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Well Child Care at Months

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					                                SAPPHIRE PEDIATRICS
   Weight______ ____%       Height______ ____%      Head ______ ____%
              Tylenol dose ______ every 4hrs Ibuprofen ______ every 6 hrs

                       Well Child Care at 2 Months
Feeding
Your baby still needs only breast milk or infant formula to grow healthy and strong. It is not time
to start cereal or baby foods yet. Cereal can be started at 4 to 6 months of age. At this age most
babies take about 4 ounces of formula every 3 to 4 hours.
Even if you only give your baby breast milk, it is a good idea to sometimes feed your baby with
pumped milk that you put in a bottle. Then your baby will learn another way to drink milk and
other people can enjoy feeding your baby.
Always hold your baby during feeding time. Then your baby learns that you are there to meet his
needs. This is an important and special time.
Development
Babies start to lift their heads briefly. They reach for things with their hands. They enjoy smiling
faces and sometimes smile in return. Cooing sounds are in response to people speaking gentle,
soothing words.
Normal Development: 2 Months
Sleep
Many babies wake up every 3 to 4 hours, while others sleep through the night. Every baby is
different. Feeding your baby a lot just before bedtime doesn't have much to do with how long
your baby will sleep. Place your baby in the crib when he's drowsy but still awake. Never put
your baby in bed with a bottle. Ask your health care provider for ideas about ways to keep your
baby alert and awake during the day and sound asleep at night.
Safety Tips
Never leave your child alone, except in a crib.
Carbon Monoxide Poisoning
Furnaces, water heaters, and cars are daily sources of fatal carbon monoxide. Detectors (and
routine service to your appliances) will prevent death from CO.
 Install at least one detector near your sleeping areas. Don’t rely on your landlord.
 Never use your stove to heat your house
 Never leave a car running in the garage
 Always have your furnace checked before turning it on in the fall
 Never leave children in a running car while clearing off snow. Tailpipes blocked with snow
    will cause fatal levels of CO inside the car.
 Never use a generator inside the house-- even in a power outage.
Avoid Suffocation and Choking
     Use a crib with slats not more than 2 and 3/8 inches apart.
     Place your baby in bed on his back.
     Use a mattress that fits the crib snugly.
     Keep plastic bags, balloons, and baby powder out of reach.
Prevent Fires, Burns, Scalds
     Never eat, drink, or carry anything hot near the baby or while you are holding the baby.
     Turn your water heater down to 120°F (50°C).
     Install smoke detectors.
                               SAPPHIRE PEDIATRICS
    Keep a fire extinguisher in or near the kitchen.
    Don't smoke inside the house or near the baby.

Car Safety
    Never leave a child alone in a car.
    Use an approved infant car safety seat and follow the instructions for proper use.
    Parents should always wear seat belts.
Avoid Falls
    Never step away when the baby is on a high place, even on a changing table.
    Keep the crib sides up.
Immunizations
At the 2-month visit, your baby should have a:
     DPT (diphtheria, pertussis, tetanus) vaccine
     Hib (Haemophilus influenza type B) vaccine
     hepatitis B vaccine
     polio vaccine
     pneumococcal (PCV7) vaccine
     Rotavirus Oral Vaccine
Some of these vaccines are mixed together in the same shot, so your baby will not have to have 5
separate shots.
Your baby may run a fever and be irritable for about 1 day after getting shots. Your baby may
also have some soreness, redness, and swelling where the shots were given. Acetaminophen
drops (0.4 ml, every 4 to 6 hours) may help to prevent the fever and irritability. For swelling or
soreness put a wet, warm washcloth on the area of the shots as often and as long as needed for
comfort.

Call us if:
    Your child has a rash or any reaction other than fever and mild irritability.
    You are concerned about the fever.
Next Visit
Your baby's next routine visit should be at the age of 4 months. At this time your child will get
the next set of immunizations. Please bring the shot card each time your baby is due to get shots.
                                      SAPPHIRE PEDIATRICS
                                               Schedule of Well Child Visits

AGE                          IMMUNIZATIONS/TESTS                                        VISIT DETAILS
2-3 days                     none                                                       exam, growth, development

2 weeks                      state newborn screen                                       exam, growth, newborn screen

2 months                     DTaP/IPV/HIB, HepB, Prevnar, RotaTeq                       exam, growth, development

4 months                     DTaP/IPV/HIB,( HepB*), Prevnar, RotaTeq                    exam, growth, development
                                                                                        (*no HepB if received birth dose)
6 months                     DTaP/IPV/HIB, HepB, Prevnar, RotaTeq                       exam, growth, development

9 months                     Blood Count, Lead and TB screen                            exam, growth, development

12 months                    Prevnar, HepA                                              exam, growth, development

15 months                    DTaP/IPV/HIB                                               exam, growth, development

18 months                    Varivax, MMR                                               exam, growth, devel., autism screening

2 years                      Hep A, Blood Count, Lead screen                            exam, growth, devel, hearing

3 years                       None                                                    exam, growth, devel, hearing

4 years                      MMR, Varicella                                   exam, growth, devel, vision, hearing

5 years                      DTaP, IPV, Urinalysis                            exam, growth, devel, vision, hearing

6 years                      none                                             exam, growth, devel, vision, hearing
7 years                      none                                             exam, growth, devel, vision, hearing
8 years                      none                                             exam, growth, devel, vision, hearing

9 years                      Cholesterol screen                               exam, growth, devel, vision, hearing
10 years                     none                                             exam, growth, devel, vision, hearing

11 years                     TdaP, Menactra, UA                       exam, growth, devel, vision, hearing, puberty issues*
                             Gardasil (girls only, series of 3 shots)

12 years                     none                                   exam, growth devel, vision, hearing, puberty issues*
13 years                     none                                   exam, growth, devel, vision, hearing, puberty issues*
14 years                     none                                   exam, growth devel, vision, hearing, puberty issues*
15 years                     none                                   exam, growth, devel, vision, hearing puberty issues*
16 years                     none                                   exam, growth devel, vision, hearing, puberty issues*
17 years                     none                                   exam, growth, devel, vision, hearing, puberty issues*

* Puberty issues: adolescent issues including sexuality will be discussed at these visits. These visits may
include one-on-one time for the Teen and the physician. Please prepare your child appropriately.

DtaP = Diptheria/Tetanus/Acellular Pertussis                        RotaTeq= oral Rotavirus vaccine
HIB= Hemophilus influenza type B                                    TdaP = Tetanus/Diptheria/acellular Pertussis booster
HepB = Hepatitis B vaccine                                          Gardasil= HPV (cervical cancer) vaccine
IPV = Inactivated Polio Virus                                       Menactra = meningococcal vaccine
Prevnar = Pneumococcal 7- conjugate                                 UA= urninalysis
Varivax = Varicella (chickenpox)                                    Hgb= hemoglobin (blood count)
MMR = Measles/Mumps/Rubella                                         HepA = Hepatitis A


                         Sapphire Pediatrics 4500 E. Ninth Avenue, #740 Denver, CO 80220
                                    Phone 720-941-1778        Fax 720-941-1783
                                             www.SapphirePediatrics.com
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         
        
      
  
          
                                                    
          
           
              
           
      
             
  
        
           

 
     
     
     
     
     

                                                      
                         
                       
                           
                         
                              
                          
                                      
               
            
            
               
              
              
             
              



                          
                           
                         
                         
                   
            
            
                   
                
                                       
                                             
                                             


                             
                         
                            
                          
                        
                                       
                     
               
          
          
                                  

    
    
    
    
    



                                                                
                                                           
                                                            
                                                         
                                                          
Sapphire Pediatrics

Robin Larabee, MD
4545 E. Ninth Avenue, Suite 260
Denver, CO 80220
720-941-1778
www.SapphirePediatrics.com

                           Normal Development: 2 Months Old
  Here's what you might see your baby doing between the ages of 2 and 4 months.

Daily Activities

       Crying gradually becomes less frequent.
       Displays greater variety of emotions: distress, excitement, delight.
       May begin to sleep through the night.
       Smiles, gurgles and coos, particularly when talked to.
       Shows more distress when an adult leaves.
       Quiets down when held or talked to.
       Cannot conceive of an object existing if it cannot be sensed.

Vision

       Focuses better, but still no more than 12 inches.
       Follows objects by moving head from side to side.
       Prefers brightly colored objects.

Hearing

       Knows difference between male and female voices.
       Knows the difference between angry and friendly voices.

Motor Skills

       Movements become increasingly smoother.
       Lifts chest momentarily when lying on tummy.
       Holds head steady when held or seated with support.
       Discovers hands and fingers.
       Grasps with more control.
       May bat at dangling objects with entire body.

  Each child is unique. It is therefore difficult to describe exactly what should be expected at each stage of a
  child's development. While certain behaviors and physical milestones tend to occur at certain ages, a wide
  spectrum of growth and behavior for each age is normal. These guidelines are offered as a way of showing
  a general progression through the developmental stages rather than as fixed requirements for normal
  development at specific ages. It is perfectly natural for a child to attain some milestones earlier and other
  milestones later than the general trend.
                           United States                Indoor Environments Division (6609J)   EPA-402-F-96-005
                           Environmental Protection     Office of Air and Radiation            October 1996
                           Agency



                           Protect Your Family and
                           Yourself from Carbon
                           Monoxide Poisoning
Carbon Monoxide Can Be Deadly                               Play it Safe

You can’t see or smell carbon monoxide, but at              If you experience symptoms that you think could be
high levels it can kill a person in minutes. Carbon         from CO poisoning:
monoxide (CO) is produced whenever any fuel
such as gas, oil, kerosene, wood, or charcoal is                 DO GET FRESH AIR IMMEDIATELY. Open
burned. If appliances that burn fuel are maintained              doors and windows, turn off combustion
and used properly, the amount of CO produced is                  appliances and leave the house.
usually not hazardous. However, if appliances are
not working properly or are used incorrectly,                    DO GO TO AN EMERGENCY ROOM and tell
dangerous levels of CO can result. Hundreds of                   the physician you suspect CO poisoning. If CO
people die accidentally every year from CO                       poisoning has occurred, it can often be
poisoning caused by malfunctioning or improperly                 diagnosed by a blood test done soon after
used fuel-burning appliances. Even more die from                 exposure.
CO produced by idling cars. Fetuses, infants,
elderly people, and people with anemia or with a                 DO Be prepared to answer the following
history of heart or respiratory disease can be                   questions for the doctor:
especially susceptible. Be safe. Practice the DO’s 
and DON’Ts of carbon monoxide.                                        Do your symptoms occur only in the house?
                                                                      Do they disappear or decrease when you
CO Poisoning Symptoms                                                 leave home and reappear when you return?
                                                                      Is anyone else in your household
Know the symptoms of CO poisoning. At moderate                        complaining of similar symptoms? Did
levels, you or your family can get severe                             everyone’s symptoms appear about the 
headaches, become dizzy, mentally confused,                           same time?
nauseated, or faint. You can even die if these levels                 Are you using any fuel-burning appliances
persist for a long time. Low levels can cause                         in the home?
shortness of breath, mild nausea, and mild                            Has anyone inspected your appliances
headaches, and may have longer-term effects on                        lately? Are you certain they are working
your health. Since many of these symptoms are                         properly?
similar to those of the flu, food poisoning, or other
illnesses, you may not think that CO poisoning              Prevention is the Key to Avoiding Carbon
could be the cause.                                         Monoxide Poisoning

                                                                 DO have your fuel-burning appliances --
                                                                 including oil and gas furnaces, gas water
                                                                 heaters, gas ranges and ovens, gas dryers, gas
                                                                 or kerosene space heaters, fireplaces, and
                                                                 wood stoves -- inspected by a trained
                                                                 professional at the beginning of every heating
season. Make certain that the flues and           A Few Words About CO Detectors
chimneys are connected, in good condition, and
not blocked.                                      Carbon Monoxide Detectors are widely available in
                                                  stores and you may want to consider buying one as a
DO choose appliances that vent their fumes to     back up -- BUT NOT AS A REPLACEMENT for proper
                                                  use and maintenance of your fuel-burning appliances.
the outside whenever possible, have them
                                                  However, it is important for you to know that the
properly installed, and maintain them according   technology of CO detectors is still developing, that there
to manufacturers’ instructions.                   are several types on the market, and that they are not
                                                  generally considered to be as reliable as the smoke
DO read and follow all of the instructions that   detectors found in homes today. Some CO detectors
accompany any fuel-burning device. If you         have been laboratory-tested, and their performance
cannot avoid using an unvented gas or             varied. Some performed well, others failed to alarm even
kerosene space heater, carefully follow the       at very high CO levels, and still others alarmed even at
cautions that come with the device. Use the       very low levels that don’t pose any immediate health 
                                                  risk. And unlike a smoke detector, where you can easily
proper fuel and keep doors to the rest of the
                                                  confirm the cause of the alarm, CO is invisible and
house open. Crack a window to ensure enough       odorless, so it’s harder to tell if an alarm is false or a real
air for ventilation and proper fuel-burning.      emergency.

DO call EPA’s IAQ INFO Clearinghouse (1-800-      So What’s a Consumer to Do?
438-4318) or the Consumer Product Safety
Commission (1-800-638-2772) for more              First, don’t let buying a CO detector lull you into a false 
information on how to reduce your risks from      sense of security. Preventing CO from becoming a
CO and other combustion gases and particles.      problem in your home is better than relying on an alarm.
                                                  Follow the checklist of DOs and DON’Ts above. 
DON’T idle the car in a garage -- even if the
garage door to the outside is open. Fumes can     Second, if you shop for a CO detector, do some
build up very quickly in the garage and living    research on features and don’t select solely on the basis 
area of your home.                                of cost. Non-governmental organizations such as
                                                  Consumers Union (publisher of Consumer Reports), the
                                                  American Gas Association, and Underwriters
DON’T use a gas oven to heat your home, even      Laboratories (UL) can help you make an informed
for a short time.                                 decision. Look for UL certification on any detector you
                                                  purchase.
DON’T ever use a charcoal grill indoors -- even
in a fireplace.                                   Carefully follow manufacturers’ instructions for its 
                                                  placement, use, and maintenance.
DON'T sleep in any room with an unvented gas
or kerosene space heater.                         If the CO detector alarm goes off:

DON’T use any gasoline-powered engines                Make sure it is your CO detector and not your smoke
(mowers, weed trimmers, snow blowers, chain           detector.
saws, small engines or generators) in enclosed        Check to see if any member of the household is
                                                      experiencing symptoms of poisoning.
spaces.
                                                      If they are, get them out of the house immediately
                                                      and seek medical attention. Tell the doctor that you
DON’T ignore symptoms, particularly if more           suspect CO poisoning.
than one person is feeling them. You could lose       If no one is feeling symptoms, ventilate the home
consciousness and die if you do nothing.              with fresh air, turn off all potential sources of CO --
                                                      your oil or gas furnace, gas water heater, gas range
                                                      and oven, gas dryer, gas or kerosene space heater
                                                      and any vehicle or small engine.
                                                      Have a qualified technician inspect your fuel-burning
                                                      appliances and chimneys to make sure they are
                                                      operating correctly and that there is nothing blocking
                                                      the fumes from being vented out of the house.
Returning from maternity leave: Tips for working mothers
Are you dreading the day your maternity leave ends? Don't despair. Working mothers face many challenges, but you can
prepare for the demands with careful planning.

Before you return to work

While you're still on maternity leave, set yourself up for a successful return to work.

       Let go of the guilt. Returning to work often poses emotional conflicts for new mothers. But working outside the
        home doesn't make you a bad mother. And it's OK to look forward to the challenges and interactions of your job.
        Remind yourself that you're doing what's best for you and your family, and then move on.

       Find dependable child care. Consider local child care providers and facilities or make other arrangements for
        child care, perhaps even before the baby is born. Look for a safe, stimulating environment and qualified
        caregivers. Trust your instincts when interviewing potential caregivers.

       Talk to your boss. Clarify your job duties and schedule so you'll know what's expected of you after your
        maternity leave. You might ask about flexible hours, telecommuting or working part time.

        If you're planning to continue breast-feeding after returning to work, ask your employer to help you find a private
        room for pumping. Consider buying or renting an electric breast pump that allows you to pump both breasts at
        once. If timing is a concern, offer alternatives — pumping during your breaks or working from home to make up
        for the lost time, for example.

       Set a return-to-work date. If you can, go back to work late in the week. That'll make your first week back to work
        a short one.

Once you're back at work

When you go back to work, expect ups and downs as you become more adept at managing multiple demands. These tips
can help:

       Get organized. Make a daily to-do list. You might divide the list into tasks for work and tasks for home, or tasks
        for you and tasks for your partner. Identify what you need to do, what can wait — and what you can skip entirely.

       Stay connected. Plan a daily phone call to your baby's caregiver to find out how your baby's doing. Place a
        favorite photo of your baby on your desk or in your work area. Set aside time after work to reconnect with your
        baby.

       Make backup plans. Know what you'll do if your baby is sick or your baby's caregiver is unavailable on a
        workday — whether it's taking a sick day yourself or calling a friend or loved one to care for your baby.

       Honor your commitment to breast-feeding. Bring your breast pump, containers for expressed milk, an
        insulated bag and ice packs to work. Keep a stash of breast pads and extra blouses handy, in case your breasts
        leak.If you can't express milk at work, breast-feed your baby or pump just before you go to work and as soon as
        you return home. You could also pump between feedings on weekends for extra breast milk to be used while
        you're working.
       Seek support. Don't try to do everything yourself. Accept help from your partner, loved ones and friends. Speak
        up if you're feeling guilty, sad or overwhelmed. If you're having trouble pumping milk at work or nursing your baby
        at home, contact a lactation consultant from a local hospital or clinic.

       Nurture your own well-being. Relax in the tub after you put the baby to bed, or unwind with a favorite book or
        soft music. Cut down on any unnecessary commitments. Pick a reasonable bedtime, and stick with it. On
        weekends, sleep when your baby sleeps.

Above all, maintain a positive attitude. Tell your baby how excited you are to see him or her at the end of the day. Your
baby may not understand your words, but he or she will pick up on your emotions.
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             
             
       

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             
          
            
                                          
                
                                
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
              
           
           
           
         
                                                                                  
                                                  
          
              
                                                  
                                                                      
 
         
                                             
            
                  
                      
            
                                     
                                                                                   
                                         
        
          
                   
                                                        
                                                                     
                                                      
                              
                                                                       
                     
              
    
  
                                 
                                  
                                                                                  
                                                                                                      
                                                                                   
                                  
                       
                                    
                                 
                              
   
  
                                                                                                 
                          
                               
                            
                                                         
                                                                                                


  
   
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 

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                                                                        
                                                                                                                      
                                                                                                                                  
Sapphire Pediatrics

Robin Larabee, MD
Molly Gilpin, PA-C
4500 E. Ninth Avenue, Suite 740
Denver, CO 80220
720-941-1778
www.SapphirePediatrics.com

          Flattened Head Syndrome (Positional Plagiocephaly)
What is flattened head syndrome?
  If a baby lies on his back with his head turned in one position for a long time, day after day, the
  head can become flat on the back or on one side. This can cause the baby to have a crooked looking
  forehead and face. These changes can remain for the rest of the child's life. You can help prevent
  this flattening by constantly changing your baby's head position. This is especially important when
  the baby is very young and can't move around a lot.

How does it happen?
  Babies have very little room inside the uterus towards the end of pregnancy and may get "stuck" in
  one position. Infants who are in a breech position (bottom down) or twins have less room to move
  around, but even single babies in a normal position may have so little room that they can't change
  position. Babies who stayed in one position in the uterus continue to lie in that position after they
  are born. They may not have the strength to change their position without some help from their
  parents.

  A newborn's head is soft and easily molded into a flat shape. If your baby continues to lie with her
  head turned to one side all the time, the head will become flattened and eventually facial changes
  will develop. You can start to see flattening as early as 4 to 6 weeks of age. You may notice facial
  changes by 3 to 4 months.

How can I help my child?
  If you pay close attention to your baby's head position and make sure that her head is in many
  different positions throughout the day and night you can prevent head flattening.

  Here is what you can do:

       Sleeping: Always lay your baby down to sleep on her back. This is important to prevent
   sudden infant death syndrome (SIDS). However, change your baby's head position each time you lay
   her down. Lay your baby with the head towards the top of the crib one time and the next time lay her
   down with her head at the other end. Babies like to look out towards the room and this encourages a
   baby to move her head to a different side each time she is laid down. Put toys or mirrors in the crib
   to cause the baby to look towards the outside of the crib.
       Infant seats, strollers, bouncy seats, and swings: Watch to see if your baby likes to put his
   head to the same side all the time while sitting in a seat. Roll up a blanket or use a neck roll to put
   around the baby's head to keep the head in the center.
        Playtime: It is very important to start placing your baby on her stomach for playtime once the
   umbilical cord has dried up and fallen off. Time spent lying on the tummy helps develop neck,
   stomach, arm, and back strength. It also helps to get the baby ready for rolling, sitting, and crawling.
   Babies don't like lying on their tummies at first because they are weak and it is hard for them to push
   up. Don't worry if your baby fusses some of the time. Begin for short periods of time (2 to 3
   minutes), 3 or 4 times a day. Try it after a feeding or a diaper change. Talk to your baby, place toys
   in front of him, and encourage him to lift his head and begin to push up. Gradually increase the time
   spent on the tummy and your baby will get stronger and eventually like to play on her tummy.
   "Tummy time" is a time for playing with your baby. Do not allow your baby to fall asleep while
   lying on the stomach.
        Carry your baby: Your baby's favorite place is in your arms. Holding your baby or wearing
   your baby in a front pack is a great way to get him off his head and move the head in different
   positions. This also allows your baby to experience a variety of positions and is great for bonding
   and play.

When should I call my healthcare provider?
  Call during office hours if:

      Your baby always wants to lie in one position and resists changing that position. Sometimes
   special stretching exercises or positioning are needed for babies who have tight neck muscles or
   have been very cramped in the uterus.
      Your baby's head looks misshapen.
        

                                             
                              
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                                                              
                                                                                   
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              
                                                    
                                                                    
                                                                                   
                                                                                     
                  
                                                                      
                                                                  
                                                 
                                                                                   
          
          
                                                                                   
                                                                                      
                                                              
                      
                                                                                   
         
                                                                               
 
                                                  
 
                                                                                    
   
                                                 
   
          
                                                               
                                                                                  
                                                         
   
 
                                                                                 
               
                                                                                 
 
                                                                                 
   
    
                                      





  











                                                                                         
                                                                                        
                                                                                                                                            
                                                                                                                                                       
                                        Infant and Child Stooling Patterns

FEEDING      AGE   STOOL TYPE                  DESCRIPTION                          STOOL                            TIPS
  TYPE                                                                           FREQUENCY
Breast milk 1-3    Meconium          green-black, sticky                      1-4x/day
            days
            3-6    Transitional      between meconium                         Each feeding or so       Frequent stools at this age are a
            days                     and yellow mustard or cottage cheese -                            sign of good milk intake
                                     like
          1 week- Breast milk        yellow liquid mustard, but may be        Each feeding to
          2 weeks stools             brown, green, orange. Often runs out     every
                                     of the diaper and down the legs or
                                                                              Other feeding
                                     back; also cottage cheese with clumps
                                     or curds; also seedy.
          2-3      Breast milk                                                Variable: each           Baby’s intestines are more
          weeks    stools as above                                            feeding or as little     mature; there is little waste in
                                                                                                       breast milk so stools may be
          and      (less frequent)                                            as once per week
                                                                                                       infrequent. Babies naturally
          older                                                                                        grunt and strain, even when
                                                                                                       stools are soft.

Formula   1-3     Meconium           green-black, sticky                      1-4x/day
          days
          3-6     Transitional       between meconium                         Several times a day
          days                       and yellow-green soft stools
          1 week- Formula stools     Soft, seedy, or pasty stools; color      A few times a day
          2 weeks                    varies between brown, green,
                                     grey, and yellow
          2-3      Formula stools                                             Once or twice a        Babies grunt and strain just
          weeks    as above (less                                             day; as little as once because. If the stools are not
                                                                                                     small pellets, straining is not a
          and      frequent)                                                  every 3-4 days
                                                                                                       sign of constipation or a medical
          older                                                                                        problem.
                                                   What is Constipation?
Normal stooling efforts for babies include:
    -straining with stools
    -grunting with stools
    -turning red in the face with stools
    -play-dough consistency stools

Constipation is:
     -in a breast fed baby:
            -more than 7 days between stools (assuming good feeding and weight gain)
            -stool is hard, dry pellets
     -in a formula fed baby:
            -more than 4 days between stools
            -stool is hard, dry pellets

At-Home Constipation treatment:
    -for immediate relief:
          -glyerine liquid suppositories (baby-lax®, available over the counter); solid suppositories ok if liquid not available
                -squeeze contents into baby’s rectum; baby will have a stool within 15 minutes
    -for more consistent relief:
          -1 oz of prune juice mixed with 1 oz of water
                -give to baby in a bottle 1-2x daily until stools are soft (7 days max); then stop
      DO NOT USE HONEY OR KARO® SYRUP IN INFANTS UNDER AGE 1. THESE ITEMS CAN CAUSE SERIOUS HEALTH PROBLEMS FOR YOUR BABY.


If your child has true constipation that doesn’t improve with the above treatments, call the office for an
appointment. Your child may need additional treatment.
        
        


               
                               
                     
                                                       
                                                           
                                                      
                                                                
                                                       
                                                                                       
                                                        
                                                                                       
                                
                                                                  
                                                                                         
 
                                                                                         
 
                                                                                       
 
                                                                                         

                                                                                       
   
                                                                                       
  
                                                                                          
     
                                                                                         
 
    
 
                                                                                         
  
                                                                                     
 
                                                                                      

                                                                                    
     

                                                                                    
 
       
          
                                            
                                                                                     
                           
                                                                            
                                                                                     

 
                                                                                    


                                                                                    

                                                                                    
 
                                                               
                                                                                      
                                                                                     
           
 
                                                                                    

                                                                                   
 
                                                                                   

                                                                                  
                                                                                   

                                                                                    
                 
  
             
   
  
                                                                                  

                                                                                    
  
                                                                                   
 
                                                                                     

           
        

           
     
       
                                      
                                                                                  
                                                               
                                                                                  
                          
                                                                                   
                    
  
                                                                                  
    
                                                                                  

                                        
                                                                                  
  
                                                                                    
  
                                                                                  
              
           
         
                                                    
                                                          
                                               
 
                                                                                    
             
                                                 
          
   
 
                                                                                  

              
              
         
           
                       
                                                                                   
                                                                                                    
                                                                                      
                          
                           
                         
                                                                 
                                                                                               
                                                                                               
                  

                                                                                                 
                                                                                                 

                                                                                                 
                                 
                                       
                                                                                               


  

                                 
  
  
 




  


 




 
















                                                                   
                                                                      
                                                                                                                    
                                                                                                                                
YOUR BABY’S FIRST VACCINES
   WHAT YOU NEED TO KNOW

                      Babies get six vaccines
                         between birth and
                           6 months of age.

                      These vaccines
                   protect your baby
             from 8 serious diseases
                 (see the next page).

                  Your baby will get vaccines today that prevent
                                   these diseases:
                  Hepatitis B      Polio      Pneumococcal Disease
                  Diphtheria, Tetanus & Pertussis  Rotavirus     Hib
                                       (Provider: Check appropriate boxes)


                  These vaccines may be given separately, or some might be given
                 together in the same shot (for example, Hepatitis B and Hib can be
                      given together, and so can DTaP, Polio and Hepatitis B).
                     These “combination vaccines” are as safe and effective as
                    the individual vaccines, and mean fewer shots for your baby.

                      These vaccines may all be given at the same visit.
              Getting several vaccines at the same time will not harm your baby.

This Vaccine Information Statement (VIS) tells you about the benefits and risks of
these vaccines. It also contains information about reporting an adverse reaction, the
National Vaccine Injury Compensation Program, and how to get more information
about childhood diseases and vaccines.

Please read this VIS before your child gets his or her immunizations, and take it home
with you afterward. Ask your doctor, nurse, or other healthcare provider if you have
questions.
                        Individual Vaccine Information Statements are also available for these vaccines.
         Many Vaccine Information Statements are available in Spanish and other languages. See www.immunize.org/vis


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                                                                      § 
          
                                                                                                           
                             Vaccine Benefits: Why get vaccinated?
   
    
    
    
   
   
   


                       8 Diseases                                      HEPATITIS B                                                
    Prevented by Childhood Vaccines
                                                                        
                                                                       
 DIPHTHERIA                                                    
                    
               
                           
                                                                       
  
                                                                        


 TETANUS (Lockjaw)                                         
                                                                                                                                  
            P0LIO
                                                           
                                                                       
  
                                       
                                                                       
  
            
                                                                       


                                                           
 PERTUSSIS (Whooping Cough)                                                                                                    
                    PNEUMOCOCCAL
                                                                        
  
     
                                                    
         
                                               
                                                                       

            (Haemophilus influenzae type b)                
 HIB
                    ROTAVIRUS                                                  

               
 
                                                                        
  
                                                                       
 
           
                                                                       


How Vaccines Work
Immunity from Disease: When a child gets sick with one of these diseases, her immune system produces immunity, which
keeps her from getting the same disease again. But getting sick is unpleasant, and can be dangerous.
Immunity from Vaccines: Vaccines are made with the same bacteria or viruses that cause a disease, but they have been
weakened or killed to make them safe. A child’s immune system responds to a vaccine the same way it would if the child
had the disease. This means he will develop immunity without having to get sick first.
                                  Routine Childhood Vaccines

 


 DTaP       
  
  

 Hepatitis B     

 Polio      

 Hib       
  

 Pneumococcal     
  

 Rotavirus     


                                                Vaccine Risks

   



 


 


Other Reactions


 
DTaP Vaccine






Polio Vaccine / Hepatitis B Vaccine / Hib Vaccine


Pneumococcal Vaccine
 
Rotavirus Vaccine
 


                                                    Precautions
  





        
          
          
          
          
        

        
          
        

        
          
        

        
          
          
          
          
        


          What if my child has a moderate or severe reaction?
What should I look for?                                       What should I do?
     

                                                               
        

                                                               

                                                              
             
                                                              
               
                                                               
            
                     



                                                                           For More Information
           The National Vaccine
      Injury Compensation Program                             
                                                              
     
                  
             
             

                                                               
                                                              
                              SAPPHIRE PEDIATRICS




                AFTER YOUR CHILD’S IMMUNIZATIONS…

EXPECTED SYMPTOMS: may occur from 1-3 days after shots

 Soreness or redness at the injection site
 Small, red, hard nodule lasting a week or more
 Fussy, tired, fever to 101-102 F

To help your child with these symptoms, use Tylenol® every four hours and try an ice pack
at the injection site.

UNEXPECTED AND SERIOUS SYMPTOMS:
 Allergic reactions
     Trouble breathing
     Rapid heart rate
     Hoarseness
     Dizziness
     Wheezing
     Throat swelling
     Hives

 Systemic symptoms
     Fever of 105 F
     Weakness
     Extreme fatigue
     Pale skin

 Changes in child’s behavior
    Seizures
    Trouble waking up
    Non-stop crying (more than 3 hours)

If your child is having any of the unexpected/serious symptoms, record the date and time of
the event, and call the office to report it and obtain medical advice.
            ???
Have Questions about your Child?


         Medication doses…
        Symptoms and signs…
          When to worry…
          When to call us…


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