104 - One Month Old

You are starting to get into the groove of this new parenting thing and your baby is now 1 month old. You should start to see those smiles and the super cute cooing. In this episode, Dr. Carole Keim MD talks about what to expect from the 1 month check-up along with eating, peeing, pooping, sleeping, and skincare. She goes into great detail on gas, colic, reflux, and the benefit of a probiotic. It is also a good time for you to start thinking about your relationship again and enjoying a date night.

This is the peak age for discoordinate stooling, reflux, and skin issues. Knowing the difference between learning bowel control and constipation or spit up vs green projectile vomit. Knowing what to watch for is half the battle when caring for your little one.

Parents: (00:25)

• Finally feeling in the groove of things
• Baby has nights and days figured out
• Don’t overstimulate
• Still narrate your day, take turns talking with baby
• Find time for a date night!

Eating: (02:04)

• 8-10x per 24 hours, 24-30oz per 24h
• Starting to go from q2-3h to q4-6h

Peeing/pooping: (02:40)

• Discoordinate stooling
• Gas/colic: belly rubs, bicycle legs, up and downs, tiger in a tree pose, tummy time, simethicone drops, probiotic drops
• Reflux: Explain LES, normal spit ups. Signs of severe reflux: weight loss, spitting up more than half of their feed every time, arching back and screaming, aspirating (choking/coughing/sputtering)
  • Pyloric stenosis: getting progressively worse, turns green (grass green)
• Reflux tx: smaller and more frequent feeds, hold upright for 20-30 mins after feeding, sleep in a reclined position (tilt the crib or bassinet with a phone book), NO pillows

Skin: (10:11)

• Bathing 1-2x per week
• Can use lotion or cream or ointment after baths
• Diaper rash - if it lasts more than 2-3 days despite normal diaper cream (zinc-oxide-based like Desitin or petroleum-based like Vaseline or Aquaphor) it might be infected.
  • Candida (yeast/fungal) - solid pink area with tiny pinpoint-sized pink dots around it (satellite lesions). Can try mixing apple cider vinegar and water 1:1, OTC antifungal cream, or call a doctor for a prescription for Nystatin.
  • Bacterial infection: pimples or boils, often MRSA, can try applying Neosporin TID but if it doesn’t help, they need mupirocin TID. Treat the whole family - nails and nose.

Checkup: (14:08)

• baby should have gained about 2 pounds from birth weight (based on 7 lb baby)
• Neuro/devel: grasp reflex, rooting/suckling reflex, moro reflex, responds to calming actions when upset, follows parents with gaze, recognizes familiar voices, communicates needs (hungry/wet), lift head when prone / on parent’s chest, fontanels open until 1 year of agepo
• Anticipatory guidance:
  • Eating - nothing but breast milk or formula for 4-6 months
  • Mom should eat a wide variety of foods and take PNV while breastfeeding
  • Supplement with 400 IU of vit D daily, or mom can take 6400 IU
  • Sleep: back to sleep, no blankets, stop swaddling. ABC = Alone, on Back, in Crib.
  • Put baby to bed awake but drowsy
  • Fever and how to take temp
  • Never leave baby on high surface
  • Rear facing car seat til age 2
  • Avoid secondhand smoke
  • Set water temp to 120 degrees to avoid scald burns
  • Bathing baby 1-2x per week
  • Skin care / peeling skin
  • Tummy time

Next checkup is at 2 months: (21:48)

• First round of vaccines: DTaP, polio, HiB, Hep B, PCV, Rotavirus
• No need to pre medicate before shots, but DO buy some infants or children’s Tylenol / acetaminophen before the visit
• Ask doctor for the dose of Tylenol at the 2 month visit
• Pooping will consolidate further: rule of 7’s at this age is that anything from once a week to 7x per day is normal
• Should keep peeing every time they eat
• Still need to wake them up once every 4h to eat

Resources discussed in this episode:

• The Baby Manual - Available on Amazon

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