The Care and Handling of Babies -- Ann Douglas -- 10/7/2003

By Ann Douglas
WebMD Live Events Transcript

Hey -- where's the owner's manual? Diapers, bath time, where does Baby sleep? When do you call the doctor, and what equipment do you need? We had lots of questions, and our Baby Bootie Camp instructor, Ann Douglas, had the answers on Oct. 7, 2003.

The opinions expressed herein are the guest's alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

Moderator: Welcome to WebMD University: "Bootie Camp: A Four-Week Guide to Baby's First Year." Your instructor today is Ann Douglas, author of "The Mother of All Baby Books." Today she will answer your questions about the care and handling of your baby. You may send in your questions at any time during the event. Welcome back to WebMD University, Ann.

Douglas: It's great to be back. We certainly have a lot of interesting topics on the agenda for today.

Member question: We are expecting our first baby. I'm very excited but I don't have experience with babies, so I'm nervous. I feel like an idiot -- how will I know what the baby wants when she cries? I don't understand how you are supposed to know if she is hungry or thirsty or needs a diaper change or just wants to be held. Help!

Douglas: Let me reassure you that every mum on the planet has this worry the first time around. I remember worrying about the exact same thing. It's kind of like when you take delivery on a new computer with a new operating system. You fire it up and through a lot of experimentation, you begin to understand how the system and the software work. If you're doing something wrong, you get an error message. In this case, the error message you receive is an enraged howl from your baby who is telling you, "Hey, mum, I'm not asking to have my diaper changed, I'm hoping someone is going to feed me right now!"

So yes, those early weeks of parenthood can be a bit of a challenge for both you and your baby as you sort out your baby's communication signals; in other words, her various cries. But you will be amazed how quickly you learn to distinguish between the hunger cry, the dirty diaper cry, the I'm sleepy cry, and every other cry in your baby's repertoire and every day your parenting confidence will increase tenfold. I promise.

Member question: Is a fever of any kind in a newborn, even one or two degrees above normal, cause for calling the doc?

Douglas: When I had my babies my doctor told me it was very important to check out any fever in a newborn, because this could be an indication of a sign of infection. I don't want to alarm anybody, but one of my children did end up developing viral meningitis at four weeks of age, and the only symptom that I had to deal with initially was a high fever.

My son seemed a little warm to me, so I took him to the doctor's office for a checkup. By the time we arrived, some of the other symptoms of viral meningitis had begun to set in, including extreme irritability and behavior that indicated that he might have a stiff neck. My baby ended up spending a week in the hospital, but fortunately was just fine in the end.

So I'm a firm believer in checking out all fevers in very young babies. In most cases it's something much less worrisome, but when your baby is very young it never hurts to err on the side of caution.

Member question: People keep asking us what gifts we want for the baby (our first). What should we tell them besides "we need everything?"

Douglas: I like your answer. How true. If this is baby No. 1, you do need an awful lot of stuff. What I might suggest is that you start keeping a list of things you need so that you can start checking off things you have picked up yourself and things that you receive as you start to receive baby gifts.

You won't believe how many baby gifts you are likely to receive during the months ahead. I was stunned when people I had barely spoken to in my neighborhood showed up with presents after the births of each of my babies. I sometimes wondered if they thought they had to bring a gift in order to sneak a peek at the new baby! Keeping a list of baby items needed and baby items acquired will help to prevent you from ending up with 10 dozen newborn sleepers -- far more than even the most fashion conscious newborn could possibly wear.

A lot of new parents are taking advantage of online baby registry services for big ticket items, like baby strollers, cribs, car seats, and so on, so you may wish to look into some of these services. You don't necessarily have to purchase all of the items through the particular vendor, but it's a great way to let grandma in New York and Uncle Fred in California know that you're already taken care of in the high chair department. Hope this advice helps.

Moderator: What do you see as essential supplies for baby?

Douglas: Believe it or not, your baby only needs a fraction of the baby items available for sale in a typical baby store. Initially, at least, your baby needs a safe place to sleep, a car seat, some kind of baby carrier, and a stroller. Of course, you will also need diapering supplies, clothes, blankets, and other toiletry items, but for now, I'm just discussing the major pieces of baby equipment.

A lot of parents immediately ask, "What about the changing table?" because they're used to seeing photos of a typical nursery consisting of a crib, a changing table, and a dresser drawer set. I would argue that the changing table is a bit of a frill. If your budget can swing it and you love the idea of having a perfectly coordinated nursery, then by all means go for it. But if you're looking for a way to save yourself a couple of bucks, this is one of the first items that should go on the chopping block.

Here's why: Over time you are likely to start changing your baby in other locations than the changing table anyway. If, for example, you're downstairs in your family room you may find it's just as easy to grab a diaper and change pad from the diaper bag from the front door than it is to carry your baby all the way up to the changing table in his bedroom.

Once your baby hits the ultra squirmy toddler stage, changing your child on the change table becomes somewhat of a wrestling endeavor that you may wish to avoid for safety reasons (it's a lot more difficult for a toddler to fall and hurt himself if you're changing him on the floor than it is if you're changing him on a changing table).

I also mentioned that dresser drawer set. Again, you can certainly go ahead and buy the coordinating dresser that matches your child's crib if your family's finances allow for such a purchase. But if you're looking for a way to save a few extra dollars at this point in your life, you may wish to delay the purchase of your child's dresser until you actually need a dresser. Some parents find it works just as well to store the baby's clothes in baskets under the crib or in some sort of closet organizer system.

You can decide what will work best for you. Just don't assume that you have to spend thousands of dollars equipping your baby's room with nursery furnishings and then decorating it with all kinds of expensive wall coverings and fabrics. Sure, go ahead and indulge, if you have the financial means, but don't put yourself under undue financial stress at a time in your life when your budget is likely to be taking a bit of a hit anyway.

Hope this helps you to differentiate between some of the necessities and the frills. By the way, you can find some additional tips on scouting for baby bargains and avoiding baby fever when you're shopping for baby stuff by checking out the baby fever tip sheet on my web site at www.having-a-baby.com/article.htm.

Moderator: We used a well-padded changing pad on top of a desk for our daughter. The drawers functioned for supply storage. And when she was older, instead of having a useless piece of equipment in her room, she had her own desk.

Member question: Is it OK to use baby things from garage sales? I know I can wash the clothes, but am concerned about strollers, cribs, etc.

Douglas: You're very wise to worry about the safety issues involved in shopping secondhand at garage sales. You really need to know what you are getting. First of all, there is the issue of product recalls. You would want to go to the consumer product safety commission web site (www.cpsc.gov) to verify that the product you're considering has not been subject to a product recall. Otherwise, you could be purchasing a potentially dangerous, even deadly product for your baby.

Secondly, you need to consider overall wear and tear. A stroller that may very well conform to current product safety standards may, nonetheless, be no longer safe for your baby if it has been abused by a tribe of wild toddlers who have used it as a trampoline for the past year or two, completely destroying the frame and making it completely unsafe for use for any subsequent children.

I also need to add a separate cautionary note regarding car seats. It's almost always a bad idea to purchase a car seat secondhand. The only time I would even consider purchasing a car seat secondhand is if I were purchasing it from a close friend or relative and I knew the entire history of that car seat.

  • I would want to be certain that the car seat was new enough to conform to all current safety standards.
  • I would want to be sure that the car seat was not subject to any product safety recalls.
  • I would want to be sure that the friend or relative could supply me with a copy of the owner's manual.
  • Most important of all, I would want to be sure that the car seat had never been involved in a car accident, not even the most minor fender bender. Even the kind of fender bender that can happen in a parking lot can damage the integrity of a car seat to the extent that that car seat can no longer be guaranteed to provide the protection necessary to protect a child in the event of a more serious car accident.

You simply can't afford to gamble with your baby's safety when it comes to car seats. So unless you are completely sure the car seat in question is completely safe, I would recommend spending a little more and purchasing a brand-new car seat for your child.

Member question: What do you think of baby slings? There are so many kinds out there. If you like them, do you recommend any features or types?

Douglas: I love baby slings, because they allow mum to use her hands again. It may sound like an exaggeration on my part, but if you don't use a baby sling or other type of baby carrier you're going to spend a lot of time with your arms wrapped around your baby, something that prevents you from being able to do pretty much anything else. While this sounds lovely in theory, after a while it can be very frustrating not be able to even make yourself a sandwich without putting your baby down and possibly having to listen to her cry while making your lunch.

There's a huge difference between baby slings and baby carriers. Baby slings are kind of like a hammock that you wear over your shoulder. The baby lies in this hammock and floats fairly freely. A baby carrier tends to be much more form fitting and confining and is designed to hold the baby much more closely to your chest. Some mums and babies prefer slings; other mums and babies prefer carriers. It's very much a matter of individual preference.

The nice thing about a baby sling is that they are much less fidgety when you're trying to get your baby in and out. You can pop your baby in and out in a matter of seconds. In my experience some of the carriers require a lot more work and it can be much more difficult to remove a sleeping baby without waking the baby up. And we all know that one of the cardinal rules of parenting is that you should avoid waking up a sleeping baby at all costs.

You may want to borrow both a sling and a carrier during the early days of your baby's life until you figure out which product will work best for you and your baby. Then you can decide which item you will want to purchase and own, unless, of course, the friends who lent you the other products are willing to do a long-term loan, in which case you will not have to hit the baby store at all.

In terms of features to look for in a baby sling, the big thing is washability. It sounds like a no-brainer, but you want a product that can be easily washed and dried, ideally something that can go in the dryer. You don't want your baby sling to be out of commission an entire day while it air dries on the line just because your baby had a diaper blowout. You also want a baby sling that is highly adjustable. The better models can be used hammock style for young infants and sidesaddle style for older toddlers, so you can get about two years worth of use out of the product.

Member question: I'd love to know what you think of cloth diapers versus disposable diapers. What about cost, ease of use, environmental concerns? Thanks.

Douglas: Wow! I have to tell you that the diapering issue is definitely one of the more complicated issues of parenting. There is no clear right or wrong answer on this front, and in a perfect world I think we would all probably use cloth diapers, but sometimes that's neither possible nor practical, given our sometimes crazy-busy lives.

I have used a mix of different diapering options over the years, ranging from having three children in cloth diapers at one point to having three children in disposables at one point when the cloth diapering option didn't work out particularly well for our family after a yearlong attempt. So I feel that I can comment on the pros and cons of each option.

I think that daytime cloth diapering is relatively easy to pull off, and I would recommend that anyone who is concerned about environmental issues or cost give that serious consideration. Where I think cloth diapers sometimes don't measure up to disposables is in the overnight department. I never did succeed in finding a brand of cloth diapers that was able to keep my children, both boys and girls, dry overnight. I tried double diapering, adding cloth inserts -- basically every trick of the trade that anyone recommended. So I'm not particularly a huge fan of nighttime cloth diapering.

The other time that I think parents tend to use disposables rather than cloth is when they are traveling. It can be difficult for anyone but the most committed cloth-diapering parent to stick with cloth diapers during a weekend getaway to Grandma's house. I do, however, know some parents who have managed to do it, and I say all the power to them.

For parents who do choose to go the disposable route, the environmentalist in me would make one plea: When your child's poopy diapers start to become more solid, please dump the solid waste into the toilet and flush. Otherwise you are contaminating our landfill sites in an unnecessary manner that can dramatically increase the spread of disease. Now I'll get off my soapbox.

Member question: While we're in heated controversy territory, do you care to wade into the sleeping debate? Family bed? Crib? Bassinette by the parents' bed?

Douglas: I noted in the newspaper this week that there is a brand new study indicating that babies who co-sleep with their parents face a significantly increased risk of suffocation. The study, which is reported in the latest issue of the journal Pediatrics, found a 40-fold increase in the risk of suffocation in infants younger than 11 months if those babies slept with their parents, as opposed to sleeping in cribs or bassinettes. Obviously this is a disturbing study, and will cause a lot of people to rethink the whole co-sleeping issue.

I think we need to look at some of the other safety factors associated with co-sleeping:

  • It is not a good idea to co-sleep with your baby if you have been drinking heavily or if you are on a medication that may make it difficult for you to tell if you have rolled over on your baby in the night.
  • Some studies have also indicated that co-sleeping may not be a good idea if one of the parents who is sharing a bed is an extremely heavy sleeper or is severely obese.
  • If you sleep on a waterbed or overly soft mattress it is not a safe option.
  • If there is a gap between the mattress and headboard or mattress and wall, your baby could potentially get trapped and suffocate.
  • You also need to think about what you can do to prevent your baby from falling out of bed and becoming injured.
  • You will have to make sure that your bed is free of fluffy pillows, heavy comforters, and other bedding that could interfere with proper air circulation around your baby's face.
  • Studies have shown that babies who breathe in "stale" air (previously breathed in air) face a higher risk of SIDS (sudden infant death syndrome) than other babies.

Even if you feel that co-sleeping is a safe option, most of the time you need to have a backup plan in place for those times when you or your partner have the flu and are taking some kind of nighttime cold and flu medication that is designed to make you extra drowsy so that you can get some sleep. This would not be a safe situation because this is the very kind of medication you should be avoiding when you're co-sleeping with a baby.

In terms of crib versus bassinette, a lot of parents like to start their baby off in a bassinette because they can have the bassinette in their own room as opposed to having their baby sleeping in a crib in the baby's own room. Some parents also purchase sidecar units that attach to their own mattress and allow the baby to co-sleep with them and yet have the baby's own distinct sleeping space. This may feel like a good compromise for some parents.

These issues are very complicated and seem to become more controversial by the day. I would encourage parents to check out the American Academy of Pediatrics web site for some balanced insights into this issue and to also do some additional reading on this subject by checking out some of the many excellent articles on this subject available here at WebMD.

Member question: Just how much help do you think a 7 year old can safely hold and carry a brand-new sibling? What tips do you have for letting big sister help out?

Douglas: It's great that big sister wants to help out because I know some families where the older children try to pretend that the new baby didn't exist. How's that for healthy denial? But you're right to want to be sure that the 7 year old's baby handling skills are suitably safe before she's allowed to go solo.

There's always the risk with a 7 year old who seems to be adjusting well to the new baby's arrival that there could be a bit of hidden resentment and you don't want this hidden resentment to be expressed through the baby "accidentally" getting dropped or "accidentally" getting pushed over while the two of them are playing on the floor. I know a family who thought their 6 year old was adjusting extremely well to the arrival of his new baby sister until the day they discovered that he had removed most of the screws from the baby's baby swing. Kind of diabolical, if you ask me!

So siblings do need to be supervised carefully and trained in careful baby handling techniques; even the most loving 7 year old may not necessarily understand that newborns aren't up for a lot of rough horseplay.

Member question: Any tips for bathing the baby? Is it okay to bathe the baby in the kitchen sink? I have a bad back.

Douglas: By all means if you have a big enough kitchen sink that can be an excellent solution to bathing the baby initially. It sure beats what our mums used to go through, trying to use those horrible plastic bathtubs that pretty much guaranteed a trip to the chiropractor's office.

Just make sure that you get the temperature right before you put the baby in the sink and that you move the tap and the faucet out of baby's reach before you put baby in the sink. Otherwise, if baby starts kicking and waving her arms, she could potentially kick the faucet or the tap and scald herself.

Moderator: A towel or a rubber sink mat on the bottom of the sink helps too.

Douglas: You can also buy some plastic form-fitting devices that will act as an extra set of hands so your hands are free to focus on washing baby. Here's a quick tip that some parents find very helpful: Put on a pair of cotton gardening gloves, the very thin light weight ones, and lather them up with soap. Voila, you have two built-in washcloths!

Moderator: We are almost out of time. Before we wrap up for today, do you have any final comments for us, Ann?

Douglas: These questions about bathing babies have made me remember how scary that first bath can be for parents. Like all baby milestones it's something you will get through and have fond memories from. Sometimes I wish the big kid issues would be so easy to take care of. Have a great week, everyone. See you next week.

Moderator: Thanks for joining us, members, and thanks to Ann Douglas for sharing her expertise and experience with us. For more information, please read "The Mother of All Baby Books," by Ann Douglas.



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