Two to Four Week Visit

Development

Babies like to look at faces. His/her eyes may wander and occasionally cross. Your baby will respond to sounds and recognize voices. He/she will calm at the sound of your voice.

All babies begin to have a fussy time, often in the evening, at around two weeks of age.This "colicky" time peaks at six to eight weeks of age and then disappears by three to four months of age. If your child is suffering from significant colic, speak with us so we can help support you thru this difficult period.

Spitting up may increase in the next 1-2 months. Baby acne may appear.

First smiles are often seen around six weeks of age.

Activities

- Baby massage: even the youngest newborn loves skin to skin contact. Holding and touching provide cues to a new baby that he/she is protected, loved and cared for. It can stimulate or calm a baby.
- Cuddling, singing, playing music, moving gently and sucking all help to sooth your baby. Rock your baby in your arms, swing in an infant chair or read a magazine out loud.
- Do baby sit-ups and stand-ups (do smoothly and slowly supporting your baby's head and neck).
- Walks outside or trips to the store are OK at this age if your baby is dressed for the weather.

Sleep

Parental sleep is VERY important. Take shifts; nap when you can. Your infant should only sleep on his/her back on a firm mattress without loose blankets, comforters or crib bumpers as this reduces the risk of sudden infant death syndrome.

Over the next few weeks start to encourage the development of good sleep habits; place your infant in the crib drowsy but awake. Keep middle of the night feedings brief and boring to encourage sleep.

Safety

- Use a properly fitting rear facing car seat. The center rear seat is the safest position.
- If your baby has a rectal temperature above 100.4 degrees F, please call the office immediately, day or night.
- Never leave your baby unattended on surfaces above the floor as newborns wiggle and move. Do not place car seats on counters or high surfaces.
- Check your smoke detectors and fire extinguishers on a regular basis. Have a family fire exit plan with ladders in upstairs bedrooms. Have a carbon monoxide monitor especially in older homes with erratic heating or wood burning stoves.
- Turn your water thermostat down to 120 degrees F or less to prevent accidental burns.
- Do not use the microwave to warm bottles. They heat unevenly and increase the risk of burns.
- Avoid necklaces, hood ties or more than 8 inch pacifier cords because they pose a strangulation risk.
- Confirm that your crib slat distance is less than 2 2/8 inches.
- Never leave an older sibling or pet alone with the baby.
- Secondhand smoke is harmful. A new baby in the family is excellent motivation to stop smoking. Visit www.quitline.com or talk to your own physician about smoking cessation resources.

Parenting

Talk to your doctor or your baby's doctor if you feel sad or depressed. Post partum blues are very common. It is important to take care of yourself, get some sleep and allow others to help.

Parenting groups are a helpful source of support for many new parents. Consider joining a PEPS group (Call 206-547-8570 or visit www.pepsgrooup.org for details).

Older siblings often show jealously by acting out. They need love and positive attention. Try to keep the same rules and schedule for siblings that were in place before the baby arrived.

Say YES when people ask if they can help!

Nutrition

Feed your baby breast milk or formula with iron. If feeding is going well and your baby is back to birth weight, it is no longer necessary to wake him/her for feedings during the night. Typically babies eat every 2 to 3 hours during the days with a longer stretch at night.

Breast feeding is encouraged as breast milk has many proven benefits. If you are having difficulties let us know so that we can assist you.

To prevent vitamin D deficiency, the American Academy of Pediatrics recommends that all breastfed infants begin 0.5ml of Tri-Vi-Sol (available over the counter) daily by age 2 months unless they are taking at least 16 oz daily of formula.

When breast feeding is going well, you may begin to introduce your baby to the bottle. Familiarizing your baby with the bottle at an early age can be helpful particularly if you plan to return to work and will need to transition to some bottle feeds in a few months. Three to four bottle feeds per week (pumped breast milk or formula) will help to familiarize your baby with the bottle. Water, tea or juice is not indicated at this age.

Hold your baby during feedings. Do not put your baby to bed with a bottle or prop it in his/her mouth.

If there is a family history of eczema, asthma or allergies, consider avoiding highly allergic foods while breastfeeding; peanuts, tree nuts (almonds, cashews) and possible fish and shellfish.

Tests This Visit

If your baby did not pass the hearing test at the hospital, talk with us about scheduling a hearing test.

Next Visit

Please schedule a visit for when your child is 2 months old as you leave today. Your baby's first series of immunizations will be given at the next visit.

Books/Resources

- Your Baby's First Year by the American Academy of Pediatrics
- Caring for Your Baby & Young Child: Birth to Age 5 by the American Academy of Pediatrics www.aap.org
- www.vaccine.chop.edu- great site for vaccine information