WHAT TO EXPECT® THE FIRST YEAR Also available from What to Expect® What to Expect® When You’re Expecting Eating Well When You’re Expecting The What to Expect® When You’re Expecting Pregnancy Organizer What to Expect® Pregnancy Planner Que se Puede Esperar Cuando se Esta Esperando (What to Expect® When You’re Expecting—Spanish edition) The What to Expect® Baby-Sitter’s Handbook What to Expect® the Toddler Years WHAT TO EXPECT® THE FIRST YEAR Heidi Murkoff Sharon Mazel, Arlene Eisenberg & Sandee Hathaway, B.S.N TO EMMA AND WYATT, RACHEL, ETHAN, AND ELIZABETH FOR THE MAGICAL, MEMORABLE FIRST YEARS EACH OF YOU GAVE US TO OUR PARTNERS IN PARENTING, ERIK, HOWARD, AND TIM, WITHOUT WHOM WE COULDN’T HAVE MADE IT THROUGH THOSE FIRST YEARS Copyright © 1989,1996,2003 by What to Expect LLC Book illustrations © 2003 by Judy Francis Design copyright © by Workman Publishing What to Expect ® is a registered trademark of What to Expect LLC Front cover illustration: Tim O’Brien based on a photograph by Fiona Alison/Getty Images Back cover illustration: Tim O’Brien based on a photograph from Banana Stock/Photolibrary Cover quilt: Lynn Parmentier,Quilt Creations, www.quiltcreations.net Quilt photography: Davies + Starr All rights reserved No portion of this book may be reproduced—mechanically, electronically, or by any other means, including photocopying—without written permission of the publisher Published simultaneously in Canada by Thomas Allen & Son Limited Library of Congress Cataloging-in-Publishing Data available upon request ISBN 978-0-7611-5212-5 (pbk) ISBN 978-0-7611-5079-4 (hc) Workman books are available at special discounts when purchased in bulk for premiums and sales promotions as well as for fund-raising or educational use Special editions or book excerpts can also be created to specification For details, contact the Special Sales Director at the address below Workman Publishing Company, Inc 225 Varick Street New York, NY 10014-4381 Printed in the U.S.A First printing October 2003 40 39 38 37 36 35 Note: All children are unique and this book is not intended to substitute for the advice of your pediatrician or other physician who should be consulted on infant matters, especially when a baby shows any sign of illness or unusual behavior ACKNOWLEDGMENTS A SECOND ROUND OF THANKS If there’s anything harder than writing a book, it’s rewriting a book Like reinventing the wheel (how can we it better?), it takes a lot of reevaluating, a lot of revisiting, and a lot of second-guessing (What works well already? What used to work but doesn’t anymore? What never really worked in the first place? What could work—with a little work?) It also takes a lot of help, from a whole bunch of people From friends, colleagues, academics, health care professionals—and some special folks who fit into all four categories at the same time; some who have supported us from the first draft of the first edition, others who have only recently joined the team; many more wonderful people than we could possibly list here, that is, without running even farther over the expected page count in this second edition than we already have We gratefully thank all of you, including: Suzanne Rafer, a wonderful editor and even better friend, who has gamely waded through thousands and thousands of What to Expect manuscript pages over the last twenty years, shepherding sentences gone astray (and puns gone bad), deftly deleting words (the extraneous ones, that is), relentlessly waving her pink flags until we surrender to her better judgment—for everything you do, and for always being there Peter Workman, a publisher of uncommon (at least these days) character, skill, and most of all, faith—for standing behind us from the humble beginnings of What to Expect We share every success with you and with … Lisa Hollander, for making every book look its best, and Barbara Balch, for giving her a hand with this one; Judith Cheng, for another beautiful cover (and another memorable baby), and Judy Francis, for her adorable (and illuminating!) illustrations Anne Cherry, for smoothing out the kinks in the manuscript Robyn Schwartz, for good humor and fast reflexes Carolan Workman, Suzie Bolotin, David Schiller, Jenny Mandel, Sarah Edmond, Jim Eber, Kate Tyler, Bruce Harris, Pat Upton, Saundra Pearson, Beth Doty, and all the other wonderful members of the Workman family—lots of hugs and kisses to each and every one of you, for all your hard work, support, and love Thanks also to all of you who worked on the first edition but have since moved on Sharon Mazel, for absolutely everything you (and for the amazing speed with which you it all; it probably helps that you never sleep): favorite e-mail companion (you’ve got mail—again!), tireless researcher (who takes her research seriously—and has Kira and Sophia to show for it) and writer, steadfast gatekeeper of TMI—you’re half of our onetwo punch, and I treasure you Thanks, too, to Dr Jay Mazel—not just for sharing Sharon but for offering endless after hours medical advice —and to the four (and counting?) Mazel girls: Daniella, Arianne, Kira, and especially timely Sophia Special thanks to the girls’ pediatrician, Dr Jeffrey Bernstein, who patiently answered the hundreds of First Year questions Sharon snuck into well-baby visits And Aliza Graber, for getting us organized Dr Mark Widome, Professor of Pediatrics at The Penn State Children’s Hospital and star of both pediatric practice (we envy those kids in your care!) and the Today show, and our extraordinary medical adviser Not only for your invaluable knowledge, wisdom, and insights, which make us look good, but for your humor, empathy, and compassion, which make us feel even better Your attention to detail (through every word on every last page of manuscript) always went above and beyond—and we can’t thank you enough Lisa Bernstein, Executive Director of the What to Expect Foundation, for your determined dedication to the health and well-being of all babies—and always, for your love, support, and friendship (And, of course, to Zoe, Teddy, and Dan Dubno.) Marc Chamlin, Ellen Goldsmith-Vein, and Alan Nevins—for protecting me, standing up for me, and most of all, for caring about me Medora Heibron, for her invaluable insights on adoption All the dedicated, wonderful people at the American Academy of Pediatrics, whom we can always count on for the most up-to-date (and most balanced) facts and positions And to the countless AAP members who have answered questions, offered feedback, and helped make this book the best it could be With love, to my husband, best friend, partner in parenting, partner in business, and partner in life, Erik Murkoff, for making everything possible I couldn’t begin to it without you, and I’d never want to try And to Emma and Wyatt, my inspiration and (real live) guinea pigs; I love you guys To two of the best husbands and fathers around, Howard Eisenberg, and Tim Hathaway, to those amazing Hathaway kids, Rachel, Ethan, and Liz And to Mildred and Harry Scharaga, Victor Shargai, and John Aniello, for your love and support To Arlene Eisenberg, for everything; your legacy lives on in the hearts of so many We’ll always love you and miss you With admiration, to all the doctors, PNPs, and nurses everywhere who take care of babies—and their nervous parents And to our readers—our inspiration, our favorite resource, and the reason we what we do—and keep doing (and redoing) it —HEIDI MURKOFF CONTENTS Foreword: A Parenting Book That Stands Alone, by Mark D Widome, M.D., M.P.H Introduction: A Second Baby Is Born Part THE FIRST YEAR Chapter 1: Get Ready, Get Set Feeding Your Baby: Breast or Formula, or Both Facts Favoring Breastfeeding Breastfeeding Myths Facts Favoring Formula Feeding Factoring in Feelings When You Can’t or Shouldn’t Breastfeed Adoption and Breastfeeding What You May Be Concerned About Coping with Motherhood Mother Care A Changing Lifestyle This Book’s for You, Too Whether or Not to Go Back to Work Leave: It’s Not Just for Mothers Anymore Grandparents A Lack of Grandparents A Baby Nurse or Doula Other Sources of Help Circumcision Which Diapers to Use Quitting Smoking A Name for Baby Preparing the Family Pet Preparing Your Breasts for Breastfeeding Don’t Express Yourself—Yet What It’s Important to Know: SELECTING THE RIGHT PHYSICIAN Pediatrician or Family Practitioner? Health Insurance for a Healthy Family What Kind of Practice Is Perfect? Finding Dr Right Making Sure Dr Right Is Right for You When the Choice Isn’t Yours The Prenatal Interview Your Partnership with Dr Right Chapter 2: Buying for Baby Register for Your Baby Needs Baby’s Wardrobe Baby’s Linens Baby’s Grooming Needs Don’t Go Nuts Baby’s Medicine Cabinet Baby Feeding Supplies Nursery Necessities and Niceties Calling All Recalls Equipment for Outings What’s in a Buckle? Rear-Facing Infant Seat The LATCH System Convertible Seat/Forward-Facing Seat When Baby Gets Older Buying for Baby’s Future Chapter 3: Breastfeeding Basics Getting Started Breastfeeding Getting Help Breastfeeding How Lactation Works Beginning to Breastfeed Breastfeeding Positions A Proper Latch Sucking Versus Suckling How Long to Feed What Type of Nurser Is Your Baby? moving from strained to mashed, 371–372 organic, 349 starting, 312–315 types of, to offer baby, 312, 347–349 warming up, 329 Sore nipples, see Nipples Sore throat, 778–779 treatment for, 547 Soy formula, 107, 177 allergy to, 543 Soy milk, 3, 483, 543 Spacing children, 690–692 Spanking, 457 Spastic movements, 272 Speaking to baby, see Talking Special needs baby, 625–651 accepting life support treatment for, 632–633 diet and, 326 effects of, on parents’ relationship, 636–637 effects of, on siblings, 633–636 feeling angry about, 626–627, 628 feeling responsible for defect of, 626 getting the best treatment for, 633 getting the right diagnosis for, 630–632 handling the responsibility of, 629–630 not loving the, 627–628 repeat with next baby, 637–638 telling others about, 628–629 Speech, see Language Spermicide, 699–700 SPF, see Sunscreen Spina bifida, 648–649 Spitting up, 174–176 and breast milk, excessive, and GER, 556 Spit-up blood in, 176 cleaning up, 176 Splenda, and breastfeeding, 97 Splinter, first aid for, 588 Spoiled food, 328–329, 516 Spoiling baby, 191–194, 372–374 by grandparents, 374–375 Sponge bath, 133–135 Sponging, as treatment for fever, 569–571 Spoon, type of, to feed baby, 313–314 Spouse relationship with, 689–690 feeling unappreciated by, 708–709 sharing baby care with, 18, 723–724 Stairs, safety on, 64, 406, 413 Standing, 295–296 pulling up to, 427–428 Startle reflex, in newborns, 104 Startling, 125 States of consciousness, in newborn, 120 Stationary entertainers, 64–65, 333–334 Steam, 758; see also Humidifier Stepping reflex, in newborns, 104 Steps, see Stairs Sterilization, 700–701 Sterilizing bottles, for bottle feeding, 109 water, for formula feeding, 109 Steroid cream, for eczema, 325 Stimulating your baby, 224–225, 383–384 early months, 242–248 older baby, 366–369 one-year-old, 502–505 Stimulation, sensitivity to, 240–241 Stings, insect, see Insect bites marine animal, first aid for, 574 Stool, 131–132 as sign that baby is getting enough to eat, 164 black, 303–304 blood in, 177–178 mucus in, 131, 176, 316 orange, 359 sandy, 424 strange looking, 424–425 see also Bowel movement, Constipation, Diarrhea Storage of expressed breast milk, 162 of food, 328–329 of formula, 110 Storage bags, for breast milk, 161 Stork bites, 126–127 Stranger anxiety, 429–430, 485–486 Strawberry hemangioma, 126 Strep throat, 780–781 Stroller exercise, 685 Strollers, 55–57 Stuffed animals as comfort object, 430–432 safety of, 308 see also Toys Sucking and crying, 194 nonnutritive, reflex, in newborns, 104 versus suckling, 75 Suckling, 75 ineffective, 166 Subcutaneous ring block, and circumcision, 21 Sucralose, and breastfeeding, 97 Sudden Infant Death Syndrome, see SIDS Summer rash, 509 weather, baby care during, 508–517 Sun and damage to the eyes, 512 and vitamin D, 510 keeping baby out of the, 510–512 safety in the, 510–512 Sunburn first aid for, 577 preventing, 510–512 signs of, in baby, 512 Sunscreen, 148, 511–512 Superbaby, raising a, 383–384 Supplement, vitamin, see Vitamins Supplemental nutrition system (SNS), 92, 166, 167, 168, 657–658 Supplementing when baby isn’t thriving, 218 with bottles, 215–218 Swaddling baby, 150, 151, 199 and crying, 193 to keep on back while sleeping, 241–242 Swallowing difficulty with, as symptom, in sick baby, 534 foreign object, and first aid for, 589 Sweeteners, and breastfeeding, 97 Sweets, holding off on introducing, 419 Swim, teaching baby to, 515–517 Swimming class, 515 pool, 515–517 Swing, 54, 335 Swinging baby, by the arms, 480 Symptoms, of sick baby, 532–535 Synagis, 562 Syphilis, and hearing loss, 101 Syringe pump, 158 Systematic awakening, and getting baby to sleep through the night, 351–352 T Table feeding baby at, 420 manners, 439–441 Talk, helping baby to, 467–470 Talking first words, 388–389 second language, 222–224 to baby, 220–221, 222, 368 see also Language development Taste, sense of, stimulating, 244 Tay-Sachs disease, 649–650 Td immunization, for older children, recommended schedule, 231 Tea bags, for sore nipples, 84 Tear duct, blocked, 207 Teeth and breast milk, and fluoride, 175 broken, 583 brushing, 359–361 chipped, 465 coming in crooked, 383 early, 128 flossing, 360 grinding, 443 injury, 465, 583 knocked out, 583 lack of, at nine months, 432 stains on, because of excess iron intake, 175, 383 see also Tooth decay, Teething Teething, 319–321 and refusing to breastfeed, 293 and sleeping, 321, 427 early, 128 late, 432 order of, 321 treatment for pain of, 321–322, 547 Television, watching, 497–499 Temperament, of baby, 237–241 Temperature abnormally high body, 563 abnormally low body, 581 as symptom, in sick baby, 533 normal body, 564, 567 taking axillary (underarm), 566 taking baby’s, 564–567 taking rectal, 566 Temporal artery thermometer, 48, 566 Tempra, see Acetaminophen Tension, parental, see Anxiety Testicles, undescended, 234 see also Scrotum Tetanus vaccine, see Diphtheria, tetanus, acellular pertussis vaccine Tetanus, 780–781; see also Diphtheria, tetanus, acellular pertussis vaccine Thalassemia, 650–651 Thawing frozen breast milk, 162 Thermometer choosing a, 565–566 digital, 47, 565 glass mercury, 565 mercury, 47–48 pacifier, 565 temporal artery, 48, 566 tympanic, 48, 565, 566 Thin baby, see Skinny baby Throat, sore, treatment for, 547 Thrush and baby’s refusing to breastfeed, 294 and breast pain during breastfeeding, 82 in baby, 128–129 on mother’s nipples, 129 Thumb sucking, 298–299 Thyroid problems and PPD, 673 testing for in infant, 647 Ticks protecting baby from, 513 removing, 573 Tidemark dermatitis, 270 Tied tongue, and breastfeeding, 166 Time dividing, among siblings, 741–744 father’s lack of, 724–725 finding, for yourself, 702–703 quality, 709–710 Tobacco, see Smoking Toddler years, 496 Toes, injuries to, and first aid for, 579–581 Toilet, childproofing, 411 Toiletries, for baby, see Medicine cabinet Tongue thrust reflex, and starting solids, 292–293 Tonic neck reflex, in newborns, 105 Tonsillitis, 778–779 Tooth, see Teeth Tooth decay and propping the bottle, 111 and co-sleeping, 266, 353, 362 and baby-bottle mouth, 361–362 and sippy cups, 327 preventing, 359–362 and discoloration, 383 Toothbrush, for baby, 360 Toothpaste, 360 Total parenteral nutrition (TPN), 601 Touch, sense of, stimulating, 246–247 Toxoplasmosis, and hearing loss, 101 Toys, 307–309, 366–367, 503–504 for young baby, 245 safety of, 308 TPN, 601 Tracheoesophageal fistula, 651 Train, traveling by, 529 Transitional milk, 78 object, 430–432, 485 stool, 131 Traveling and using formula, 110 with baby, 522–531 by train, 530–531 by air, 528–529 by car, 529–530 Trigger-operated pump, 158 Tub baby, 52; see also Bath seat, 64 Tubal ligation, 701 Tuberculosis, maternal, and breastfeeding, 10 Tubes, for ears, 555 Tummy baby sleeping on, 241, 355 baby playing on, 210 Turning over, during night, 355 TV, see Television Twins, 170–171 Tylenol, see Acetaminophen Tympanic thermometer, 48, 565–566 U Umbilical cord care of stump, 151, 197 clamping after birth, 100 healing of, 196–197 infection of, 197 Umbilical granuloma, 197 hernia, 197–198 Underarm, taking temperature, 566 Understanding your baby, 223 Underweight baby, see Skinny baby Undescended testicles, 234 Unhappy baby, 239 Upper respiratory infection (URI), see Cold Urinary incontinence, postpartum, 681–682 Urinary tract infection (UTI), 559–560 and circumcision, 20 Urine and dehydration, 553 bright pink, 94 cloudy, and UTI, 559 color of, in baby not getting enough to eat, 164 frequency of, in healthy baby, 164 frequency of, in sick baby, 534, 553 more frequent, and UTI, 559 pink, 164, 534, 559 smelly, and UTI, 559 Usher’s syndrome, and hearing loss, 101 Uterus placental fragments in, and lack of breast milk, 168 shrinking, and breastfeeding, V Vaccine Adverse Event Reporting system (VAERS), 228, 232 Vaccines, see Immunizations Vagina baby playing with, 397 defect in (hypospadias), 199 discharge from, in newborn, 102 stretched, postpartum, 688 Vaginal dryness, postpartum, 686 Vaginal lubrication, postpartum, 686 Vaginal sponge, as birth control, 698–699 Var, see Varicella vaccine Varicella vaccine (Var), 230, 231 Varicella, see Chicken pox Vasectomy, 701 Vegan diet, 363–364 breastfeeding, and supplemental vitamins for baby, 173, 363–364 Vegetables and dietary recommendations for, 318 getting enough, 490–491 in postpartum diet, 668 peeling, before serving to baby, 342–343 to offer baby, 312, 315 Vegetarian diet, 363–364 Venous hemangioma, 126 Vernix caseosa, in newborn, 102 Violent feelings, toward baby, 191 Viral infection, nonspecific, 772–773 Virus, and stool appearance, 131 Vision, 203–206 stimulating, 244–245 Vitamin A, foods, dietary recommendations for, 318 Vitamin B12, 173, 363, 364 Vitamin C, 174–175 foods, dietary recommendations for, 318 foods, in postpartum diet, 667–668 Vitamin D, 174 Vitamin K, for newborn, 103 Vitamins for baby, 173–175, 319, 343 in postpartum diet, 669–670 prenatal supplements, 8, 173 Vomit and GER, 556 as sign of allergy, when introducing solids, 316 as symptom, in sick baby, 534, 553 in milk allergy, 177 projectile, 176 treatment for, 547, 552 W Waardenburg’s syndrome, and hearing loss, 101 Waking and teething, 321 baby, at mealtime, 122–123 early, 354–355 patterns, in early infancy, 180–181 see also Night waking Walkers, 331–334 Walking early, 428–429 not yet, at twelfth month, 479–480 shoes for, 448–449 Walking reflex, in newborns, 104 Wardrobe, baby’s, see Clothing Warm compresses, 758 Warming, bottle, 109–110 solids, 329 Washing baby, see Bath, Sponge bath, Baby care baby’s clothes, 208 diaper area, 135 hands, to prevent spread of infection, 548 Water contaminated, and minimizing risk to baby, 337–339, 343 giving baby, 173, 301, 514 intoxication, 515, 516 purifier, 339 safety of baby near, 412, 413–414, 515–517 temperature, in the house, 411 Weaning baby’s readiness for, 294 deciding when to, 437–439 early, 267 from the bottle, 460–462 from the breast, 474–477 sudden, 475 Wearable pumps, 158 Wearing baby, and crying, 192–193 see also Slings Weather changing, 518 summer, and caring for baby, 508–517 winter, and caring for baby, 517–522 Wedges, to maintain sleep position, 261 Weight, baby’s, 101–102, 163, 302 at birth, 100, 113 charts, 782–783 Weight gain lack of, in milk allergy, 177 poor, 302–303 Weight loss in newborn period, 116 early, in low-birthweight baby, 602 postpartum, 682 Well-baby checkups, see Checkups Wheat, introducing, 315 Wheezing and inhaled object, 592 and milk allergy, 176 as sign of allergy, when introducing solids, 316, 330–331 White grape juice, 300 Whole grains, dietary recommendations for, 317 Whole wheat, 418–419 Whooping cough, 774–775; see also Diphtheria, tetanus, acellular pertussis vaccine Will, writing a, 63 Window, safety, 404, 513 Winter weather, and caring for baby, 517–522 Words, baby’s first, 388–389 Work and breastfeeding, 250–254 and diminishing breast milk, 167 flexibility in types of, 712–713 when to return to, 714 whether to go back to, 13–14, 710–714 Workplace, bringing baby to, 288 X X ray, dental, 465 Y Yasmin, 694 Yeast infection in diaper area, 270 in mouth, see Thrush Yellow fruits, see Fruits vegetables, see Vegetables Yellowing, of skin, 130–131 Z Zoloft, 673 Zoo, petting, and minimizing risk to baby, 340 .. .WHAT TO EXPECT THE FIRST YEAR Also available from What to Expect What to Expect When You’re Expecting Eating Well When You’re Expecting The What to Expect When You’re Expecting... to Expect the Toddler Years WHAT TO EXPECT THE FIRST YEAR Heidi Murkoff Sharon Mazel, Arlene Eisenberg & Sandee Hathaway, B.S.N TO EMMA AND WYATT, RACHEL, ETHAN, AND ELIZABETH FOR THE MAGICAL,... Organizer What to Expect Pregnancy Planner Que se Puede Esperar Cuando se Esta Esperando (What to Expect When You’re Expecting—Spanish edition) The What to Expect Baby-Sitter’s Handbook What to Expect