Newborn Skin Care

The skin of a newborn is different from adult skin. When you choose a topical skin treatment used on an infant’s skin parents must take these differences into consideration. An infant’s skin is about 50% thinner than compared to adult skin and has a more alkaline rather than an acidic pH. It takes about one year for an infant’s skin to mature to adult skin. These differences make it more difficult to keep good things in and bad things out.

Skin plays a role in infection protection, body hydration, electrolyte and water function. When an infant is born, the vernix (vernix caseosa) found on the body of an infant born after 36 weeks of gestation helps the infant stay healthy. It fights infection and has antimicrobial properties that help prevent infection. It is important to leave the vernix on for the immediate period after delivery and not remove it with bathing during the first day of life. It provides a hydrating and naturally moisturizing function.

The top layer of an infant’s skin is low in collagen and the adhesion between the two top layers (epidermis and dermis) of infant skin is less than in adult skin. The skin is also alkaline in pH as opposed to an acidic pH for adult skin. An acidic pH helps protect adult skin from infection.

The large area of skin coverage relative to body mass in an infant compared to an adult is why infants are prone to heat and water loss as well as the passage of substances across the skin barrier. Certain topical exposures are especially dangerous to babies. This is why it is important for parents to read labels to find out the composition of the topical agent. Rashes due to contact can be triggered by these agents.

Topical corticosteroids can lead to skin atrophy, and neomycin can lead to neural deafness. Silvadene can cause kernicterus and providone-iodine can cause hypothyroidism. Surfactants and antiseptics included in these topical agents can cause irritant dermatitis reactions and fragrances, preservatives, surfactants and parabens can cause contact sensitization after multiple exposures. Preservatives are often blamed but are essential to increase shelf life for many of these topical agents.

Some topical agents describe so-called organic or natural agents as being safer and healthier. Not all organic or natural agents are equally safe and the definition of what is organic is often vague. Sunflower oil appears to be better than olive oil, which may cause some disruption in the skin barrier. Botanical oils can cause skin sensitization reactions, and fragrance free products may have a masking agent that makes the product fragrance free, while still having a sensitizing agent present.

Parents must read labels and decide what topical agents are helpful and necessary in the care of their infant. The use of topical agents in infants who have a personal or family history of skin reactions should limited. The general rule in infant skin care is less is best. Early exposure increases an infant’s risk of skin sensitization and reading labels is always the best way to prevent future problems.

The Fussy Baby

Every infant will have strengths and weaknesses but each one is perfect. Some infants easily self soothe while other so called “difficult infants” are slow to settle. In addition, some infants experience colic. You know your infant better than anyone, and you are in the best position to understand and respond to your child. Infants who have difficulty settling require more time and attention. If you invest the extra time and attention and limit the sensory distractions that bombard new infants and lead to unsettled behavior, you will reap major benefits.

Colic is the name given when an infant has fussy or extreme cranky periods usually in the evening. During these periods all attempts to soothe and settle the infant fail. These episodes can occur anytime during the day and for some infants they occur throughout the day. Most often the peak period is between 6pm and midnight. These fussy periods begin at two to four weeks of age and peak at about six weeks of age. They can last for up to 3 hours and gradually taper to one to two hours by three to four months. About 20% of all infants develop colic. It is normal and does not mean there is anything wrong with your infant. During these prolonged crying episodes infants may cry or scream inconsolably, bicycle their legs and pass gas. They often swallow air and their stomach becomes painfully distended.

Although there is no known cause of colic recent findings support colic being an indicator of a child being at risk for the future development of migraine headaches. Colic is felt to be due to a delay in the ability of the nervous system to self-regulate. Infants with colic appear to be oversensitive to environmental stimuli and have difficulty being consoled. The inability to self-soothe leads to constant crying and associated behaviors.

If you feel your child has colic talk to your doctor. There are several medical reasons for behavior that appears to be colic. These include food sensitivities and gastro-esophageal reflux.  These problems are treatable.

After delivery babies need to learn how to live in a new environment. Sounds, smells and visual sensations abound. Your infant is no longer living in the tight, warm and quiet environment of the womb. Your heart rate is no longer the primary sound your infant hears. This change in environment disrupts many babies. Allow your infant time to deal with the frustrations associated with this change. By providing ongoing unconditional love and support your infant will adjust to the new surroundings.

If you have a fussy baby it is important you remain calm and relaxed. Your infants can sense your emotions and negative emotions can heighten and exacerbate your infant’s behaviors. If you are tense or anxious consider asking someone to give you a break. A brief break allows you to find a positive balance.

Make sure a fussy infant is not cold, wet or hungry. Checking on all “comfort needs” is always the first step in the response to a crying baby. Some infants cry when they need to be burped. If you have concerns that your infant is sick check for a temperature and call the doctor.

If all comfort needs have been met and there is no sign of illness it is time to pursue common interventions for so called high needs babies. Walking with your infant provides a calming swaying movement. Make sure you do not over-feed your infant and consider skin to skin contact. Breastfeeding is always best. Stomach distension can make your infant uncomfortable so make sure to burp your infant. The use of a pacifier can also be very helpful. Sucking lowers your infant’s heart rate, evens out breathing patterns, encourages relaxation, decreases stress and promotes the onset of sleep. Sucking also decreases the risk of SIDS. Distractions such as making shushing sounds, playing soft music or softly stroking your infant’s head from the forehead to the back of the head are other ways to settle your baby. Always try to limit distractions and make sure the room is not too warm or too cold. Infants should always sleep on their backs. It is alright to try some tummy time if this position helps soothe your infant but you must remain in the room and watch your infant. Never leave a sleeping infant on his or her tummy to sleep. This increases the risk for SIDS.

Cry it out (CIO) approaches are not appropriate for infants. It is always best to respond right away to a crying infant and if you notice pre-crying behaviors such as anxious facial expressions, breathing pattern changes or jerky arm and leg movements it is best to pick up and try to soothe your infant.

Role of the Father

A Father must take an active role prior to the delivery of their new child. The paternal-maternal relationship must be supported and flourish prior to the delivery. The most visible roles of the father have included economic and physical protection. Yet roles of equal importance include the fostering of social-emotional, cognitive, language and motor development.

Fathers must be competent and caring role models. They must be attentive and responsive to the needs of their child. The quality of interaction is just as important as the quantity of interaction and it is important paternal involvement be supported and encouraged prior to and at the time of delivery to prevent fathers from disengaging from the care of their child.

Mothers and fathers can both experience post-partum depression. The added responsibilities, obligations and stress that come with a newborn can lead to depression. Intervention must be sought for post-partum mood changes. Two-way communication between parents and the sharing of feelings are the first steps in the identification and management of post-partum depression.

Although generalizations oversimplify gender patterns of support there are two types of support infants and children must receive. This support may come from traditional gender relationships or from non-traditional gender relationships. Gentleness and security are typical maternal support patterns while independence and confidence building are typical paternal support patterns. Fathers often provide a “rough and tumble” approach to life experience. They teach children how to manage aggressive impulses and how to learn how to control emotions. In this way fathers teach their children how to make their way through the rigors of the outside and often unforgiving world. These skills enable a child to develop the discipline to control emotions and frustrations. This leads to personality traits that support empathy, respect of others and the importance of genuineness.

Fathers must provide a secure, safe and supportive environment for their child. This must begin early in the child’s life and must be linked to the building of emotional competence. Emotional competence allows a child to recognize, respond to and understand emotions and leads to increased self-esteem and self-worth. The life skills that result from this training and modeling foster the development of social confidence and competence. Fathers who teach these skills to their child improve their child’s ability to initiate and maintain friendships throughout their lives.

When fathers engage in vigorous play intellectual development is supported. Children learn how to use their bodies to solve problems and learn the importance of exploration and risk-taking. Fathers support the use of more challenging language and focus on the importance of social communication and teamwork. Vigorous play improves motor skills for both large and small muscle groups, improves hand-eye coordination skills and encourages both one on one and team directed activities. Such activities encourage and support independent thought and behavior for a child.

Fathers are the model of so many important behaviors for children.  The goal of every father is to share what they love with who they love.

Birthmarks in Infants and Children

About 1% of newborns are born with congenital nevi or moles. These are brown or black in color and may be raised or flat with the skin. They grow with the child and are safe if less than 2-3 inches in size.  Children can also develop acquired nevi or moles following delivery. These are common in Caucasians who have an average of 10-30 pigmented nevi or moles. They often develop after age 5 years.  Warning signs for neoplastic changes include asymmetry, border irregularity and color change. If a nevi or mole “looks different” from neighbor nevi it needs to be evaluated by a doctor.

Sun freckles are common and increase with sun exposure. These dark spots are flat and run in families. They are more prominent in the summer. If your child is prone to freckles then sun protection is a must. Children with fair skin are prone to freckles as well as having an increased risk for skin damage due to unprotected sun exposure and have an increased risk of skin cancer and malignant melanoma.

Hemangiomas are raised red or reddish blue bumps. They are caused by the growth of blood vessels that cause an abnormal amount of blood vessels to grow. They are seen in 2% of infants and often develop after 1-2 months of age. Treatment usually is not needed but depends on size, rate of growth and location. Locations around the mouth, eye, and nose and in the throat raise concern for treatment. If multiple hemangiomas are present then there are concerns about internal hemangiomas on various body organs.

Flat angiomata are called “stork bites or angel kisses”. They are seen on the face an on the nape of the neck. They become more visible when an infant cries or becomes hot. No treatment is needed. They usually fade by school age.

Port wine stains are rare and often indicate an underlying medical condition. This type of birthmark can be seen on the face and limbs. They are large in size and dark red to purple in color. They are not raised.

Tips on Baby Basics

  • Be attuned and responsive to the needs of your infant by watching, touching and listening.
  • Always provide love, attention and affection to your infant.
  • Breastfeeding through one year of age is always best. Longer is better.
  • Breast feed your new infant every 1-2 hours until your milk comes in.
  • If your infant is urinating 6 times a day and the urine is clear and copious your infant is not dehydrated.
  • A double electric breast pump that is adjustable provides speed and efficiency benefits.
  • Breast milk can be kept in the fridge for four days and in the freezer for 3-6 months.
  • Always thaw breast milk overnight in the fridge or by immersing in tepid water.
  • Keep visitors to a minimum during the first few weeks of life.
  • Safety at home, in the car and out of the home is very important.
  • Dress your infant in layers to help with temperature regulation.
  • Always follow the “Back to Sleep” rules to decrease your infant’s risk of SIDS.
  • The use of a lubricant such as petroleum jelly in the diaper area after every diaper change prevents diaper rashes.
  • Consider giving your infant a soft full body massage with olive oil, coconut or Neutrogena bath oil twice a day to prevent skin dryness.
  • Infants startle due to sudden noises or an unexpected touch or body movement. This is normal.
  • Infants under 6 months of age cannot be spoiled.
  • The use of a body carrier helps both mother and baby.
  • Co-sleeping does have risks associated with it.
  • The best ways to calm a baby include walking or swaying, sucking on a finger or pacifier, upper body swaddling and making sushing sounds.
  • Watch a You Tube video about how to swaddle your infant. Leave the legs loosely wrapped but supported. This helps to prevent hip problems.
  • Infants who swallow excess air often feed less well
  • Three burping positions are the throne and shoulder positions, the belly flop on lap position and the walking strut with baby facing away.
  • Diaper changing stations need proper safety, set-up and hygiene.
  • Chewing, rubbing, cold and rare pain medications are the best ways to decrease teething pain.
  • Avoid cereal and pureed baby food before 4-6 months of age.
  • Never leave an infant alone in a tub and always check the water temperature.
  • Baths 1-2 times a week are often enough.
  • Tummy time can become fun time but it often takes practice and patience.
  • Always look for snooze clues such as eye rubbing and cranky behavior.
  • Sleep schedules are often irregular through 4-6 months of age.
  • After 4-6 months most infants benefit from scheduled naps twice a day.

Skin to Skin Contact After Delivery

Much has been written about the importance of the first hour following delivery. Your infant encounters a new and previously unseen world. Sounds begin to take on new meanings and basic processes we take for granted such as breathing and eating begin. It is a time of heightened perception for both parent and infant. It is a time when every parent must be both a soldier and an ambassador as their child encounters and enter a potentially hostile world.  Parents provide comfort and safety to the new infant.

Following delivery your infant experiences major physiologic changes that can cause imbalances in the respiratory, circulatory and metabolic systems. Your infant can become cold and glucose levels can drop. It is also a time when your infant is at increased risk for infection.  To help deal with this turbulence hospitals and professionals have enacted and supported policies to make this transition safe and loving.

Your first act as a parent should be to provide skin to skin contact with your infant. Studies have shown such contact provides physiologic stability for your infant.  Benefits include improved blood oxygenation and glucose levels and reduced stress hormone levels in your infant. Basic body functions including temperature regulation, respiratory pattern and blood pressure also improve. Your infant will cry less and more easily enter a quiet alert state.

Additional benefits include a fostering of a secure attachment between you and your baby. Skin to skin contact increases the release of maternal hormones that induce and encourage attachment between mother and baby.  One of these hormones is oxytocin which has been shown to increase relaxation, facial recognition and maternal to child attraction. Such behaviors are essential for the care and protection of your infant.  In this critical post delivery period these behaviors have been associated with an increase in touching, holding and positive speaking behaviors between mother and child as distant as 1 year following delivery.

In addition to attachment the skin to skin contact prevents the risk of stress induced by separation. Your infant has never been separated from you. It is well known that infants are able to sense physical separation from their mother. Harm from separation has been seen in animals. We must assume newborns are at risk for similar negative physiologic and brain affects.  In addition, recent brain research supports the importance of early attachment for normal brain growth in terms of both myelination and synaptic development. Specific parts of our brain involved with our emotional responses are especially sensitive and reliant on both activation and modulation during this critical period.  These effects impact our learning, memory and our sympathetic nervous system.  Holding, carrying and caressing during the newborn period and infancy fosters and supports brain growth and the development of self regulation in your infant.

A final benefit of skin to skin contact is the fostering of breastfeeding. This type of contact initiates a cascade of events that results in successful breastfeeding. Skin to skin contact is the first step in a progression of stages that result in familiarization of the infant with the mother’s nipple which is then followed by self -attaching and eventual suckling. Sleep then follows soon thereafter.  Early stages include crying, relaxation, awakening, increased activity and resting and crawling.

Skin to skin contact on the mother’s chest allows the infant to be closely monitored by both mother and staff. The infant should be positioned so the face and nares are visible and the infant’s color, skin perfusion and respiratory patterns can be followed closely.

Nursery routines such as weighing and bathing that interrupt skin to skin contact should be avoided. All nursery and post-partum activity should be directed to the immediate needs of the mother and infant. Actions that can be delayed until after the first breastfeeding include vitamin K injection, body measurements and eye ointment prophylaxis. Usually a hat is not required when mother and child are skin to skin and a diaper is often not needed except after a cesarean section.  The cord can be initially clamped away from the infant so the clamp does not pinch the baby and mother during skin to skin contact. The cord can be re-clamped and trimmed at the first bath. The first bath should be delayed until at least 8-12 hours following delivery.

Pacifier Advice

Pacifiers do not harm an infant but there are some risks to pacifier use. Never loop a pacifier around an infant’s neck. This can lead to strangulation. Self-made pacifiers may be dangerous due to the risk of choking if part of the pacifier breaks off. There should be small ventilation holes at the base of a pacifier and make sure the pacifier is the right size for your infant.  A BPA (Bisphenol A) free pacifier is also a good idea. The pacifier should be dishwasher safe and buy several so they can be washed in the dishwasher or washed frequently with hot soapy water and allowed to air dry.

Pacifiers can help soothe an infant. Many infants benefit from sucking and infants who use a pacifier have a decreased risk of SIDS. Pacifiers are also helpful on airplane flights where middle ear pressure can cause pain for many infants. They also help many infants fall asleep easier.

Pacifiers should not be used on a hungry infant to delay feeding and it is best to avoid having the pacifier become a “lovey” or a transitional object. By fading the use of a pacifier at about 12 months the transition off a pacifier is often easier. Delaying elimination of the pacifier beyond 18 months of age often makes the transition off a pacifier much more difficult.

Children who continue to use a pacifier beyond age two may change the alignment of their teeth. This can lead to future dental problems. The older your child is the more difficult it is to transition away from the pacifier. Many children use the pacifier as a sleep cue or as a transitional support. This dependence often causes sleep consequences such as frequent interval waking that are difficult to manage. Never pressure your child to stop using a pacifier. Pressure and punishment are not helpful. By relying on praise and distraction most parents are able to substitute an acceptable and less risky transitional support.

Deciding whether to use a pacifier is a great opportunity for you to learn how to recognize, understand and respond to your infant or child’s cues.  Infants who soothe and self settle easily without using a pacifier often do not need a pacifier. Infants who suck on their own hands and fingers are able to rely on these natural pacifiers in the same way as infants who suck on the little finger of a parent.

Infants who are breastfed should not be given a pacifier for at least several weeks after delivery. This allows maternal milk production to increase and supports the development of a strong physical attachment between mother and child.

Breastfeeding Success in the Hospital

Mothers who receive emotional encouragement and informational support about the positive benefits to their health and the health of their child throughout their pregnancy are more likely to breastfeed after delivery and continue to breastfeed for at least 1 year following delivery. Support and advice are available during prenatal visits and from family and friends but involvement in breastfeeding classes or breastfeeding support group meetings can be very beneficial. Mothers often decide whether to breastfeed very early in their pregnancy. This is not a decision that is made at the end of the pregnancy. Healthcare providers play an essential role in this process. Information and support must be provided as soon as the mother to be is aware she is pregnant. Spousal support and workplace support are also essential.

From the moment of delivery contact between mother and the new infant must be supported if breastfeeding success is to be enhanced. This includes skin-to-skin contact between mother and infant immediately after birth and frequently thereafter. This contact has many physical and emotional benefits for both mother and child. Breastfeeding should be initiated within the first hour after delivery and Vitamin K injection and the application of topical eye ointment should be delayed until after the first breastfeeding.

During the first 48 hours following delivery rooming in should be encouraged and supported. This allows maternal-infant contact. Skin-to-skin contact should also continue to be encouraged and supported. There should not be time restrictions to breastfeeding. Breastfeeding should be frequent. Mother and staff must wake the infant if needed to allow breastfeeding 6 to 8 times on the first day and 8 or more times on the second day. Breastfeeding technique should be observed and close attention given to latch problems.  Formula, water, glucose water, bottles and pacifiers should be discouraged. During the first two days of life the infant’s weight and elimination patterns should be closely monitored.

Breastfeeding success is often linked to an infant’s readiness to nurse, breastfeeding positioning and the infant’s ability to obtain an effective latch. Parents must be aware of cues from their new infant that indicate a readiness to breastfeed. These include sucking on the hand, rooting and smacking of the lips. Mothers must be comfortable with and in their surroundings. Due to body exposure during breastfeeding mothers often feel uncomfortable, anxious or hesitant. Privacy and a well supported chest to chest position between mother and infant are essential. During breastfeeding the goal is for the infant to achieve a wide open mouth position with the tongue down and the entire nipple and some of the areola in the infant’s mouth. While the infant is nursing the mother should look for rhythmic sucking movements and listen for audible throat clicks which indicate her infant is swallowing. As milk production increases this audible swallowing will increase. Initial breastfeeding during the first few days may cause some discomfort. Care must be taken to prevent pain from breast engorgement, an improper latch or skin irritation. Overall, breastfeeding should be pain free.

Breastfeeding Success After Discharge Home

During the first week following discharge home your infant should breastfeed between 8 and 12 times every 24 hours. Some infants may breastfeed more often. Your infant should show signs of being full and satisfied within 30 minutes. You will notice after nursing that your breasts will feel softer and less full. Your infant’s stools will transition from black to green and then become brown and eventually a wet yellow mustard color and consistency. Stool output will gradually increase and near the end of the first week stool frequency may increase to 4 or more stools per day. Often your infant will stool with every breastfeeding. Urine output will also increase to at least 5 times per day and often occurs with every stool.

After arrival home it is important your spouse and all of those who love and care about you provide you the emotional and physical support to allow you to continue to breastfeed. Arriving home with a new baby is a time of joy which can be easily displaced by anxiety and guilt. By asking for support and allowing yourself to receive support you will lessen the chance of fear, guilt or anxiety hindering the development of a secure attachment between you and your infant. If you are having difficulty with milk production or latch seek support and advice from your doctor and seek advice from a Lactation Consultant. Joining a Breastfeeding Mothers support group can also be very helpful.

Every mother must support her own needs. Resting every time the infant rests is a good place to start. A healthy diet and adequate hydration are essential. The use of a pacifier or supplemental formula should continue to be discouraged until adequate milk supply is established. This often takes about 1 month. Occasionally the use of an electric breast pump to encourage milk production will be recommended. Supplemental expressed or pumped breast milk is also occasionally given. During the first week of life 400 IU/day of Vitamin D should be initiated.

During the first 6 weeks of life feeding every 8 to 12 times per day is normal. Some infants may continue to require even more frequent feeding. Night feedings are normal and during growth spurts feeding may be even more frequent. Typical growth spurts occur after 10 days and then after 3 and 6 weeks. These spurts may last for 1-2 days. The more milk your infant takes from your breast the more milk will be produced. This allows milk production to be based on the needs of your child. Your child does know best. Continue to stay well hydrated, eat healthy and use alcohol and caffeine in moderation. No specific food restrictions are necessary. If you are placed on a medication talk to your doctor to make sure it is safe to continue to breastfeed. Very few medications prevent breastfeeding.

Continue to avoid formula supplementation if at all possible. The use of formula increases your infant’s risk for illness and changes the gut flora which keeps your child healthy and prevents many gastrointestinal illnesses. Breast milk is the only food your infant needs during the first 6 months of life.

Challenges to Breastfeeding

Although there are many challenges to breastfeeding most of them can be managed with adequate preparation, education and support.

If a mother is HIV positive or is suffering from ongoing drug or alcohol use then breastfeeding is contraindicated. Rare infants with Galactosemia, Tyrosinemia and certain forms of PKU should also receive special formula and not breastmilk.

Mothers should avoid the use of medications, supplements and herbal preparations while breastfeeding unless they are clinically necessary. The vast majority of medications a mother would be prescribed while breastfeeding are safe to use. If a mother is experiencing depression subsequent to the delivery of her infant, it is much safer for the mother to be treated with an anti-depressant medication than for the mother not to be treated. Most anti-depressant medications can be safely used by breastfeeding mothers.

The risk of exposure to a maternal medication during the first few days of breastfeeding is lowest since the volume of maternal milk is lowest at this time. The book titled Medications and Mother’s Milk by Dr. Thomas Hale is a good reference.  Drugs should be chosen for breastfeeding mothers that have a short half-life, high protein binding and low oral bioavailability. Most of the time it is safer and healthier for an infant to continue to breastfeed rather than changing to formula. In some situations discontinuing breastfeeding for a short period of time while continuing to pump and discard breastmilk is necessary. This is seen when a mother is required to receive a radioactive compound to treat her own medical condition.

Jaundice is a common problem seen in infants who breastfeed or formula feed. In the past when an infant who was breastfeeding developed jaundice the breastfeeding was stopped due to concerns breastmilk would increase the jaundice. This is no longer the case. Breastfeeding should continue and if there is not effective milk transfer due to the infant being sleepy or if there is excess weight loss supplemental breastfeeding with expressed breastmilk should be initiated. The level of jaundice should be followed closely especially for premature infants.  Other options include donor human milk or formula. Advice from a Lactation Consultant in these situations is very helpful.

Breast engorgement is a common issue. It can be prevented by frequent breastfeeding and hand or pump expression of milk if engorgement is an issue. Warm compresses before nursing and cold compresses after nursing can also be helpful. On occasion anti-inflammatory medication like ibuprofen can be used.

Mothers are often concerned about inadequate milk supply. This is usually a false perception. It is important this issue is addressed directly and accurate answers given.  Parents must document adequate urine and stool output while monitoring weight gain in the infant. These are the best indicators for adequate milk supply and milk transfer from mother to the infant.

Although smoking is strongly discouraged smoking is not a contraindication to breastfeeding. Breastfeeding reduces the risk of respiratory illness in infants even if the mother is still smoking. A mother should not, however, smoke around her child. Homes, cars and child care locations should all be smoke free.

Some babies who breastfeed can be very fussy. This is usually due to your infant’s temperament and not due to breastfeeding. Providing skin to skin contact, increasing carry time either in your arms or in an infant body carrier and increasing the frequency of breastfeeding can often help. Walking with your infant is helpful as are swaddling, swaying and making soft white noise shushing sounds.  Avoid excessive stimulation due to sights, smells and sounds and do not overly stimulate with motion. A final option is to encourage sucking on your finger or a pacifier if your infant is over age 1 month.

Another challenge to the new breastfeeding mother is sore nipples. Time and patience are essential. Soreness can frequently be avoided by improving your infant’s position and latch during feeding. Superficial fungal or bacterial infections can also occur but these are uncommon. Talk to your doctor and medication can be prescribed if required. If there are signs of a fungal infection (yeast) then treatment of both infant and mother is necessary. Antifungal ointment can be applied to your nipples after each feeding and continued until you are symptom free for 3-4 days. Your infant should be treated with oral mycostatin (nystatin) drops which can be prescribed by the doctor. These can also be applied to your nipples after nursing. Your infant may show white plaques in the mouth and on the tongue. This is called thrush. All pacifiers should be washed well in hot soapy water and nystatin can be applied to the pacifier. Other treatments that can be considered for your infant include oral 0.5% Gentian Violet that is applied to your infant’s mouth one time each day for three days. This can cause staining of clothes and skin. Always check to see if your infant has signs of a yeast diaper rash that is common when your child has thrush. If this is present then treatment with an OTC medication such as clotrimazole 2-3 times per day is needed.

Mastitis is common when your breast is not emptied after nursing. This can lead to pain, redness and swelling of the breast. Weaning is not recommended. The best treatment is frequent breastfeeding to “empty the breast.” Continuous warm compresses are helpful as is soft breast massage prior to nursing. Pumping can be used if breastfeeding is too painful. Anti-inflammatory medication such as ibuprofen can be helpful and antibiotics are prescribed for you if there is pain and fever over 12 hours in duration.