Newborn

Proactive in your child’s care.

Empowering families for over 50 years.

Please take the time to read through this material. We provide this information because

we see value in educating our patients.

Congratulations!

As you anticipate the birth of your child, we wanted to take

some time to introduce ourselves and our services to you and

your family and hope that you will consider us in caring for the

growth and development of your baby.

We have included several documents that may be helpful to

you in making your choice for pediatric care.

For more information, please visit our website,

www.wmpeds.com, email newpatient@wmpeds.com, or call

our offices!

We will be happy to help you!

Choosing a Pediatrician: Frequently Asked Questions

There are many factors families must consider in selecting a pediatrician including practice

style, office resources, office hours and locations (accessibility) and more. Ultimately, you

must decide which features are most important. We recommend that you take me to

interview a few pediatric practices in your area to make sure you are comfortable with your

choice. We offer “Meet the Practice/Newborn Classes” regularly. Visit our website,

www.wmpeds.com or call our office for the class schedule.

Here are some of the more FAQs (along with the answers for Westwood-Mansfield Pediatrics).

Who are the providers that would see my child?

Patients of Westwood-Mansfield Pediatrics are seen by pediatricians and nurse practitioners.

(See “About Our Providers” on page 4.) For more comprehensive information, our provider

biographies are present at www.wmpeds.com.

Who will see my baby in the hospital?

During your hospital stay, your baby will be cared for by one of the pediatricians or nurse

practitioners (NPs) who sees newborns where you deliver. We do not round at any hospitals.

(See “Who Will See My Baby in the Hospital” on page 5.)

Do you have experience with children who have special needs or complex medical

histories?We take pride in providing comprehensive healthcare to many children with special needs

including autism spectrum disorders, ADHD, asthma and many more. We work closely with

parents to coordinate the care of children whose conditions may require multiple specialistsand services. To that end, our practice is currently in the process of becoming a Certified

Medical Home which will enhance the development of a partnership between the family and

the child’s primary health care professional based on mutual trust and respect to deliver

primary care that is accessible, continuous, comprehensive, family-centered, coordinated,

compassionate and culturally effective care.

What special resources does your office offer patients and families?

In addition to pediatricians and nurse practitioners, Westwood-Mansfield Pediatrics has

other staff members with specialized areas of expertise in childhood issues. We have an

Education Specialist available to help families navigate the school system and identify

resources available for children with learning style issues. Our Medical Care Coordinator

provides assistance in coordinating care for children with multiple specialists. Additionally,

Lactation Consultants are available for any breastfeeding questions.

Why Choose Westwood‐Mansfield Pediatrics?

Westwood-Mansfield Pediatrics is an established

group that has been serving children and their

families since 1957. Our providers are dedicated to

providing quality, caring and compassionate

healthcare to our patients from infancy to young

adulthood. Our office is open every day except for

Thanksgiving and Christmas (including weekends

and the other holidays). In addition, we are open onMonday through Thursday evenings to help

accommodate your busy schedule. We utilize

electronic medical records and are pleased to offeronline access to request appointments, referrals,

prescription refills, and to ask a question of a nurse or provider.

Westwood-Mansfield Pediatrics is well-recognized within the pediatric health care

community for our commitment to the education of our patients and the public. Our

providers have spoken at conferences and our office has organized and sponsored numerous

community forums to promote health and wellbeing. Additional education efforts include

regular e-newsletters and e-alerts, online videos, and information packets and literature.

We work hard to continue our own education as well (with monthly provider meetings) and

ensure that all our providers have similar, up-to-date approaches to different medical issues

(for example, our philosophy towards vaccinations or the treatment of ear infections). We are

a unified group. As a group, however, our providers all have their own styles. Patients have

the opportunity to meet many of our providers offering different

perspectives and increased patient choice. Additionally, each of

our providers has a specific area of interest and specialization (for example, asthma,

breastfeeding, international adoption, or concussions) giving an opportunity to consult witha different doctor/nurse practitioner within our group for improved care.

Children with special needs make up a sizeable portion of our practice. Our SKIP (“SpecialKids In our Practice”) program is designed to increase the attention and care given to our

sickest and most medically (or behaviorally) challenging children. We routinely administer

developmental tests to screen for autism, anxiety and other developmental issues.

Westwood-Mansfield Pediatrics is affiliated with Children’s Hospital Boston and the Pediatric

Physician’s Organization (PPOC) at Children’s Hospital. The PPOC is actively involved in the

quality improvement of pediatric practices throughout Massachusetts. We were one of 40

private practices nationwide to be chosen for a series on improving quality in the primary

care office. Recent independent evaluations by the Massachusetts Healthcare Quality

Partners ranked us 4 out of 4 stars in well baby care, provider communication, and

healthcare promotion.

About Our Providers

Westwood-Mansfield Pediatric Associates is staffed by Board Certified Pediatricians and

Nurse Practitioners. For updated information on our providers, please visit our website,

www.wmpeds.com.

What is a Pediatrician?

Pediatricians are doctors who specialize in the care of children and adolescents and are

educated in childhood physical, emotional, and social development. They understand that

children are not simply small adults, and that each age brings its own set of challenges,

developmental issues, and common illnesses.

Pediatricians provide guidance to help you to understand and promote your child’s healthy

development. At times, they may also address issues affecting a child’s family and home

environment (including major life stressors such as death or divorce). (Adapted from theAmerican Academy of Pediatrics)

What is a Nurse Practitioner in a Pediatric Practice?Nurse Practitioners (NPs) are health care providers dedicated to improving children’s health.

They have advanced education in pediatric nursing and health care, pharmacology, and child

development. Some are further certified as Lactation Consultants. They provide a wide range

of high quality primary health services for children through adulthood. (Adapted from the

National Association of Pediatric Nurse Associates and Practitioners)

At Westwood-Mansfield Pediatric Associates, NPs are an integral part of our team and work in

collaboration with pediatricians providing high quality care for both well and sick children.

They manage many chronic conditions including asthma, ADHD, and obesity and are an

essential part of our team.

Pediatricians and Nurse Practitioners are trained to provide:• Counseling on growth and development (physical, emotional, and social)

• Diagnosis and treatment of acute illnesses

• Management of chronic diseases including asthma, ADHD, and obesity

• Advice intended to prevent injuries and to promote a healthy lifestyle

• Treatment of serious childhood conditions requiring complex care

• Guidance in anticipating your child’s needs from birth to adulthood

Who Will See My Baby in the Hospital?

During your hospital stay your baby will be cared for by one of the pediatricians or nurse

practitioners (NP) who work in the hospital where you deliver. This pediatrician/NP will

provide you with written information describing your baby’s hospital stay to bring to your

first visit.

We ask you to call us for an appointment the day you leave the hospital. We plan to see

newborns within the first few days after discharge in order to meet you, closely monitor the

baby for weight gain and jaundice, and to offer support for you and your family.

Lactation consultants are available to provide breastfeeding support and triage nurses to

answer phone calls for any questions you may have.

We look forward to meeting you and your baby and to developing a working relationship that

ensures excellent health, development, and safety for your family. Please do not hesitate tocontact us with any questions.

Vaccines (Immunizations)

Westwood-Mansfield Pediatric Associates is a pro-vaccine practice. It is our expectation that

you will vaccinate your child according to the schedule recommended by the American

Academy of Pediatrics.

Thanks to the success of immunizations, many of us have not witnessed the devastatingeffects of illnesses like whooping cough (pertussis), polio, mumps, and measles (among

others). Polio paralyzed millions of children in the pre-vaccine era. Mothers exposed to

measles during pregnancy often had babies with devastating birth defects. While these

vaccine-preventable diseases are now uncommon, outbreaks do still occur.

In the 21st century we live in a global community where travel between continents is routine.

Children may still become infected with preventable diseases if they are not immunized,

putting others at risk as well. Babies, the elderly, and people with immune disorders (as well

as a small portion of otherwise healthy individuals) may not develop adequate protection

following vaccines. If enough people in the community are immunized, the vulnerable

members can be protected by “herd immunity.”

All parents are committed to providing their children with the best possible care. Vaccines are

a valuable tool to keep your child healthy. Despite the negative publicity vaccines haverecently received in the media, the World Health Organization and UNICEF estimate that

vaccines save over three million lives worldwide each year.

Westwood-Mansfield Pediatrics strongly believes that vaccines save lives.

We will be happy to discuss any concerns that you may have. Please visit the American

Academy of Pediatrics website for more detailed information on immunizations

(www.aap.org).

Important Things to Have at Home

When preparing to bring a baby home from the hospital, there are certain items that we

believe each household should have. These include the following:

• Rectal Thermometer

• Vaseline

• Infants’ Tylenol*

• Ocean Drops (Saline Nasal Drops)

• Bulb Syringe

• Cool Mist Humidifier

• Balmex or Desitin (or other diaper cream with Zinc Oxide) Nail Files

* Please call the office before using Infants’ Tylenol for any baby under 3 months of age!

Normal Newborn Things Which Can Frighten Parents!

Eye Rolling – Uncoordinated eye movements in a newborn is normal as long as it is

intermittent. It does not represent a seizure.

Twitching Movement of Arms and Legs – As newborns fall asleep (or are waking up) their

arms and legs may twitch for several seconds. If this twitching is brief and if you can stop itwith your hand, it should not be a concern.

Vaginal Bleeding – In babies, vaginal bleeding may occur in the first two weeks of life. Theblood spots can be the size of a quarter and may last up to a few days.

Choking Episodes – When a newborn chokes it appears quite frightening. Breast milk (orformula) can come out of the nose and the child may turn a dark red color. As long as the

child is not blue and the episode is brief, the only intervention necessary is to use a bulb

suction syringe to clear the mouth and nose.

Hiccups, Sneezing, Yawning, Wheezy-like Noises, and Irregular Breathing –The above

noises are very common and generally normal in a healthy newborn. Wheezy-like noises

don’t suggest asthma, but almost always represent the fact that

newborns breathe through their nose (and not their mouth) until they get close to four-to-six

months old. Therefore even the smallest amount of mucous can cause noisy breathing. Nointervention is needed as long as your child feeds comfortably, has good color, and sleeps

well.

Mildly Irregular Breathing – In a pink baby, mildly irregular breathing is normal and will

become more regular as the child gets older. This is not a warning sign of Sudden Infant

Death Syndrome (SIDS). SIDS occurs in approximately 1 in 2,000 births. One way to lower the

chance of SIDS is to place your baby on the back to sleep, not on the stomach or side.

Feeding Choices: Breast Milk or Formula

The method by which you choose to feed your baby is a personal choice and one of the more

important decisions you will make in the first year of your child’s life. We at Westwood-Mansfield

Pediatric Associates are supportive of whatever feeding method you choose.

The American Academy of Pediatrics recommends exclusive breastfeeding for the first 6

months of life and continued breastfeeding for a minimum of 1 year. They state that human

milk is the “ideal food” for infants and that the benefits of breastfeeding include protection

from infection (during the first 6 months of life), improved developmental outcomes,

decreased rates of obesity, decreased rates of allergies, and many more.

While breastfeeding may not be the right option for all families, we hope you will give it

consideration. We are committed to supporting any mothers who wish to breastfeed their

babies but who may require special assistance or instruction.

International Board Certified Lactation Consultants are on staff and are available to answer

questions and meet with you to help with any breastfeeding needs.

Whatever decision is right for you, Westwood- Mansfield Pediatrics will work with you to

promote and ensure your child’s health and well-being.

Recommended Resources

As a new parent, you will quickly realize that nearly everyone you meet has a different

opinion about parenting and newborn care (many are not shy sharing these opinions). It is

important to remember that there are many “correct” ways to raise children, and that you

must sort through this advice to find the information that is helpful to you. We have compiled

the following selection of recommended resources to help you.

A great place to start is the American Academy of Pediatrics “Health Topics” website,www.aap.org/healthtopics. This website contains terrific information on all the topics listed

below (and many others).

Child Development• Caring for Your Baby and Young Child-Birth to Age 5 (Steven Shelov, American Academy of

Pediatrics)

• Caring for Your School Age Child-Ages 5-12 (Edward Schor, American Academy of

Pediatrics)

• Touchpoints: Your Child’s Emotional and Behavioral Development (T. Berry Brazelton)

• The Incredible Years (Carolyn Webster-Stratton)

Breastfeeding• New Mother’s Guide to Breastfeeding (Joan Younger Meek, American Academy of

Pediatrics)

• International Lactation Consultant Association – www.ilca.org

• Massachusetts Breastfeeding Coalition – www.zipmilk.org

• La Leche League International – www.lli.org

Sleep Resources• Solving Your Child’s Sleep Problems (Richard Ferber)

• The No-Cry Sleep Solution (Elizabeth Pantley)

• Nighttime Parenting (William Sears)

• Healthy Sleep Habits, Happy Child (Marc Weissbluth)

• Sleeping Through the Night (Jodi Mindel)

• Secrets of the Baby Whisperer (Tracy Hogg and Melinda Blau)

General Health and Nutrition• Guide to Your Child’s Symptoms (Donald Schiff, American Academy of Pediatrics)

• Guide to Your Child’s Nutrition (William Dietz, American Academy of Pediatrics)

Car Seats• American Academy of Pediatrics (keyword “car seats”) - www.healthychildren.org

• National Highway Transportation Safety Administration (select “Child Passenger Safety”) -

www.nhtsa.dot.gov

• SafetyBeltSafe USA - www.carseat.org

The New Enigma in My House(A Toddler’s Perspective on the Newborn Sibling)

Dear Mom and DadI’ve really been had.

It’s like if either of you brought in an additional spouse

Oh, what strife there’d be in the house!

This new little creature gets all the attention

And I’m supposed to respond with no apprehension.

My fear and jealousy force me to act out,

Saying and doing “mean” things no doubt.

You had me toilet trained and out of a crib,

When I regress, please don’t think I’m so spitefully glib.

And hence there will be less to pay.

1. Before the birth, go to the library and get me a video or book on where babies come

from, how they act and how they look.

2. Get out my baby pictures, And make them central fixtures.

3. Get me a present on arrival of the baby, So the first day home won’t be so crazy.

4. Include me in the “creature’s care”, Job assignments make me feel important and

teach me how to share.

5. When guests come to visit the baby, And your attention is away from me, Anticipate

my acting out and let me be. Don’t feel shame, For this is a normal phase and I’m not

to blame.

6. No matter how well I’m prepared Mommy for your leaving, My separation anxiety, Will

have little satiety.

Most of all Mommy and Daddy, remember normal is not easy,

But work as a team, and just watch me beam.

By: Dr. Hartman

Follow Dr. Hartman on Twitter @DrHartmanWMPEDS

“Proactive in your child’s care”

At Westwood-Mansfield Pediatrics, we are concerned with the health of your whole family as

data indicates that the mental health of parents has a direct influence on the developmentand well-being of their children. As part of our ongoing effort to be a proactive practice, we

will be screening for post-partum depression and anxiety.

Postpartum depression and anxiety affects about 10% of mothers and can affect mothers

anytime in the 1st year after the baby is born.*

Who is at greater risk?

Mothers with a history of anxiety and depression

Mothers who are worriers by nature

Mothers who had challenges getting pregnant and/or had difficult pregnancies (i.e.

pre-term labor, hospitalization, bed rest, gestational diabetes and assistedreproduction)

The most common presenting symptom is generalized anxiety and partners very often

recognize symptoms before the mom does.

Treatment usually entails therapy and may include medication with selective Serotonin

Reuptake Inhibiters (SSRI’s), which does not affect a mother’s ability to breastfeed.

If you are concerned that you or your partner may be suffering from depression or anxiety,

please either contact your obstetrician or utilize the contact information for therapists

specializing in post-partum issues.

As always, please feel free to contact us should you have any concerns between visits.

For more information, please visit www.acog.org (American College of Obstetricians and

Gynecologists): keyword postpartum depression.

* Please not that while our screening focuses on the mother’s mental health, emerging data suggests that fathers also have asignificant increase in depression rates in the first year following the birth of a baby.

03/2015

Postpartum DepressionHaving a baby is a joyous time for most women. But many women feel sad, afraid, angry, or anxious

after childbirth. Most new mothers have these feelings in a mild form called postpartum blues.Sometimes these feelings are called "baby blues." Postpartum blues almost always go away in a fewdays.

About 10% of new mothers have a more serious problem called postpartum depression. Postpartumdepression lasts longer and is more intense. It often requires counseling and treatment. Postpartumdepression can occur after any birth, not just the first.

This pamphlet will help you learn about causes of postpartum depression how to tell if you have postpartum depression what you can do to ease these feelings

Baby BluesMany new mothers are surprised at how weak, alone, and upset they feel after giving birth. Theirfeelings do not seem to match the feelings they thought they would have. They wonder, “What have Igot to be depressed about?” They fear that these feelings mean that they are bad mothers.

In fact, about 70–80% of women have baby blues after childbirth. About 2–3 days after birth, they beginto feel depressed, anxious, and upset. For no clear reason, they may feel angry with the new baby,their partners, or their other children. They may also

cry for no clear reason have trouble sleeping, eating, and making choices almost always question whether they can handle caring

for a baby

These feelings may come and go in the first few days afterchildbirth. The baby blues often go away in a few hours or a weekor so without treatment.

Postpartum DepressionWomen with postpartum depression have such strong feelings ofsadness, anxiety, or despair that they have trouble coping withtheir daily tasks (see box). Postpartum depression can occur atany time after birth, but it most commonly starts 1–3 weeks afterdelivery. Women with postpartum depression need treatment withcounseling and sometimes medication. Without treatment,postpartum depression may become worse or may last longer.

Postpartum depression does not seem to relate to the mother’sage or number of children she has had. It is more likely to occurin women who lack emotional support or who have had

postpartum depression before a psychiatric illness recent stress, such as losing a loved one, family illness,

or moving to a new city

Postpartum depression also can occur in women without any ofthese risk factors.

A few new mothers will develop a more severe mental illnesscalled postpartum psychosis. However, this condition is very rare.Women are more at risk if they have had manic depression(bipolar disorder) or schizophrenia or if family members have hadthese diseases.

Reasons for Postpartum DepressionPostpartum depression is likely to result from body, mind, and lifestyle factors combined. No two women have the same biologicmakeup or life experiences. These differences may be why some women have postpartum depression and others do not. It alsomay help explain why a woman can cope with the demands of everyday life but find the stress of a new baby hard to handle.

When to Suspect Postpartum DepressionA new mother may be developing—or already have—postpartum depression if she has any of the followingsigns or symptoms:

The baby blues do not start to fade after about1 week, or if the feelings get worse.

Strong feelings of depression and anger come1–2 months after childbirth.

Feelings of sadness, doubt, guilt, orhelplessness seem to increase each week andget in the way of normal functions.

She is not able to care for herself or her baby. She has trouble doing tasks at home or on the

job. Her appetite changes. Things that used to bring her pleasure no

longer do. Concern and worry about the baby are too

intense, or interest in the baby is lacking. Anxiety or panic attacks occur. She may be

afraid to be left alone in the house with thebaby.

She fears harming the baby. These feelingsare almost never acted on by women withpostpartum depression, but they can be scary.These feelings may lead to guilt, which makesthe depression worse.

She has thoughts of self-harm or suicide.

A new mother having any of these signs or symptomsshould take steps right away to get help

Body ChangesThe postpartum period is a time of great changes in the body. These changes can affect a woman’s mood and behavior for daysor weeks.

Levels of the hormones estrogen and progesterone decrease sharply in the hours after childbirth. This change may triggerdepression in the same way that much smaller changes in hormone levels can trigger mood swings and tension before enstrualperiods. Some women are more bothered by these changes than others. They may be more likely to have postpartum blues ordepression.Hormone levels produced by the thyroid gland also may decrease sharply after birth. If these levels are too low, the new mothermay have depression-like symptoms, such as mood swings, nervousness, fatigue, trouble sleeping, and tension.

Many women feel very tired after giving birth. It can take weeks for a woman to regain her normal strength. Some women havetheir babies by cesarean birth. Because this is major surgery, it will take them longer to feel strong again.

Also, new mothers seldom get the rest they need. In the hospital, sleep is disturbed by visitors, hospital routine, and the baby’sfeedings. At home, the baby’s feedings and care must be done around the clock, along with household tasks. Fatigue and lackof sleep can go on for months. They can be a major reason for depression.

Emotional AspectsMany emotional factors can affect a woman’s self-esteem and the way she deals with stress. This can add to postpartumdepression.

Feelings of doubt about the pregnancy are common. The pregnancy may not have been planned. Even when a pregnancy isplanned, 40 weeks may not be enough time for a couple to adjust to the extra effort of caring for a baby.

The baby may be born early. This can cause changes in home and work routines that the parents did not expect. If the baby isborn with a birth defect, it may be even harder for the parents to adjust.

Having a baby who must stay in the hospital after birth can cause sadness and guilt. A woman may feel guilty that she didsomething wrong during pregnancy. Sadness about coming home without the baby is very common.

Mixed feelings sometimes arise from a woman’s past. She may have lost her own mother early or had a poor relationship withher. This might cause her to be unsure about her feelings toward her new baby. She may fear that caring for the child will lead topain, disappointment, or loss. Feelings of loss are common after having a baby. This can add to depression. The loss can takemany forms:

Loss of freedom. This can include feelings of being trapped and tied down. Loss of an old identity. The mother may be used to someone else taking care of her or of being in control. Loss of prepregnancy shape and feelings of having sex appeal.

Lifestyle FactorsA major factor in postpartum depression is lack of support from others. The steady support of a new mother’s partner, otherfamily members, or friends is a comfort during pregnancy and after the birth. It helps when others can assume household choresand share in child care. If a woman lives alone or far away from her family, support may be lacking.

Breast-feeding problems can make a new mother feel depressed. New mothers need not feel guilty if they cannot breast-feed orif they decide to stop. The baby can be well nourished with formula. Your partner or other supportive person can help with someof the feedings, giving you more time for yourself or for rest.

The Role of MythsWomen who have an idea of the “perfect mother” are more likely to feel let down and depressed when faced with the needs ofday–to–day mothering. Three myths about being a mother are common:

Myth No. 1: Motherhood Is Instinctive. First-time mothers often believe that they should just know how to care for a newborn.In fact, new mothers need to learn mothering skills just as they learn any other life skill. It takes time and patience. It takesreading child care books, watching skilled child caregivers, and talking with other mothers. As a mother’s skills grow, she willbecome more sure of herself.

Mothers also may believe that they must feel a certain way toward their newborns or they are not “maternal.” In fact, somewomen feel very little for their infants at first. Mother love, like mothering skills, does not just happen. Bonding often takes daysor even weeks. When the special feelings of motherhood begin to emerge, they should be nurtured.

Myth No. 2: The Perfect Baby. Most women dream about what their newborns will look like. When the baby arrives, it may notmatch the baby of their dreams.

Also, babies have distinct personalities right from birth. Some infants are easier to care for. Others are fussy, have upsetstomachs, and are not easy to comfort. A new mother may find it hard to adjust to the baby.

Myth No. 3: The Perfect Mother. For some women, being perfect is a never-ending goal. A mother may think she is not livingup to the ideal. She may feel that she is a failure.

Of course, no mother is perfect. It is not true that every woman can “have it all.” Most women have trouble finding a balancebetween caring for a new baby and keeping up with household duties, other children, and a job. They often feel this way evenwith a lot of support.

What You Can DoIf you are feeling depressed after the birth of your child, there are some things you can do to take care of yourself and yourbaby:

Get plenty of rest. Do not try to do it all. Try to nap when the baby naps. Ask for help from family and friends, especially if you have other children. Have your partner help with feedings at night. Take special care of yourself. Shower and dress each day, and get out of the house. Get a baby sitter or take the baby

with you. Go for a walk, meet with a friend, and talk with other new mothers. Tell your partner or a friend how you feel. Often just talking things out with someone you trust can provide relief.

Call your doctor if your feelings do not improve or if you feel hopeless. Blues that do not go away after about a week or feelingsthat get worse may be signs of a more severe depression. Tell your doctor if you are afraid you might neglect or hurt your baby.

Your doctor can refer you to experts in treating depression. These experts will give emotional support, help you sort throughyour feelings, and help you make changes in your life. You also may be given antidepressants. These drugs generally areconsidered safe to use during breastfeeding.

Hotlines and support groups are available for women with postpartum depression. Talk to your doctor about finding help in yourarea.

To get well, women with postpartum depression need realistic goals and support. Learn how to nurture yourself as well as yourfamily. Small, daily things can make a big difference. It is important to take time for yourself, get out of the house, and reach outto family and friends. Do only what is needed, and let the rest go.

Women who have had postpartum depression before are at risk for having it again after another pregnancy. Your doctor maysuggest that you begin treatment right after your next pregnancy to prevent postpartum depression.

Finally...Many new mothers feel sadness, fear, anger, and anxiety after having a baby. This is normal. It does not mean that you are afailure as a woman or mother or that you have a mental illness. Having these feelings means that you are adjusting to the manychanges that follow the birth of a child.

If the baby blues do not improve or get worse, you may have postpartum depression. Talk with your doctor. Use resources forcounseling and treatment. Even if your depression is severe, treatment can help you return to normal soon.

GlossaryAntidepressants: Medications used to treat depression.Cesarean Birth: Delivery of a baby through an incision made in the mother’s abdomen and uterus.Estrogen: A female hormone produced in the ovaries.Postpartum Blues: Feelings of sadness, fear, anger, or anxiety occurring about 3 days after childbirth and usually fading after 1week (sometimes called “baby blues”).Postpartum Depression: Intense feelings of sadness, anxiety, or despair after childbirth that interfere with a new mother’sability to function and do not go away after a few weeks.Progesterone: A female hormone that is produced in the ovaries and prepares the lining of the uterus during the second half ofthe menstrual cycle to nourish a fertilized egg.

Postpartum Therapists

We strongly suggest you speak with your obstetrician if you feel you might be experiencing signs of

postpartum depression.

Therapists

JoAnn Feldstein, Ed.D.

93 Union St, Suite 401

Newton Center, MA 02459www.drjoannfeldstein.com/

617-332-9887

Debra Greenberg, LICSW

15 Cottage St

Norwood, MA 02492

dgreenberglicsw@comcast.net

781-329-6696

Eda Spielman, Psy.D

6 Fairfield St

Newtonville, MA 02360

http://www.jfcsboston.org/

617-969-4117

Kathleen O’Meara, APRN

27 Mica Ln

Wellesley, MA 02481

781-431-0207

Ellis Waingrow, MSW, LICSW

24 Lincoln St

Newton Highlands, MA 02461

http://www.selfleadership.org/

617-244-8132

Wendy Hrubec, LICSW

275 Turnpike St, Suite 108

Canton, MA 02021

http://www.selfleadership.org/

781-821-2063

Janet Leibowitz, PsyD

345 Neponset St, Suite 6Canton, MA 02021

http://www.janetleibowitz.com/

781-258-3587

Christine Gardosik, LICSW

21 Cohasset St, Suite 3

Foxborough, MA 02035

978-808-1635

Needham Psychotherapy Associates, LLC

992 Great Plain Ave

Needham, MA 02492

http://npaonline.com/

781-449-7522

Psychiatrist

Ann Briley, MD

18 Wareland Rd

Wellesley, MA 02481

781-237-7896

Allison Phillips, MD

27 Mica Ln

Wellesley, MA 02481

781-431-0207

How to Take a Child’s TemperatureWhat's the best way to take a child's temperature?While you often can tell if your child is warmer than usual by feeling her forehead, only athermometer can tell how high the temperature is. A digital thermometer can be used to takea rectal (in the bottom), oral (in the mouth), or axillary (under the arm) temperature. Your child's doctor can recommendhow to use it depending on your child's age. Taking a rectal or oral temperature is more accurate than taking an axillarytemperature.

Ways to use a digital thermometer by ageChild’s Age Rectal Oral AxillaryNewborn to 3 Months X3 Months to 3 Years X X4 to 5 Years X X X5 Years and older X X

Tympanic (ear) thermometers are another option for older babies and children. However, while it gives quick results, itneeds to be placed correctly in your child's ear to be accurate. Too much earwax can cause the reading to be incorrect.While other methods for taking your child's temperature are available, they are not recommended at this time. Ask yourchild's doctor for advice.

Mercury thermometers should not be used. The American Academy of Pediatrics encourages parents to remove mercurythermometers from their homes to prevent accidental exposure to this toxin.

How to use a digital thermometerIf your child is younger than 3 years, taking a rectal temperature gives the best reading. The following is how to take arectal temperature:

Clean the end of the thermometer with rubbing alcohol or soap and water. Rinse it with cool water. Do not rinse itwith hot water.

Put a small amount of lubricant, such as petroleum jelly, on the end. Place your child belly down across your lap or on a firm surface. Hold him by placing your palm against his lower

back, just above his bottom. Or place your child face up and bend his legs to his chest. Rest your free handagainst the back of the thighs.

With the other hand, turn the thermometer on and insert it 1/2 inch to 1 inch into the anal opening. Do not insert ittoo far. Hold the thermometer in place loosely with 2 fingers, keeping your hand cupped around your child'sbottom. Keep it there for about 1 minute, until you hear the "beep." Then remove and check the digital reading.

Be sure to label the rectal thermometer so it's not accidentally used in the mouth.

Once your child is 4 or 5 years of age, you can take his temperature by mouth. The following is how to take an oraltemperature:

Clean the thermometer with lukewarm soapy water or rubbing alcohol. Rinse with cool water. Turn the thermometer on and place the tip under his tongue toward the back of his mouth. Hold in place for about

1 minute, until you hear the "beep." Check the digital reading. For a correct reading, wait at least 15 minutes after your child has had a hot or cold drink before putting the

thermometer in his mouth.

Although not as accurate, if your child is older than 3 months, you can take his underarm temperature to see if he has afever. The following is how to take an axillary temperature:

Place the tip of a digital thermometer in your child's armpit. Hold his arm tightly against his chest for about 1 minute, until you hear the "beep." Check the digital reading.

Last Updated 1/9/2012Source Fever and Your Child (Copyright © 2007 American Academy of Pediatrics, updated 9/07)

Infant & Toddler Car Seat Safety (0-2 Years of Age)

(excerpted from HealthyChildren.org)

Infants & Toddlers: Rear-Facing

The AAP recommends that all infants should ride rear facing starting with their first ride home from the hospital. All infants and

toddlers should ride in a rear-facing car seat until they are at least 2 years of age or until they reach the highest weight or heightallowed by their car seat's manufacturer.

Types of Rear-Facing Car Seats

There are 3 types of rear-facing car seats: rear-facing only seats, convertible seats, and 3-in-1 seats.

When children reach the highest weight or length allowed by the manufacturer of their rear-facing only seat, they should continue to

ride rear-facing in a convertible seat or 3-in-1 seat.

Rear-Facing Only Seats

Are used for infants up to 22 to 40 pounds, depending on the model.

Are small and have carrying handles (and sometimes come as part of a stroller

system).

Usually come with a base that can be left in the car. The seat clicks into and out of

the base so you don't have to install the seat each time you use it. Parents can buy

more than one base for additional vehicles.

Should be used only for travel (not for sleeping, feeding, or other uses outside the

vehicle).

Convertible Seats (used rear-facing)

Can be used rear-facing, then "converted" to forward-facing for older children.

This means the seat can be used longer by your child. They are bulkier than

infant seats, however, and do not come with carrying handles or separate bases

so are not routinely used outside of the vehicle.

Many have higher rear-facing weight (up to 40-50 pounds) and height limits than

rear-facing only seats, which make them ideal for bigger babies.

Have a 5-point harness that attaches at the shoulders, at the hips, and between

the legs. Convertible car seats with overhead shields are no longer made.

However, if you have one you can use it safely until its expiration date.

Should be used only for travel (not for sleeping, feeding, or other uses outside the

vehicle).

3-in-1 Seats (used rear-facing)

Can be used rear-facing, forward-facing, or as a belt-positioning booster. This means the seat may be used longer by

your child.

Are often bigger in size, so it is important to check that they fit in the vehicle while rear-facing.

Do not have the convenience of a carrying handle or a separate base; however, they may have higher rear-facing

weight (up to 40-45 pounds) and height limits than rear-facing only seats, which make them ideal for bigger babies.

Installation Tips for Rear-Facing Seats

Figure 2: Rear-facing car seat.

Figure 3: Convertible car seat used rear-facing.

When using a rear-facing seat, keep the following in mind:

Place the harnesses in your rear-facing seat in slots that are at or below your baby's shoulders.

Ensure that the harness is snug and that the harness clip is placed at the mid-chest level.

Make sure the car seat is installed tightly in the vehicle. If you can move the seat at the belt path more than an inch

side to side or front to back, it's not tight enough.

Never place a rear-facing car seat in the front seat of a vehicle that has an active front passenger air bag. If the air bag

inflates, it will hit the back of the car seat, right where your baby's head is, and could cause serious injury or death.

If you are using a convertible or 3-in-1 seat in the rear-facing position, make sure the seat belt or lower anchor and

tether is routed through the correct belt path. Check the instructions that came with the car seat to be sure.

Make sure the seat is at the correct angle so your infant's head does not flop forward. Check the instruction manual to

find out the correct angle for your seat and how to adjust the seat angle if needed. All rear facing seats have built-in

angle indicators or adjusters.

Still having trouble? There may be a certified CPST in your area who can help. If you need installation help, see the

end of this article for information on how to locate a CPST.

Common Questions About Rear-Facing Car Seats

What if my baby's feet touch the back of the vehicle seat?

Your child can bend his legs easily and will be comfortable in a rear-facing seat. Injuries to the

legs are rare for children facing the rear.

What do I do if my baby slouches down or to the side in his car seat?

Blanket rolls may be placed on both sides of the infant and a small diaper or blanket between

the crotch strap and the infant. Do not place padding under or behind the infant or use any

sort of car seat insert unless it came with the seat or was made by the manufacturer of the

seat.

Why should I dress my baby in thinner layers of clothing before strapping her into a car seat?

Bulky clothing, including winter coats and snowsuits, can compress in a crash and lead to increased risk of injury.

Ideally, dress your baby in thinner layers and tuck a coat or a blanket

around your baby over the buckled harness straps if needed.

Do preemies need a special car seat?

The car seat should be approved for the baby's weight. Very small babies who can sit safely in a semi reclined position

usually fit better in rear-facing only seats. Premature infants should be tested while still in the hospital to make sure

they can sit safely in a semi reclined position. Babies who need to lie flat during travel should ride in a crash-tested car

bed.

Figure 4: Car seat with a small cloth between crotch

strap and infant, retainer clip positioned at themidpoint of the infant’s chest, and blanket rolls on both

sides of the infant.

Area Car Seat Safety Technicians

Attleboro Fire Department100 Union St

Attleboro, MA 02703

508-222-2324

Contact: Stephen Stellakis, Phillip DeCosta

Brockton Police Department

7 Commercial St

Brockton, MA 02042

508-897-5208

Canton Police Department

99 Revere St

Canton, MA 02021

781-828-5090

East Bridgewater Police Department

153 Central StEast Bridgewater, MA 02333

508-378-7223

Easton Police Department

46 Lothrop St

Easton, MA 02356

508-230-3322

Contact: Darren Mangott

Mansfield Police Department

50 West St

Mansfield, MA 02048

508-261-7300

North Attleboro Fire Department50 Elm St

North Attleboro, MA 02760

508-699-0140

Contact: Daniel Jackman

North Attleboro Police Department

102 South Washington St

North Attleboro, MA 02760

508-695-1212

Plainville Fire Department

157 South St

Plainville, MA 02762

508-695-5252

Plainville Police Department

157 South StPlainville, MA 02762

508-699-1212

Sharon Police Department

213 South Main St

Sharon, MA 02067

781-784-1588

Stoughton Police Department

26 Rose St

Stoughton, MA 02072

781-344-2424

Information for New Parents

Important Things to Have at Home

When preparing to bring a baby home from the hospital, there are certain items that we believe each

household should have. These include the following:• Rectal Thermometer

• Vaseline

• Infants’ Tylenol*

• Ocean Drops (Saline Nasal Drops)

• Bulb Syringe

• Cool Mist Humidifier

• Balmex or Desitin (or other diaper cream with Zinc Oxide)

• Nail Files

• Please call the office before using Infants’ Tylenol for any baby under 3 months of age!

Normal Newborn Things Which Can Frighten Parents!

Eye Rolling – Uncoordinated eye movements in a newborn is normal as long as it is intermittent. It

does not represent a seizure.

Twitching Movement of Arms and Legs – As newborns fall asleep (or are waking up) their arms and

legs may twitch for several seconds. If this twitching is brief and if you can stop it with your hand, it

should not be a concern.

Vaginal Bleeding – In babies, vaginal bleeding may occur in the first two weeks of life. The blood

spots can be the size of a quarter and may last up to a few days.

Choking Episodes – When a newborn chokes it appears quite frightening. Breast milk (or formula) can

come out of the nose and the child may turn a dark red color. As long as the child is not blue and the

episode is brief, the only intervention necessary is to use a bulb suction syringe to clear the mouth

and nose.

Hiccups, Sneezing, Yawning, Wheezy – like Noises, and Irregular Breathing –The above noises are

very common and generally normal in a healthy newborn. Wheezy-like noises don’t suggest asthma,

but almost always represent the fact that newborns breathe through their nose (and not their mouth)

until they get close to four-to-six months old. Therefore even the smallest amount of mucous can

cause noisy breathing. No intervention is needed as long as your child feeds comfortably, has good

color, and sleeps well.

Mildly Irregular Breathing – In a pink baby, mildly irregular breathing is normal and will become

more regular as the child gets older. This is not a warning sign of Sudden Infant Death Syndrome

(SIDS). SIDS occurs in approximately 1 in 2,000 births. One way to lower the chance of SIDS is to place

your baby on the back to sleep, not on the stomach or side.

Are you choosing to Breast Feed your baby?

If so…

For our families choosing to breast feed, we are able to provide lactation support in both offices.

Our breast feeding philosophy is to support and help each of our moms and families to meet their

breast feeding goals.

Recommended bottles:

Breast feeding moms (to be introduced when you newborn is 3-5 weeks old)- Playtex NaturaLatch slow flow nipples with the drops in (backed by research)

- Avent bottles

- Dr. Browns

New Mom Groups

MOMS Club of Canton

www.meetup.com/MOMS-Club-of-Canton

Dedham Parent Time

www.bigtent.com/groups/dedhampt

Dover Mothers’ Association

www.bigtent.com/groups/dovermoms

MOMS Club of Easton

www.facebook.com/momsclubofeastonma

MOMS Club of Foxboro

www.foxboromom.com/Home.php

MOMS Club of Franklin

www.meetup.com/MOMS-Club-of-Franklin

The Mansfield Mothers’ Club

www.mansfieldmothersclub.com

MOMS Club of Medway and Bellingham

www.momsclubmb.com

Millis Moms

www.facebook.com/millismomsanddads

Newton Mothers’ Forum

www.newtonmoms.com

MOMS Club of Norfolk, Plainville and Wrentham

www.npwmoms.org

MOMS Club of North Attleborough

www.northattleboroughmoms.org

MOMS Club of Norton

www.nortonmoms.org

The Working Mom’s Playground (Norwood)

www.meetup.com/TheWorkingMomsPlaygroup

MOMS Club of Sharon

www.momsclubofsharon.com

MOMS Club of Stoughton

www.meetup.com/MOMS-Club-of-Stoughton

MOMS Club of Walpole

www.bigtent.com/groups/momswalpole

Canton-Westwood Mom Social Group

www.meetup.com/Westwood-Moms-Social-Group

Wellesley Mothers Forum

www.wellesleymothersforum.com

The Parent Connection

Welcoming a new baby into the home can be a joyful, exciting and sometimes overwhelming

experience, especially for first-time parents. The Parent Connection at Beth Israel Deaconess

Medical Center continues your care, after you leave the hospital, and in those early weeks as

you become parents.

MENTORING MOMS SERVICENew moms who join this FREE service are paired with a Parent Connection volunteer who

provides weekly phone call support through the first three months after giving birth. Ourvolunteers, all experienced moms, are there to answer questions, provide information about

resources available in your community as well as listen to your concerns and support you

through the joys, fears and challenges you might face as a new mom.

NEW MOMS GROUPSParent Connection groups are all facilitated by an experienced group leader and provide an

opportunity for new moms to meet other new moms, to raise questions, and have an easy,comfortable place to go with your baby. The groups are FREE and meet weekly in Dedham,

Lexington and Chestnut Hill. Our Needham group is a Working Moms group and meets during

evening hours. If none of our group locations work for you, call us and we’ll try to help youfind a group in your community. To sign up for one of our groups, or register for our

Mentoring Moms Service, please call us at 617-667-BABY (2229).

BABY KNOW HOW BLOGCheck out our blog, Baby Know How, at bidmc.org/babyknowhow for postings on new

parent issues or to ask questions.

Westwood-Mansfield Pediatric Associates

Information for New Parents

Recommended Resources:

As a new parent, you will quickly realize that nearly everyone you meet has a different opinion about parenting

and newborn care (many are not shy sharing these opinions). It is important to remember that there are many

“correct” ways to raise children, and that you must sort through this advice to find the information that is

helpful to you. We have compiled the following selection of recommended resources to help you.

A great place to start is the American Academy of Pediatrics “Health Topics” website, www.aap.org/healthtopics.

This website contains terrific information on all the topics listed below (and many others).

Child Development

Caring for Your Baby and Young Child-Birth to Age 5 (Steven Shelov, American Academy of

Pediatrics)

Caring for Your School Age Child-Ages 5-12 (Edward Schor, American Academy of Pediatrics)

Touchpoints: Your Child’s Emotional and Behavioral Development (T. Berry Brazelton)

The Incredible Years (Carolyn Webster-Stratton)

Breastfeeding

New Mother’s Guide to Breastfeeding (Joan Younger Meek, American Academy of Pediatrics)

International Lactation Consultant Association – www.ilca.org

Massachusetts Breastfeeding Coalition – www.zipmilk.org

La Leche League International – www.lli.org

Sleep Resources

Solving Your Child’s Sleep Problems (Richard Ferber)

The No-Cry Sleep Solution (Elizabeth Pantley)

Nighttime Parenting (William Sears)

Healthy Sleep Habits, Happy Child (Marc Weissbluth)

Sleeping Through the Night (Jodi Mindel)

Secrets of the Baby Whisperer (Tracy Hogg and Melinda Blau)

General Health and Nutrition

Guide to Your Child’s Symptoms (Donald Schiff, American Academy of Pediatrics)

Guide to Your Child’s Nutrition (William Dietz, American Academy of Pediatrics)

Car Seats

American Academy of Pediatrics (keyword “car seats”) - www.healthychildren.org

National Highway Transportation Safety Administration (select “Child Passenger Safety”) -www.nhtsa.dot.gov

SafetyBeltSafe USA - www.carseat.org

Child Care ResourcesGo to: http://www.childcareaware.org/en/ to find child care near you.

Early InterventionWe will screen your baby for developmental issues at each visit. Your provider may suggest you contact one of the following agencies.

Enable Inc. Early Intervention 275 Prospect Street

Norwood, MA 781-255-1817

Thom Neponset Valley Early Intervention 101 Vanderbilt Ave. Route 1 Norwood, MA 781-551-0405

Riverside Early Intervention at Dedham 450 Washington St. Suite 102 Dedham, MA 781-329-0909

Kennedy Donovan Center EIP -Attleboro25 Forest Street

Attleboro, MA 508-226-6035

On Location, Resource CenterPlease visit our “Resource Centers” located in both offices. These centers offer parents and patients the opportunity to borrow books or DVD’s on a variety of “Doctor” recommended subject matters. Please feel

free to request any medical or educational material on topics of interest.

Important Contact Information

Emergency: 911

Regional Poison Center: 1-800-222-1222

Police Department: ____________________________

Fire Department: ______________________________

Doctor: ______________________________________

Local Hospital: ________________________________

Dentist: _____________________________________

Specialist: ____________________________________

Specialist: ____________________________________

Babysitter: ___________________________________

Emergency Contact Person: _______________________________

Phone Number: _______________________________

_____________________________________________

_____________________________________________

_____________________________________________

_____________________________________________

_____________________________________________

_____________________________________________

_____________________________________________

_____________________________________________

We hope you find this information to be helpful.

Westwood/Mansfield Pediatrics - 2011

541 High Street Westwood, MA 02090

781-326-7700 Fax: 781-251-0910

454 Chauncy Street Mansfield, MA 508-339-9944

Fax: 508-261-7772

To find out more information about our providers and what our practice has to offer,

visit our website at: www.wmpeds.com

Informational Brochure for New Parents

You need to schedule appointments for your baby throughout his/her first 2 1/2 years of his/her life. We en-courage you to set up your next appointment before you leave the office, or call ahead of time.

Here are a list of appointments that need to be scheduled:

Appt. Scheduled Date1 Month

2 Month

4 Month

6 Month

9 Month

12 Month

15 Month

18 Month

24 Month

2 1/2 Year

If you chose to breastfeed, we have our own on staff lactation consultants. Please contact the office for further information.

If you need additional support, our lactation consultants can be helpful facilitators.We have provided some com-munity resources, however, we encourage you to use the one with whom you are most comfortable with. We do not endorse any one in particular.

www.ziplink.org - Web page designed by the Massa-chusetts coalition of Breastfeeding to help you find the lactation support close to home.

Norwood Hospital’s Breastfeeding Drop-in Groups on Wednesdays at 11:45am. Contact Anita for more informa-tion at Anita.ponica@caritaschristi.org

Isis Parenting- Free weekly Breastfeeding Drop-in Groups in all 4 of its locations (Needham, Boston, Brookline, and Arlington). Check out their website at www.isisparenting.com for dates and times.

Lactation Care Inc. in Newton, Ma - Providing breast pump, Breastfeeding accessories and support . For more information call 617-244-5593 or visit their website at www.lactationcare.com

New Mom’s Groups, Classes & Support GroupsDo you want to meet other new moms, have a place to talk about the joys and challenges of motherhood, and be able to ask questions?

The Parent Connection at Beth Israel Deaconess Medical Center offers Free groups for moms and their babies. Groups are located in: Braintree, Chestnut Hill, Dedham, & Lexington.

To register, or for more information, please contact BIDMC Parent Connection Office at 617-667-BABY (2229) or www.bidmc.harvard.edu/obgyn

The Center for Early Relationship Support provides free support groups for the community. Contact them at 781-647-5327 or visit their website at www.jfcsboston.org/fcs/early_relationship.cfm for more information on the different groups available.

The Center for Early Relationship Support Locations:Boston

617-227-6641

Newton 617-558-1278

Norwood 781-551-0405

Caritas Norwood Hospital Me and My Baby 781-0278-6402

Caritas Norwood Hospital Me and My Toddler

781-0278-6402

ISIS Parenting Brookline, Needham

781-429-1500 www.isismaternity.com

Mansfield Mothers Clubmansfieldmothersclub@yahoo.com

To find your local Massachusetts Mom’s Club visit www.momsclub.org/links.html#Massachusetts

Other Resources Available for Expecting and New Parents: Products & ServicesAcademy of Breastfeeding Medicine

www.bfmed.org

American Academy of Pediatrics www.aap.org/healthtopics/breastfeeding.cfm

Lactation Care, Inc. Newton, MA 617-244-5593

Lactation Consultants www.iblce.org

International Lactation Consultant Association www.ilca.org

La Leche League International http://www.llli.org/

Massachusetts Breastfeeding Coalition http://massbfc.org/zipmilk/

Cambridge Medical Supply for pump rentals and pumping supplies

617-876-3810 or 617-491-1511

Compass Medical Supply for pump rentals and pumping supplies

617-566-6772

M&M Medical Supply Company They carry only Medela pumps 877-966-6337 or 508-966-3290

ISIS Parenting Isis Maternity centers are the premier resource

for Boston’s expecting & new parents. Classes and products addressing needs from

early pregnancy through the early childhood years. 781-429-1500

www.isisparenting.com

JF&CS Jewish Family & Children’s Services Support groups/home consultation

617-558-1278 www.jfcsboston.org

National Woman’s Health Information Center www.womanshealth.gov/breastfeeding