming Your Baby

• Check that the blanket’s not very tight over any of the sides and that the
baby can move his/her hips or has space to wiggle. You can check this by
placing two fingers between the blanket and the baby’s chest. There should
be space enough for two or three fingers to slide.

• After the baby starts to roll over, AAP recommends stopping swaddling.
How to deal with frustration
• Take deep breaths when frustrated and count to 10 to calm yourself down.
• Avoid shaking or throwing the baby.
• Place the baby in the crib and let him or her calm down for a few minutes.
• Get help from another family member, friend or trusted neighbor to handle

the baby for a while.
• Take “timeouts” when needed and pick the baby up only when you are

calm.
• Take the baby to the hospital or call the doctor if you think your baby is sick.

- 16 -

It’s my birthday, give me a hug!

Skin-to-skin contact for you and your baby

What’s “skin-to-skin”?

Skin-to-skin means your baby is placed belly-
down, directly on your chest, right after she is born.

It’s my birthday,Your care provider dries her off, puts on a hat, and
covers her with a warm blanket, and gets her settled
on your chest. The first hours of snuggling skin-to-
give me a hug!skin let you and your baby get to know each other.
They also have important health benefits. If she

y birthday,needs to meet the pediatricians first, or if you deliver

me a hug!by c-section, you can unwrap her and cuddle shortly

Skin-to-skin contactafter birth. Newborns crave skin-to-skin contact, but

it’s sometimes overwhelming for new moms. It’s ok

for you and your babyto start slowly as you get to know your baby.

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deiyfafoisenturfeeganendtdrbeyesoterrwatueaivegercrercheo.marbhktaTmnasgsahbometdmfyeuttyoeedhatcrfnhiakeueledSsbessirsosidbxkhrseittakdiwthhsvanetlae.eeenes-atepKtsstkdahaytnoesrlohetlut-wilpoborfensosninrkinirkfenrgtgaianghensbnorayta.wtfoantecTusbeuwhrdiidehibneneasdAgnbtmlmyhbitnaoeseobrkgifiicfrecytenhiaoeoesmr-nednu.tsstorbptAahEi-nebeiyscKnfnuvmakaeebeedeidaf,ewnyinwepfttewmsfiiesmncepdlfaiulyolcelehadarcytosfdiysibttsfeakalehsoilyafPrinlninoyearrgbwd-sdwifititsarlfintoktarafehg-mhitetnys,.rrewek-iosSactirobioknssu,o-iidnstsrkhr-kctitieonhnoimln-g,aas,ffk-tatoaiteennrnrotdbtkawcydo-beaaobsoeblniuerkt.ptyehholhFaietinsnaehnatltvpfyyetyheememooeekrtndureeuhsoirseconetpraacmegthlnhdmybioledocisssikaupentameb,srindltnaynaoydnlu.tut—dhcrhRgsoeiarzgnesytgl.sweesidhfkaohrimnech’sh-ootsledloreree-sbpsawhkyb.iiaiDentvshaesmdktswihnoc-aeamtntiorc-ssshnbktueiaongdbughliceee,lhsp
nregaesrt.feTehdeinaAgmlbitdaetbrluieicerassinlesnpeAgpecnya.addetvmimiyseiotsfktPinoe-dtitoah-tsrkeiciinsr pediatbtoraoibc.yFiiaantnthe.erresstaenddinmnouthrseirnsgwihf oheh’sosldleebpayb.iDesasdksAinc-abtnoo-ssnkuuingtghlteeh,lpe research
ing your baby skin-to-skin in his first few

Skin-to-skin beyond the delivery roomknow when to fAeedshmim,oesopetchialltyrifahne sisition
keep them calm and cozy. Multiple studies over the past 30 years have shown the
benefits of skin-to-skin contact. For more information, see
transititkoheepncwtooiuenYmtlsolaiudfacorefKrcirtwbhete,oaeresrsbklptbdilin.eiscr-Ctuttohoohden-m.sdbkpySeilnasoikrtneubipdngarlba-wscictekeiohtshif-senotsbsrak-tayyt,bioonwbiaue-easnrsncrkwmebdafaihineMtnAbtorsyhuhobaaatlnferetofoeidstlpkbapesulicdewneratj-nkslautmytdotueseodt-hdeefslruitikpe,eeotidsncslryoreiocyffvoearoeoelnuvresritnseterashbc,aetbto.hpraFnacebosdhtryhi3mno0iCMcongosyropnoeet,caoetiihsrantrrsorceafeatoh,olnsraEf—tmetoveRherDad,tsiymihnaAootioonnganwut,bdh,nsraeneeasrrtebesnushoeaSardnynbs,sidbytGntRrCgwheee,aviii.Brflsl2tehh0rsefget0aema’l7estyhadJsnyulwilennN1eaeg.8wprE;mlb(yia3.okr)rlD:aenyCnlsyDiaknddi0fcna0son-3ttcno5sa-.1tsnik9ninue
e best placeafnodrsnyhoauuvrgebgbalebetyt,etrtoobaoldoj.oudFstastuotghlaiefresr.sinand mMoothoree,rEsRw, Ahnodehrsoonld, GbCa,bBieergsmsakninN-. tEoa-rlsyksiknin-htoe-slkpinkeep them calm and cozy.
mpared with babies who are swaddled or
contact for mothers and their healthy newborn infants.
About the research-skin babies

sugars.
stay wBaromnerdanidncgalmer, cry less, Cochrane Database Syst Rev. 2007 Jul 18;(3):CD003519

Skin-Mto-uskltinipclueddstliungdmieasyoavffeecrtthhoew pyoaustre3la0teyweitahrsyohuarve shown the benefits of skin-to-skin contact. For more
babiyn. fRoersemarachteiorsnh,avseeewaMtchoeodrmeo, tEheRrs,aAndnidnfearnstos nin,tGheCfir,stBfeewrgman N. Early skin-to-skin contact for mothers and
ddling mayadanafydfteshccatuefhdtieodrrwlehbyiterohtauheli,rtrehalbanyatdebniwteheisetwhmy ynoboorouet.rircEnevdeintnhfaaatynsekatirsn.l-atCtoe-ros,kcsiknhinrma-tonom-esskDitnouamcthaombas se Syst Rev. 2007 Jul 18;(3):CD003519
ehewyantcohteicdedmsntohutahgtgerslsekdiannm-dtooi-nrsekfaiwnntimsthionmththseeitrofuibrcsahtbfieews during a visit to their pediatrician.

es more. Even a year later, skin-to-skin moms

heir babies during a visit to their pediatrician.

How to Keep
Your Baby Safe

In the United States,
close to 3500 babies
suddenly die every year
according to the Centers
for Disease Control and
Prevention (CDC). Called
Sudden Unexpected
Infant Deaths or SUIDS,
half of such deaths are
because of Sudden Infant
Death Syndrome (SIDS).
SIDS causes sudden
infant deaths for unknown
reasons. Babies who
are less than a year old
are at high risk for SIDS,
particularly from birth until
four months of age.
In 1992, the American
Academy of Pediatrics
(AAP) advised parents to
place their babies on their
backs when sleeping to
reduce the risk of SIDS.
Since then, the incidences
of SIDS-related deaths
have gone down in the
United States.
Babies dying due to other
reasons in sleep such as
getting caught in some
clothing, not being able
to breathe during sleep or
choking are still reported.
To prevent and reduce the
risk of such deaths, the
AAP has made several recommendations to create a sleeping environment
that is safe.
One of the most important recommendations made by AAP is to make the
baby sleep near the parents’ bed as close as possible in a separate sleep
surface that is designed specifically for babies. It is important for parents to
follow the other recommendations from AAP to avoid SIDS or SUID.

- 18 -

How to Keep
Your Baby Safe

Follow these AAP recommendations to prevent SIDS or SUID
• Whether it is a nap time or time to go to sleep for the night, always remember

to place the baby on his/her back.
• Always place the baby on a firm surface always to sleep. Do not use car

seats or other seats for the baby’s regular nighttime sleep.
• If you tend to fall asleep during breastfeeding, you should note this point

carefully! Avoid feeding on a soft surface or cushioning that could increase
the risk of falling asleep. The baby could choke on the breast milk when
unattended. Remember to carry the baby back to his/her crib or sleep cot.
• Babies can get caught in loose items of bedding or soft objects. Pillows,
blankets, bumper pads placed in the crib or bassinet can be dangerous to
the baby. The bumper pads or blankets can tangle up the baby leading to
suffocation. The baby could also choke on the soft pillows. Using firm but
comfortable bedding on the crib or cot with no loose items is recommended.
• Sleep positioners that are supposed to hold the baby in one position can
result in babies struggling to breathe while asleep and can cause SIDS. AAP
advises parents not to use these sleep positioners or wedges for babies.
• Smoking near the baby can be dangerous. The smoke can be inhaled by the
baby causing him/her to choke. Avoid smoking near the baby.
• AAP advises parents not to use drugs or alcohol.
• Using a pacifier can be helpful during bed time or nap time. AAP advises
mothers to wait until the baby finishes breastfeeding to introduce the pacifier
but not to force the baby to use it. AAP also advises not to add any sweet
substance onto the pacifier or to put it back in the baby’s mouth when it
falls out. It is recommended to regularly check and clean the pacifier before
putting it in the baby’s mouth.
• Using heart monitors on babies at home is not recommended to prevent SIDS.
• Instead of blankets that can cover the baby’s head, it is recommended to use
wearable warm clothing. The baby’s face should be always uncovered while
sleeping.
• Adjust the temperature of the room according to your comfort level and do not
overheat the room for the baby. Dressing the baby in an amount of clothing
that you would wear is recommended rather than bundling up the baby in too
many layers.
• Immunizations and regular well-baby checks are recommended to reduce
SIDS risk by 50 percent.

- 19 -

Breastfeeding

Newborn Feeding Pattern
The first 24 hours
Birth is very tiring for both mother and baby. This is why your baby will
focus their energy on sleeping, rather than feeding during the first 24
hours. The most important aspect of feeding during the first 24 hours post-
birth is getting the first feeding right.
Babies imprint on the mother during the first latch and this first feeding
session will help orient the baby toward the breast and will help them bond
better with the mother. It’s important to feed the baby within two hours after
the birth.
During the first 24 hours, your baby may sleep through the day, only
waking occasionally to feed. Ideally, the baby should be fed once every 2-3
hours during the day and 4-5 hours during the night. Since the baby will be
in deep sleep, you may want to wake them up for their feeding.
24-48 hours
Day 2 is when your baby will start developing a healthy appetite, and this
is when frequent feedings need to be given. Your baby may lick their lips,
suck their thumb or cry to indicate hunger.
If you’re in the 8th or 9th feeding session of the day, don’t worry. Babies
drink very small quantities of milk the first few days post-birth and this is
why they need to have frequent feedings. Anywhere between 8 and 12
feedings a day is normal during this time.
48-72 hours
Frequent feeding sessions continue, with the baby requiring multiple feeds
throughout the day. In fact, the first month after birth is characterized by
frequent feeding. But, it is from Day 3 that babies tend to cluster their
feedings around specific times of the day.
Cluster feeding is when babies feed more often during specific times of
the day. For example, your baby may prefer feeding every 20-30 minutes
between 9 and 11 in the morning. He/she may then not feed for the next
4-5 hours and then proceed to cluster feed again between 4 and 7 in the
evening.
This isn’t a cause for concern. Your baby’s metabolism and biological clock
are settling into a new schedule and this is why you’ll notice changes in
their feeding pattern.
Keeping track of the stool
The first stool that your baby passes won’t resemble the normal yellow
baby stool. It will be a black mucous-like substance called meconium. This
stool is made up of all the materials that the baby ingested when in the

- 20 -



Breastfeeding

womb. Passing the meconium is the body’s way of cleansing your
baby.
Passing the meconium within the first 24 hours is the sign of a healthy baby.
Usually, babies under a month old will have only one wet diaper a day. So,
it’s one diaper on Day 1, one on Day 2 and so on.
After passing the meconium, your baby’s stool will turn green and finally to
yellow within a week after birth.
Cluster Feeding
Cluster feeding is when your baby feeds close together at certain times of the
day. It usually happens in the evening, but all babies are different.
Cluster feeding is very common in newborns. Let’s take an example. Your
baby feeds normally during the morning, that is, once every 3-4 hours, but,
by evening, he/she prefers to feed frequently for hours at a stretch, requiring
feeding every 30-40 minutes. So, between 6 PM and 10 PM, you may find
yourself chained to the seat, constantly feeding your baby. Some babies
demand to be fed every 20-30 minutes during cluster feeds.
It’s easy to feel overwhelmed when your baby starts to cluster feed. Many
mothers often worry that they aren’t producing enough milk to satiate their
baby. But nothing could be farther from the truth. Cluster feeding is quite
normal and has nothing to do with low breastmilk production.
Although doctors aren’t quite sure why cluster feedings happen, many
believe it is the baby’s natural reaction to their growing needs. Cluster feeds
may also be the baby’s way to boost breastmilk production in the mother.
Either way, your baby is completely healthy and normal when he/she cluster
feeds.
We understand how taxing cluster feeding sessions can be. Here are some
expert tips to help make cluster feeding a soothing session for both you and
your baby:
• Make sure you are eating and drinking; this will stimulate breastmilk

production.
• Make yourself a nest for the day and make sleep a priority; it will give you

the energy to feed your baby longer.
• Talk to other moms. Get the support you need.
• Ask for help from medical professionals when you need it.
• Let the baby breastfeed whenever he/she wants.

- 22 -

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and areolaa(nFidguarere3o).la (Figure 3).

Breastfeeding

Signs your baby is getting enough to eat
• He/she feeds anywhere between 8 and 12 times in a day
• He/she has enough wet and dirty diapers for their age
• He/she produces an active and strong cry at least once a day
• His/her mouth and lips are wet and pink.
Newborn tummies are very small
It is common for babies to feed less during the first few days. And this has a
lot to do with the size of their tummy:
• Day 1 – Size of a grape; 5-7 ml
• Day 3 – Size of a cherry tomato; 22-27 ml
• Day 7 – Size of a strawberry; 45-60 ml
• Month 1 – Size of a lime; 80-50 ml
So, don’t worry if your baby appears to be underfeeding during the first
week. Once the second week dawns, your baby’s feeding pattern will start to
stabilize.
But sometimes, some babies don’t feed much even after the first week post-
birth. If you feel your baby isn’t getting enough to eat, these are the signs that
you need to look for:
• His/her body weight doesn’t increase
• He/she looks visibly tired and weak
• Your baby has dark stools and urine
• Your baby is constipated
• Your breasts are too hard and the milk ducts are blocked
If you notice any of these signs, please contact your healthcare provider or
lactation consultant immediately.
The best way to encourage a baby to feed is skin-to-skin contact. Keep your
baby close to your body and let your warmth soothe them and encourage
them to feed.

- 24 -

When You Go Home

Building your milk supply: What goes in, must come out. Look for:

pply: • Feed early and often, at the earliest sWignshofat goe•sAtinlea,stm3 puoospstpecrodamy byedaoy 4u. t. Look for:
hunger.
• Poops change from dark black to green/brown to
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liest day 4.
• At least 6 heavy/wet diapers after
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weeks. Frequent feeds, not formula: Otonlylouosese yellowina.s your milk comes in.
ule. formula if there’s a medical reason.
nstlyinutsheef•oFfSirenrlmeeusetdrpus4elanaletywaiitrnfehgyeteohkdueoser.warberna’ls.biey,setvseingantshoomf eh.WuLnAUeaghtrrenilneret:oeanssthY6oouhleuda•OvbAyGfevrl/leewpqboruaaebteltieniHmedtsyliyehoea.a:lplvmoeerwdseaaaysfstweyhroeudnratyhme4yil.nkucrsoemmeosrein.
• BdWraeyahssatatsnwgdeoiletlisnisgiNnn,OomrTmuasaltslyicgolnemsoseefndoseuactrt.eaaLbsoeooduktm7fio-l1kr0:
Over time:ome. Lea••rSHnoaftntoBdcFousenoeitdloiudneramigrnsl,yoegsauinglytdyhhoioi,unnftsregugncm,skdoatiiuolnthknwgedsemsnau,rlo.pioevpsrtelssmyitgr:neesntcotfhsh.iunngg.er. suAptplelays.t 3 poops per day by day 4.

• Cryin8g-1i2sfaeedlaintges spiegrn24ohfohurus nisgeexpr:ecdteodn, a’tlthwoaugith uthnesteilfeedings • YouPoropms cilhkanmgeafryomlodoakrk tbhlaicnk toorgrbeelun/ibsrhow, nbut it contains
gns of hunger:then!may not follow a regular schedule. firstA4 lwleebksa.bies havepdlAteoatnyllotesayossteow6yfehhlneloeauwvntyra/wsiteeyhntoudtersiay.mpeinrlks uacfotremsreedsaiymn.4.ore frequently.
Avoid pacifiers or bottles, at least in the
WatchFretqhueent bfeeadbs, yno,tnfoormtutlah: Oenclyluosecfkor:mBularief athsetre’ss wellinIgf nyUoriurnme cshaholuollydobsleeepsaslteeoynelbsloweadtassayhobuarormueiltkwc7oim-t1ehs0inb.daabyys: and
dsmtoreennt’tcthws.ianig•••t.SAIutetww’lavsntikieetOtterhrFciynsCHSSlhaKetolahrefmaehtfytseentiihideepiemendfcddodsgenwbieaobcste.inosaiaseathnrlrbla!emwgiftryc,yaelhoaooahshstuiusedetgfeotrfhhbsonnt.ibei,hg.nreasnaesgsbauwanrycots,soklf’atfteiuihnevlentuylgeeadosnnolmsktwsg,uaeeootsmrivr:nshitedgsthomogtaomrneseenrstnt’etstcls.tohfweswLou.iwcaneilifoagtltsr..nhhunon,dutrtYoopiinlbtinrotnlgrhueiseufeerstannasaerr!nsNr:ttltytymianOtgoidlTfokwnnam.us••••tairKNAAgytainOvvheeneABYloopieeintdoovrtllpiioleieuhddebstnaobdrfstNesratatshhaymkbr.bdOosytieewoieypiflTbaesfktemtbavlhnewchlamrsieaydunereuvsoditagisene:rnbgryn.inandfetl’latnoaaowsosoyrctnoegfhmssaek.rdkdewoysaettelhuchlbsyftresmiulersnntldlao,eucusstoiemhcshcbrdleioeknkebsyamms.wlhsnuuaisluitfawk,nsuroahlssdlbaebr,pusottebpmuueeporuptorrtlntlytsb7ry.ieh,-teb1.ifeocdr0toeorsiqdntn,cuhpataeyfcoinilsoslnutlnailsuodnye.twdcneahscsiee.snsoo,sf
hesoewleywci:otshIncof,dlryooobirnur •••••cLsef'TYBIHtakorafe•haoaehnnseoatruRb:btehlvctthpkyraeWoiecaenrtmASIHIwalbaunbtfaetfbawa’rglanvsteotrteaoRcoakiiehlrctaOaetphibtrtebececvsrhhngne,lrvtmhhKyboehybaoegeentsaesgtasohenasiuobeibobitfvfiratdttrhysgyeewpbtghbahh.etyceoestafebsbhiierlneeshblpelerldmwaipnoeyifecyseblecsihlhse’snwbepyeusndkhhe’esmpresbbonhaoopigtibeoirtetdyianoomysbeos:sshflws:l:wabnppgmf.tpmyess’astmytsktfl,aollkuooaatiylnyownuaosnls.otnirdlkiifwt-wu.ncuoghtledfpsioihtk-.nnsatmttlw-httah,gsphlasockiletrtdgaesloiwth-olnreasceohsewwlcfeaywikkctcidim:eooitshniihhInncnennofhu,odtesllgrygaynooilnccofbimpr:ntooeuysrcgsefocoI'rtnakerparIaaufenosunrrt:g:rrttftyhanKAANnowduabeatwaoctnaamdfvlvvrkyitruyceetpieotesneovuehooo’pce.siiregucrnonutrateghhiitrphtyhaddanl’geirrsetmgyosfu.tee,e.uft.seehsgbferhdoeleolf.eeeedecprdofwtai.ftnafimhvb.tgsrhs:yteeuoeundb••••drcftolDADBiakaapaobsSacsIeshcwflnoo.ynaseafhDDKAANAccfwadeawdrnetovvarksyenneboooeoerahsuiooc.eduiwiheenontoegooiipnnytitudhdd’rsissstohoouttttta,enoetthwulshsgtttsrlhbohfoaadm,eesbiaas,tecpsrwcofrtataellllllthihaellellmhevbochloocsertooeshbydleateeetwwukpoeheouhmwwndbpiobdrie.grcsesnafwtotalmaiiaikaihacnagbsslnsscathwn.astuhehiiylmaekhstnttkwgeooiasbifebwhydnogeweyunpyyoasootans.uhrlaebtsaofdtdbteas,fkrrucoryooeeahlonhcprttabtexeStgltrhomueeeceoebeasaswrumasleesisyrrtuhrl,yspbnh,wedfaladwnsowtbteoopaxaoaktdtde,hartouclnercboeprahtteueleutehesorleeeeydrmaarlnyltsdpsuoitb.lhdbr,b,hollfsneaieatdepbeIonefdpn,abnopnebrdebe.frstiybufn,paechofpo’efcoitesibcftlcatecninloltehloptyhtuuallnadtouadaetobultobthsrwhettcnonoieisehwfdehawcceosnnnDsaide.eeblatsdhnsedessbewcbiss,omyeuetsitshefa.paelel’ooaohatsinabotastotsnbdlysbthipc,orhynhkhyeoetdtaadaiseoeafoahh,rtal.trorhenoiboywinusebasblwta,a,nbbueradlyskitadoclyltdetlcheysbesuok.tuugde.eaotalpophldolat.bobywyubla:,aberkidlyelsbe.ugaapl.b
nhcimonotancty • ocB•t•auainmYYbyrooyoLebe’uuuBYTBYs.onooaaahYbommuumbbercoyyorkcmee’oaasuaadnnayyabyfouycyrmooehlffhhdfroaeeerneynaaaeneeeorlgysavgllsdecmntiehrltrsefdgiieceoe.hslthkknhlebimfaiaoanlnaelsnnwexbggemtedeysd-olosdddscissrifoianwgol,irwsaknmeamgnndnrlslrealo:tregioiecrwlnolfak:rtakxiwhi-encneyudlgdtgstoanoiyrofxsgouo,owareenrrurogndnnausabrsfdl:stfpirhsfteoni.eerohnraragriytsr.DDAa:aftotseisemtuss.dbyooher.,w.eoaunndrnittootedhwrttuiaasst,lllhlleooetwwph•iTentaLehmengbeTlxetBelyibaapnseeylyoybecebdlcoarsohnpsyuahyiuilse.laueoaebedrnreerrturyhehcp,eanreeboxhttwurosehwciotofspilkemotsiyismthsptoas,hpaflyopteltSpkisbhiulekteettudrreeapnhasedp,tlboealepwnasawtwwaitIlbtrhbfnheoheyhinfeaftaentahnabnsdyebttewetoiybDnyaahua’oyserobgobaboyn.htuspyhymnua.aeStdaotayhrkrtnonbaeehidynns.rgsaihoknlotmode:suokeeulddti:pslontohoiorgbtshnbheeraaddhr.eis back.
nnggtrosoarugnnusdl• psfYi.e•p•noeu““grorcf.rslsh:iiYhPyspiotrnooouelYYoh-uupinoosrtapehlruuvotrydoseo-olmmpuautbfftltiaoaardncehryyhigoerefnelefftlapieeharen.reesslegelltPbtrssv,srtriiebreorrnponcolreomaeynt:nhaxpas”oegessgepuedtcttbsaro,urmttimanbdngu-lagbrtr:tayergoiaoanyatwglycsc-ge’ttssiac,hsiynlok.b,hleniguopmaepsrt,ksriisNtlntebhk”fmvO.iuylreoasTttiunrylrN,ekptause.onrtOBibespduinrsaueTeyttesoiwcd,nnucata:shmpurhadaiisynlaed.rerteh, neburoorIitfsfirgkmhIsyfhcmeLboaearytetfyuroanoysaouSst’ksfutwhweulrheeeadhahdaraeilonvvsledsypogpe,e.aewi!tpqwarnqilunakisuengItrwsonhe,ewtanfisaotaistftlhnkniyslooseotfu,wonwbpDhrahseadhi,renboeasapliyggpstoseht,omnerdrianegSsootsrahiyksbkprtnatbaedaedfiywenons.xra,phorteyormo!irhpeunceeacalelidniwpns’ittn,hhoigther

aafst hero• rawnotfiifpdtteipheemle““w(odecfdlih.paiaed.pirerne.kel-noitapoporseel-mabnaforoorem(fadausobtasut,rierhptchak:h:s”:etb)bas—btar-aabtebbonyay’-osyc’stohm’sljeiufopsmstusbt”tftrohlhaeurecaeotnsvohitepu)rpts—cwlmoea.vrondesotrotsfjmtuhesotasrtteholea
unger hospital what you think:

Tell youred for
• BabyBhaabsy haadseaqdeuqauattee wweeigihgthgtaign:afionll:owfoulplo2wdauyspaf2terdyaoyusget
, or thirsty,afatnerdhyoomyueoagunedtmahgaoainmyate2awnedeksa.gain at 2 weeLkes.t your hospital know if you had a good or bad experience wi

breastfeeding.

Formula Feeding

When it comes to feeding and nourishing your baby, you may decide formula
feeding is the necessary option for you and your little one.
• Always check the expiration date. If it’s expired, don’t buy or use it. Check

the directions to see whether the formula needs to be mixed with water and
if it does, follow the measurements precisely. Bacteria from a baby’s saliva
can multiply in the bottle, so always toss any leftover formula.
• Nestle your baby close to you, take your time and extend the feeding
session by chatting, singing or cooing to your baby once the bottle is
drained.
Please discuss use of formula with your pediatrician.

- 26 -

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Brain-building benefits Formulated to be our
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Has brain-building MFGM*, an ingredient clinically ingredients MFGM and lactoferrin—for brain-
shown to improve developmental milestones by For easing fussiness, gas and crying in 24 hours‡ building nutrition and immune health.
one year of age1,†. and has easy-to-digest gentle proteins.

The Enfamil Family of Formulas™

Provides options to meet your patients’ particular needs—and has nutrients
important to help support brain development, immune health and growth.

Enfamil® Feeding Solutions

Enfamil Enfamil A.R.™ Enfamil® Reguline® Enfamil® Enfamil Nutramigen® PurAmino™
NeuroPro™ ProSobee® NeuroPro™ LGG®#
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Sensitive in 1 week|| works in 1 week¶

Enfamil NeuroPro™ Sensitive Reduces frequent spit-up. Designed to promote soft, A dairy-free, soy-based Nutrition designed to For infants with mild-to- Manages severe cow’s milk
is a NEW easy-to-digest comfortable stools. alternative for sensitive support brain and lean moderate food allergies protein and multiple food
formula specially formulated tummies. Clinically proven to growth in babies born including cow’s milk allergies. Has DHA to support
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Designed for toddlers who are transitioning to Has brain-nourishing DHA, prebiotics and 22 Designed to help meet the growing nutritional support brain development.
solid foods. Has 30 total nutrients such as brain- total nutrients to complement the diet. needs of older infants and toddlers with food
nourishing DHA. allergies including cow’s milk allergy.

* In an amount supported by clinical research. || vs. the same infants at the beginning of the study, in infants who regurgitate frequently (5 or more spit-ups per day).
† A s measured by Bayley-III cognitive score at 12 months in a study of a different formula with MFGM ¶ Infants fed a formula with the prebiotic blend had softer stools compared to a routine

added as an ingredient compared to a standard formula in the study without MFGM1. formula without prebiotics at 1 week.
‡ vs. the same infants at the beginning of the study. # LGG® is a registered trademark of Chr. Hansen A/S.
§ Not for infants with galactosemia. Reference: 1. Timby N et al. Am J Clin Nutr. 2014;99:860-868.

LB2992 REV 5/19 ©2019 Mead Johnson & Company, LLC

Meet Your Community
Healthcare Providers

- 28 -



BRIGHT PEDIATRICS

We serve our patients with respect, confidence, and compassion
while providing quality care in a comfortable environment.

Dr. Gu Well child exam with immunization from birth to
21 years old.
Take care of children with acute or chronic disorders.
Procedures: Perform newborn circumcision, EKG,
Echocardiogram, toenail removal, apply splint, etc.

559-625-0888

1922 S Court St.
Visalia Ca 93277

Experience For the past forty years
Matters Most Tulare Pediatric Group has
been able to bring the best
For 40 Years We’ve Been
Proudly Taking Care of the of care to thousands of
newborn babies, toddlers,
Health of Your Children children and adolescents.

So the next time the
unexpected happens with
your little one, call Tulare
Pediatric Group, because
experience matters most.

Monika
Lombardi, PA-C

Certified by the 1062 North Cherry | Tulare, CA 93274

American Board of Pediatrics 559.686.3824 M-F: 8 AM - 5 PM

Little patients, Big experience

NOW ACCEPTING NEW PATIENTS!

Kirk Coverston, MD Ramon A. Galindo, MD Kathryn L. Hall, MD

Saba Khalid, MD, FAAP Ralph P. Kingsford, MD Lance Tomooka, MD

559-739-2000 • www.vmchealth.com • 5400 W. Hillsdale Ave., Visalia



baby registry checklist
baby registry checklist

Wants, needs anWdandts,idne-eydsoaund-dtihd-yinouk-th-ionkf-o-ft-thheesesfoer afroegristary yroeurgbaisbytrwyill loyveo. ur baby will love.

bedding & essentials nursery furniture strollers & car seats

 crib

 c rib bedding sets nursery furnitureg lider or rocker  infant car seat
 b lankets & quilts  c hanging table
 infant car seat base

ssentialsc rib liners & pads  dresser  booster car seats strollers
 crib sheets  b assinet & bedside sleeper  c ar mirror
 crib s waddling & wearable blankets  c rib mattress
 car window shade

 changing pads & covers  g lider or rocker t ravel systems  i nfant car seat
 sound soother  c hanging table  stroller
 hamper  stroller accessories  infant car seat

 hangers  d resser gear & activities  booster car sea
 m obile  b assine ptlay&yarbd edside sleeper

 car mirror

ble blankets  c rib ma bs twotuirnnegcsesrss& rockers health & safe ctyar window sha
overs
 w alkers & entertainers  safety gates  t ravel systems
nursing  a ctivity gym  baby monitor  s troller
 b aby carriers  medicine

 breast pump  p acifiers  stroller accesso
 c hiled proofing
 milk storage

 nursing pillow  h umidifier

 n ursing pads  t hermometer

 nursing privacy cover gear & baatch tivities  shopping cart cover
 nipple cream  bath toys
 nursing apparel
 play yardb ath tubs & seats
 bouncerh wsoaosdh&ecdlortbhoasthctkoweerlss health

 swings toiletries gift set feeding
bath time
diapering  w alkersb &abyegnrootemirngtaseitners  b ottles
 formula  safety gates

ng  d isposable diapers  activity gym  highchairs  b aby monitor
 cloth diapers  b aby carriers  burp cloths
 wipes
 d iaper rash cream  sippy cups  m edicine

 d iaper bag  extra nipples for bottles pacifiers
 bottle warmer
clothing 
 d iaper pails
 sterilizer organization c hiled proofing
 changing pad  t ops  cleaning &
 d iaper organization  b odysuits
 wipe warmer  pajamas  bibs  humidifier
 diaper pail liner refill  bottoms  home food prep
 c hanging pad covers  n ewborn gift sets f eeding booster seat thermometer
 u tensils
ver bath  s hopping cart c

 bath toys
 b ath tubs & seats





Baby’s Daily Breastfeeding Log

Keeping a daily log of your baby’s feedings, wet diapers, and bowel movements can help you tell that your

bbereloawstBfteoaebBkdniyanogb’swyisDw’sghaoDeiintlayhgielwByr eyrBlole.urCaesosahmtsoftpuefaledereedgdeyitnoinhuggrelbLpLaoowbggyit’shpbartetaesrtnfseewdiitnhgt.he breastfeeding and diaper guidelines

H•owEnbbKttereoeeleoarpbKbuwstiertensehfletoegaeeopwseaitnkddtftegdnhiaoneaoategkdiewldniyincsaoagwlihwonglyihosgadwleiogrontthogthifgeim:oneytwhfgroeeeyyuwroleorleyu.aubloCrlc.ausbohCbhasmoyobhfm’espyuo’alespufderaldfdeeregieegndeydeyitgonitonhugshugrestresl,ablp,bpwrawatwbwbeeeyytitidtt’’sshdhd.ipipbabaaaprprteteetetaeraerssrssrt,nt,nfasfeasneewndewddiditbinhitbonghowt.ghwt.eehleebmlrbmeoraveoseatvmfseetemefnedeteisnndgctiasnangncahdanendlpihdaepydloepiaur pygtoeueliurldgtethuelianlildteteysholiauntreysour

• CHheocwHk •otthwoEenuttboseoeruxtshtfeheoedtrhacwteehhcaahinrcadth:rttibm: reeaeascthefaecehdinfgeestdairntegd.started.
• Eac•h Etin•mteCerhytehocekudtrhabetaebboayxndfhoatrismwaheicwehaecbthreafanesetddedaincirghtysfetaedrditaienpdge.srtsarctehde. ck a “pee” and/or “poop” box.
• Use• thC•ehe“EcNakcothhtteeimsb”eosyxeofcuotrriobwanbhyticohharbseraceowarsedtteaaanncdyhdcfireoteynddciineagprnesrstsaocrthreesdcp.keac“ipaelet”hainndg/sorth“paotohpa” pbopxe.ned during that feeding.

• Ea•chUstiemtheey“oNuortebsa”bsyechtaiosnatwo eretcaonrddadniyrtcyodnicaeprenrssocrhsepcekcial “tpheineg”satnhadt/hoarp“ppeonoepd”dbuorxin.g that feeding.

Sa•mUpseleth: e “Notes” section to record any concerns or special things that happened during that feeding.

Sample:

Baby’s Daily Breastfeeding LogbKreeeapsitnf1eg0Dea/da2diS1tnae/ag0iDml9yias1ptl0Doegl/ea2og21t:Ti:e/4oni05mfg9 yaTewomi2meTu:4lierl5m.baCeamB1obLr1meyeBmaf’spLrtsB1MeietanfLr1afeeertsimaMeftentsMitnduyiniitonnueuutgB1sRter0sreBisReB1,gbsRrm0airhewgiaegsatihmahbntsetstityntt’sdipaaptetPerPCseCCrDeh,neDDhheaiasaainaianpanwgnpedpgeegriesPetbreshorosPowtophoeelpHbmarneodaHvsaeetxmnfpdereeesNensdextoidspnNtregcaeosafstNatsneenesorhddtfeeedalespifdatipynegoerurfgetueelidlditenhlgianteysour

below to kn“ o10w/2w1/0h4“9e:3t0h2ea:4rm45y:3ao0muams1h5o1mu11iln5mdminginet h1e21l10pm2mimwniinnith breaPPPseeeteefeeedPinPoPgoo.opoopp Hand expressed after feeding

H•••owECEnahtcteoehDcrkutatismttheheeeDedtayb“hatoDoeteueaxtrTceafbiohnmarad4bTe:wr3tiyt0mihTm:haieimcameheseBabaLrrecwee1ahfaLt5seBMetsfLtrmfeetetaaiMifennetsnMtduaidniictnnuehdugtBsRteifre1sisReetBgsR2tyairehgaiegsmthdarhdttsittinitneadgp.esrtsarcPtPhCeCeCeDehdDeDhehaic.aainaiakpangnpepgeaegresPere“Psorpsooepoep” and/or Notes
Breast Breast
Notes
record any concerns Notes
“poop” box.

• Use the “Notes” section to oPPPrPeeeeseeepeeciaPPPlooPtooohppooiopnpgs that happened during that feeding.

Sample: PPPeeeeee PPoPoopooopp

Minutes PPeeeeee PPoPoopoopp
PPeeeeDeeiapePPorPopoopp
Date Time Left Right PPPCeeeeheeangPePosPopooopp Notes
Breast Breast

10/21/09 2:45 am 11 min 10 min PPPeeeeee PPoPooopoopp Hand expressed after feeding
“ 4:30 am 15 min 12 min PPPPPeeeeeeeeee PPPPooPoooooppoooppp Notes
PPPeeeeee PPoPoopooopp
Minutes PPPeCeeeDheeaianpgPeePorsPoopooopp
PPeeee PPoooopp
Date Time Left Right
Breast Breast

PPeeee PPoooopp

Pee Poop

Pee Poop

Pee Poop

Pee Poop

Pee Poop

Pee Poop

Pee Poop

Pee Poop

Pee Poop

Minutes Diaper Notes
Changes
Baby’DsaDteailyTBimreeastfLeeeft ding RLigohtg

Keeping a daily log of your baBbreya’sstfeedingBsre, awstet diapers, and bowel movements can help you tell that your
breastf1e0e/d2i1n/g09is go2i:4n5gawmell. C1o1mmpianre you1r0bmaibny’s pattePrenes withPtohoepbreaHsatnfdeeedxipnrgesasnedd daifatpeerrfgeueiddienlgines

below to kn“ ow wh4e:3t0hearmyou s1h5omuilnd get h1e2lpmiwn ith breaPsetfeeedinPg.oop

How to use the chart:
CEnhteeDcrbBKkatreetthaeehaepbseitndyfbega’esoatdexdDinTaafgiioanlmyirsidlleogwytogihimBonifgceryhweoeebuaaLlrrlsc.eebhCtfaatfoMbsfemeytie’espneaddfuaeriectiennehdygsiRognfsuieggtrLseha,btodrwatibgeneytdg’sd.sipatapatetrertsreC,ndaDshn.waidanitbphgoeewtrhseel
• movements can helpNyooutetesll that your
•
breastfeeding and diaper guidelines

• Each btiemlowe ytookunrobwawbhyehthaesrBayroewuasethtoaunlddgdeBtirheteyalspdtwiaitphebrrseacshtfeecekdiang“.pee” and/or “poop” box.

• Use tHheow“Ntootuesse” stheectciohnartto: record any concerns oPr espeecial Pthoionpgs that happened during that feeding.

• Enter the date and time each feeding started. Pee Poop

Samp• lCeh:eck the box for which breast each feeding started.
• Each time your baby has a wet and dirty diapers chPeecek a “peeP”oaondp/or “poop” box.

Baby’s Daily Breastfeeding LogKeepingDaad•taeUilSysealmothgpeTlo“eiNmf:oyetoesu”rsbecaBtbiLroeyenaf’ststMotferieencduoitrnedgBsRasrnie,gyahwscttoentcderianps eorrPPsCsee,pDheeaeaicnainadplgetbehrosPPinwoogsooetlpphmatohvaeppmeenendtsducraiNnngohttheealspt feyeoduintge. ll that your

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Sample: Minutes PPeeee PoPopoop
PPeeee PoPopoop
Date Time Left Right PPPCeeeeeDheaianpgePPeoorsPooppoop Notes
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11 min 10 min PPeeee PoPoopop

“ 4:30 am 15 min 12 min PPeeee PoPoopop

Minutes Pee Poop

Date Time Left Right Pee Poop Notes
Breast Breast
Pee Poop

PPeCeeDheaianpgPeeorsPopoop
PPeeee PoPopoop

PPeeee PoPopoop

Pee Poop

Pee Poop

Pee Poop

Pee Poop

Pee Poop

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Pee Poop

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Pee Poop

Welcome and Congratulations! Schedule Your Installation
We are delighted that you have chosen Contact your nurse or dial (559) 802-7520
to welcome the newest member of your to schedule your safety seat installation.
family at Kaweah Delta Medical Center. What You Can Expect:
Our highly trained staff and physicians 1. Our certified technicians will review
will provide you and your baby with the
best care and the absolute best patient inportant child safety seat information
experience. with you and inspect the safety seat
After the birth of your child, you and your that you have chosen to make sure that
baby will have time to bond and rest in it meets Department of Transportation
our mother-baby unit. However, nothing regulations.
will feel quite right until you have the 2. Our technicians will demonstrate how
opportunity to walk into your home with to properly install the safety seat in your
your newborn. vehicle.
Here at Kaweah Delta, we offer a free 3. You will then have the opportunity to
child safety seat installation service that install the seat. This exercise will ensure
is meant to help you keep your child safe that you can remove the seat and re-
while in your vehicle. If you are interested install it in your vehicle and select the
in receiving more information on this best position needed.
service, please talk to your nurse or call Certified Technicians
the Security Services Department at (559) Our child safety seat educators/instructors
802-7520. This appointment could take up are certified with the National Highway
to an hour, so we would like to meet with Traffic Safety Administration (NHTSA) as
you or a family member well before you Child Passenger Safety Technicians.
plan to leave the hospital. Technicians are required to certify every
Child Safety Seat two years and the must participate in
At Kaweah Delta, we take patient safety continuing education during the year.
very seriously. This is why we look beyond Online Resources
the hospital’s physical environment when National Highway Traffic Safety
it comes to your child’s safety. We have Administration
certified child car seat technicians that will https://www.nhtsa.gov/parents-and-
help parents learn about car seats and the caregivers
right protective equipment for their child.

We believe that having the right Safe Kids Worldwide
information is important to make the best https://www.safekids.org/
decision for you and your family. Our California Highway Patrol
certified technicians will provide you with https://www.chp.ca.gov/programs-services/
useful and relevant information about child programs/child-safety-seats
seat laws and safety equipment.

Our technicians will also provide Kids Health
instructions on how to properly install a https://kidshealth.org/en/parents/auto-baby-
child safety seat in your vehicle. toddler.html

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Neonatal Intensive
Care Unit

Dear Parents,
Welcome to Kaweah Delta’s Neonatal Intensive Care Unit. While we
recognize that this may be a very stressful time for you and your family,
we would like to assure you that your baby is receiving excellent care.
Our NICU is designed especially for premature babies and babies who
experience problems at birth. Through our partnership with Valley Children’s
Medical Group we are staffed at all times with neonatologists, neonatal
nurse practioners, and neonatal nurses who are all here to specially care
for your baby. Our hope is that this information will help you to navigate your
way through your NICU journey. Please share with staff any questions or
concerns you may have – we are here to care for your family.
Sincerely,
NICU Team

Nursing Staff Hours:
Day Shift 6am-6pm
Night Shift 6pm-6am

- 42 -

NICU Table of Contents

Chapter 1 – Visiting Your Baby ....................... 44

• Who may visit
• Safety measures
• Scrubbing

Chapter 2 - What To Expect In The NICU........ 46

• The team caring for your baby
• What you will see and hear
• Common NICU equipment
• Common NICU tests
• Common conditions treated in the NICU
• Developmental care
• Skin-to-skin holding (Kangaroo Care)

Chapter 3 - Feeding Your Baby ....................... 54

• How will I feed my baby?
• Breastfeeding
• Pumping and storing your milk
• Cue-based feeding

Chapter 4 - Taking Care Of You ....................... 56

• Understanding your feelings
• When to seek professional counseling

Chapter 5 – Taking Your Baby Home .............. 58

• Things your baby must do before going home
• Things you will need to do before you take your baby home
• Sleeping
• Car seat safety
• Crying and fussiness
• Illness prevention

Glossary ............................................................ 66

Weight Conversion Chart ................................ 69

Resources ......................................................... 70

- 43 -

Chapter 1:
Visiting Your Baby

At the time of admission to the neonatal intensive care unit, many things
need to happen quickly for your baby’s well being. Please feel free to
come and see where your baby will be, and then give the medical team
approximately one hour to settle your baby in before having a prolonged visit.
Visiting Hours
• Open: 7am to 5pm
• Open: 7pm to 9pm
• Closed: 5 to 7, morning and evening, to visitors
• Only banded persons are allowed after 9pm
• In urgent situations we may briefly close to provide the best care possible to

our patients.
Who May Visit
• To keep your baby safe and to maintain confidentiality, you will be given

a green band and an identification number when you enter the unit. You
will be asked to show your band as you enter the unit and when you are
at your baby’s bedside. When calling, you will be required to read your
identification number to the staff in order to receive information about your
baby.

- 44 -

Visiting Your Baby

• It is our hospital policy to only provide information to parents or legal
guardians so please keep your identification number private.

• Only two people can be at the baby’s bedside at one time. One of them
must have a green band on. Other visitors may wait in the downstairs
lobby, which is available for their comfort.

• If you are sick or you think you may be sick, please talk to your baby’s
nurse before coming into the unit.

• Children under 12 are not permitted in the NICU.
• During the cold and flu season only parents (or people with green bands)

will be allowed in the NICU.
Safety Measures
Nothing is more important to us than your baby’s health and safety. For that
reason, we’ve taken careful security precautions to protect your baby:
• All staff members caring for your baby are required to wear a photo

identification badge with a pink stripe.
• Infants only leave the unit when accompanied by NICU personnel.
• Babies are always within the sight of nursery staff.
• Whenever leaving the bedside, be sure that the side rails are up or the

portholes of the isolette closed to prevent accidental falls.
Scrubbing
For the well being of your baby, we
have rules that must be followed by
EVERYONE entering the NICU.
• All visitors must do a 1-minute
scrub of their hands and forearms
and apply waterless Antimicrobial
hand gel; a nurse will show you how.

• Returning visitors who remain in the hospital, only need to wash thoroughly
for 15 seconds and apply the waterless antimicrobial hand gel. If the
returning visitor leaves the hospital, he or she will be required to do another
1-minute scrub of the hands and forearms, with another application of
waterless Antimicrobial hand gel.

- 45 -

Chapter 2: What To
Expect In The NICU

The Team Caring For Your Baby
Many professionals work together to care for premature or sick babies.
You may meet some or all of the following: neonatologists, neonatal nurse
practioners, registered nurses, respiratory therapists, social workers, physical
therapists, occupational therapists, speech and language specialists, unit
secretaries, and nurse aides.
What You Will See and Hear
You will see and hear many things in the NICU. Your nurse will explain what
equipment your baby is using and what each of the alarms you may hear
means. Ask as many questions as you need to. We want you to feel safe,
comfortable and informed.
Common NICU Equipment
The NICU contains many machines and other types of equipment used to
care for sick babies with many different problems. These machines seem
less intimidating when you understand how they can help your baby.
Bililights: The bright blue fluorescent lights placed over the baby are used to
treat jaundice (yellowing of the skin and eyes). Babies with jaundice usually
receive the “photo-therapy” treatment for three to seven days.
Blood pressure monitor: A machine connected to a small blood pressure
cuff wrapped around your baby’s arm or leg. The cuff automatically takes
your baby’s blood pressure at regular times and displays the numbers on a
screen.

- 46 -

What To Expect
In The NICU

Cardiopulmonary monitor: A machine that tracks your baby’s heart and
breathing rates. It is connected to your baby by small adhesive monitoring
pads placed on her chest. If your baby’s heart rate or breathing rate becomes
too fast or too slow, an alarm will sound.
Central line: An intravenous line inserted into a vein, in the arm or leg,
and leads into a larger vein in the body close to the heart. The line delivers
medicines or nutritional solutions. A PICC (peripherally inserted central
catheter) is a type of central line, which is placed in one of the major blood
vessels.
C-PAP (continuous positive airway pressure): Air is delivered to a baby’s
lungs either through small tubes in the baby’s nose or through a tube that has
been inserted into their windpipe. The tubes are attached to a mechanical
ventilator, which helps the baby breathe, but does not breathe for them.
Endotracheal tube: A small plastic tube, which is inserted through a
baby’s mouth down into the trachea (windpipe). The tube is attached to a
mechanical ventilator, which can help a baby to breathe.
Isolette: Babies are placed in this clear plastic box, which keeps them warm
and protects them from germs and noise.
Intravenous line: Most premature and sick babies cannot be fed
immediately, so they must receive nutrients and fluids intravenously (through
a vein). A doctor or nurse will insert a very small needle or tube into a tiny
vein in the baby’s hand, foot, arm, leg or scalp. Your baby also can receive
medications and blood through the IV line.
Mechanical ventilator: A mechanical ventilator is a breathing machine that
delivers warmed and humidified air to a baby’s lungs. The sickest babies
receive mechanical ventilation, meaning that the mechanical ventilator
temporarily breathes for them while their lungs recover. The amount of
oxygen, air pressure and number of breaths per minute can be regulated to
meet each baby’s needs.
Nasal cannula or nasal prongs: Small plastic tubes that fit into your baby’s
nostrils and deliver oxygen.
Pulse oximeter: A small device that is wrapped around a baby’s foot or hand
and secured with a stretchy bandage. It uses a light sensor to help determine
if the baby has enough oxygen in their blood.
Radiant warmer: An open bed with an overhead heating that provides heat
to a baby. A warmer may be used instead of an isolette if the baby needs to
be handled frequently.

- 47 -

What To Expect
In The NICU

Umbilical catheter: A thin tube (catheter) inserted into the umbilicus.
Through this catheter, doctors and nurses can painlessly draw blood. They
don’t have to repeatedly stick the baby with needles. They can give fluids,
blood, nutrients and medications through this tube. A small device can be
attached to the catheter to continuously monitor your baby’s blood pressure.

Common NICU Tests
Your baby will have a number of different tests during their stay in the
neonatal intensive care unit (NICU). These tests help determine what your
baby’s problems may be and how they should be treated. Tests also help
monitor your baby’s progress. Your baby’s doctor will tell you what tests are
recommended and inform you of the results. If your baby needs a major test,
the doctor will ask you to sign a consent form before the test is done.
These are some of the tests done in the NICU. Your baby may need
additional specialized tests, depending on their medical condition.
Blood tests: These are among the most common procedures done in the
NICU. Blood tests provide important information on how your baby is doing.
They alert doctors to potential problems before they become more serious.
Echocardiogram: A specialized form of ultrasound examination that is
used to study the heart. It can detect structural problems (heart defects) and
problems with how the heart works.
Hearing test: Premature and other sick babies are at increased risk of
hearing problems. Before your baby goes home they will have a hearing
test. It is important to detect hearing problems early, in order to help prevent
speech and language problems.
Newborn screening test: Also called a PKU, this is a test performed by
pricking a baby’s heel to obtain a few drops of blood on a filter paper. It tests
babies for serious hereditary disorders.
Retinopathy of prematurity (ROP) examination: This test usually is done
for babies born at or before 32 weeks of gestation or weighing less than 1,500
grams (3 1/3 pounds). The test is generally performed about 4 weeks after
birth, or when your baby reaches 31 to 33 weeks. Before the examination, the
doctor places drops in your baby’s eyes so the doctor can see their retina and
determine whether the blood vessels are developing normally. If your baby
has any signs of ROP, the doctor will repeat this test regularly to see if the
condition is clearing up on its own, or whether treatment is necessary.
Ultrasound: Ultrasound takes a picture of a baby’s organs using sound
waves, rather than X-rays. A small hand-held device called a transducer
is rubbed back and forth over the area that the doctor wants to see. An
ultrasound examination is painless and is usually done in the NICU.

- 48 -

What To Expect
In The NICU

Urine tests: Like blood tests, urine tests can tell a great deal about a baby’s
overall condition. Urine tests can help determine how well the kidneys are
working, and whether your baby has an infection.
Weighing: Your baby is weighed soon after delivery, then at least once a day
while they are in the NICU. Don’t be alarmed if your baby loses some weight
in the first days or weeks after birth. This is normal, especially for very small
babies. When a premature baby starts gaining weight at a steady rate, it is
an encouraging sign that they are doing well.
X-rays: X-rays provide pictures of your baby’s lungs and other internal
organs. These pictures help your baby’s doctor plan their treatment and
monitor their progress.
Common Conditions Treated in the NICU
Premature babies and other very sick newborns face some of the same
medical issues. A list of common conditions are located in the back of the
book under “glossary.” The conditions listed may not be relevant to your
baby’s situation. We encourage you to read only what you feel would be
helpful to you and your child’s particular circumstances.
Developmental Care
Many nurseries are finding ways to help preemies develop normally during
their stay by practicing developmental care. This type of care helps prevent
the brain from being injured by intense or painful stimulation, and provides
the kinds of experiences that will help the baby to develop normally in all of
the 5 areas. These are:
1. Physiological (body systems, such as heart, breathing, and body functions).
2. Motor (movement of arms, legs, head and body)
3. Sleep/wake
4. Attention
5. Self-regulation (the ability of the infant to soothe or calm himself).
Why is Developmental Care Important?
Research shows that what happens to infants in the NICU affects the way the
brain develops, and that some problems may be the result of the preemies’
early months spent in a world that is very different from most babies.
In the NICU, there is a lot of equipment being used, as well as a lot of people
and machines that make noise; lighting is sometimes kept very bright so the
staff can see well, and many treatments are performed that may be stressful
or painful for the baby (suctioning, heel sticks, having IVs placed, X-rays).

- 49 -

What To Expect
In The NICU

These treatments may mean that the baby is disturbed many times daily,
disrupting sleep.
By making the NICU environment more suited to your preemie, some of
these problems can be prevented.
Explained below are some ways we can make the NICU space more ‘baby
friendly’:
The NICU environment can be changed to:
• Reduce the amount of sound and light
• Provide support for the baby’s position
• Make treatments less stressful
• Reduce the number of times the baby is disturbed.

Sound
Loud sound is a concern because:
• It may damage the baby’s ears, leading to hearing loss, and it is stressful

for the baby.
• Loud sounds can cause changes in heart rate, breathing, and a drop in

blood oxygen levels. They also may startle the baby and disturb sleep.
Sound levels can be reduced by talking quietly, closing doors and portholes
gently, and not dropping things on top of the isolette. The sound that
preemies enjoy the most is the sound of your voice. Quietly talking, singing,
or reading to your baby is one way to soothe or calm them. Keep in mind that
extra sounds may be disturbing when there are other loud activities in the
NICU. It is important to watch your baby to see how they respond.

Light
Light is a concern because:
• Bright light may cause injury to the eye, may disturb body rhythms, and

prevent your baby from opening his/her eyes and looking around.
• Light can affect the level of arousal of your baby. In bright light the baby is

less apt to open his or her eyes when awake, missing chances to explore
the world and to interact with you and others.
Lighting can be reduced by covering isolettes with blankets. With monitors
displaying vital signs, the staff knows how your baby is doing, even with the
isolette covered.

- 50 -