International Travel and the Risks Posed by Measles

Below are the recommendations of the CDC regarding international travel and measles along with the link to the page on their website.

Plan for Travel

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Most measles cases in the U.S. result from international travel. Make sure you and your loved ones are protected against measles before international travel.

Before international travel: Make sure you’re protected against measles

The best way to protect yourself and your loved ones from measles is by getting vaccinated. You should plan to be fully vaccinated at least 2 weeks before you depart. If your trip is less than 2 weeks away and you’re not protected against measles, you should still get a dose of MMR vaccine. The measles-mumps-rubella (MMR) vaccine protects against all 3 diseases. Two doses of MMR vaccine provide 97% protection against measles; one dose provides 93% protection.

Infants under 12 months old

  • Get an early dose at 6-11 months

  • Follow the recommended schedule and get another dose at 12-15 months and a final dose at 4-6 years

Children over 12 months old

  • Get first dose immediately

  • Get second dose 28 days after first dose

Teens and adults with no evidence of immunity*

  • Get first dose immediately

  • Get second dose 28 days after first dose

* Acceptable presumptive evidence of immunity against measles includes at least one of the following: written documentation of adequate vaccination, laboratory evidence of immunity, laboratory confirmation of measles, or birth in the United States before 1957.

If you and your children are not traveling internationally, follow CDC’s routinely recommended vaccine schedule.

Measles is still common in other countries

Measles remains a common disease in many parts of the world. Each year around the world, an estimated 10 million people get measles, and about 110,000 of them die from it.

In the United States, most of the measles cases result from international travel. The disease is brought into the United States by unvaccinated people who get infected in other countries. Typically 2 out of 3 of these unvaccinated travelers are Americans. They can spread measles to other people who are not protected against measles, which sometimes leads to outbreaks.

Since measles is still common in many countries, unvaccinated travelers bring measles to the U.S., and it can spread. Protect yourself, you family, and your community with the measles-mumps-rubella (MMR) vaccine, especially before traveling internationally.

Travel Notices

  • Israel
    Travel Notice: Watch (Level 1)

  • Brazil
    Travel Notice: Watch (Level 1)

  • Ukraine
    Travel Notice: Watch (Level 1)

  • Philippines
    Travel Notice: Watch (Level 1)

  • Japan
    Travel Notice: Watch (Level 1)

Call your doctor immediately if you think you or your child have been exposed to measles.

After international travel: Watch for measles

Measles is highly contagious and can spread to others through coughing and sneezing. Measles is so contagious that if one person has it, 90% of the people close to that person who are not immune will also become infected. An infected person can spread measles to others 4 days before the rash even develops.

Watch your health for 3 weeks after you return. Measles symptoms typically include:

  • high fever (may spike to more than 104° F)

  • cough

  • runny nose (coryza)

  • red, watery eyes (conjunctivitis)

  • rash (3-5 days after symptoms begin)

If you or your child gets sick with a rash and fever, call your doctor. Be sure to tell your doctor that you traveled abroad, and whether you have received MMR vaccine.

Related page: Signs and Symptoms

Page last reviewed: May 1, 2019

Content source: National Center for Immunization and Respiratory DiseasesDivision of Viral Diseases

Dosage Chart

***Dosages are based on WEIGHT of child and may not correspond with age 

TYLENOL (Acetaminophen): to be given every 4‐6 hours as needed

ADVIL/MOTRIN (Ibuprofen): to be given every 6‐8 hours as needed **Not to be given under 6 months of age!

Dosage Chart 2019.png

Benadryl (Diphenhydramine): to be given every 6‐8 hrs ***To be used under 4 yrs of age for allergy purposes only. 

benadryl dosage

Food Allergies Can Be Avoided! How Parents Can Fight Back with Ready, Set, Food!

Food Allergies Can Be Avoided! How Parents Can Fight Back with Ready, Set, Food!

Food Allergies and Recent Breakthrough Research

Although parenting has always been a challenge, the increasing concern regarding food allergies and the potentially serious consequences they cause has resulted in significant distress recently amongst my parents. The fact that food allergies have tripled in recent years and that the majority of this increase has occurred in children with NO family history of allergic risk only augments their worries.

But, amid this not-so-good-news is some very great news! Recent clinical studies (LEAP, EAT, and PETIT) have shown that when children are introduced to allergenic foods early and often, the risk of developing food allergies can be lowered by up to 80%.

When the landmark studies were published and supported by recommendations from the American Academy of Pediatrics (AAP) and the National Institutes of Health (NIH), I too began instructing my parents to initiate early and sustained introduction of common allergenic foods to their children.  

Early Allergen Introduction Made Easy

What I have found in making this recommendation, however, is that parents struggle following early and sustained introduction because they are unable to prepare and have their children eat these common allergenic foods on a consistent basis. As a pediatrician and a parent myself, I understand this. The truth is, it’s challenging to both prepare and get children to eat anything several times a week. In the landmark studies, participants were exposed to allergenic foods 2-7 times/week for 3-6+ months.  

When I learned about Ready, Set, Food! from my colleague and board-certified allergist Katie Marks-Cogan, M.D., I immediately knew that it was a product that would help busy families address the challenge of sustained food allergen exposure. Since Ready, Set, Food! comes in a powder form that can be easily mixed with formula, breast milk, or other foods and targets the three most common food allergens (peanut, egg, and milk), it frees parents from the work (and hassle) of getting children to eat allergenic foods.

The Ready, Set, Food! simple numbered packet system makes it easy for parents to start early allergen introduction in the critical window of 4-6 months and continue for several months or until these foods become a regular component of their baby's diet. As a bonus, Ready, Set, Food! is formulated with only natural foods, and is organic, non-GMO and contains only peanut, egg, and milk. Parents will find that this product is safe and gentle on their baby’s tummies.

As an allergy sufferer myself, I understand the discomfort and interruption to daily living that allergies cause. That's why I recommend Ready, Set, Food! at every 4 month well child visit.

Learn more about how Ready, Set, Food! makes it easy to follow the guidelines to reduce your child’s risk of developing food allergies here.

Interested in receiving a free intro pack ($24 value)?  Claim this special offer for Pacific Ocean Pediatrics families and get your head-start towards an allergy-free future here.  


Robert C. Hamilton, M.D.


Dear Parents,

Happy summer 2016! Can you believe it's already this time of year?!

At Pacific Ocean Pediatrics, summer is our busiest time of year with yearly physical exams. All of our school-age patients make their annual appointments during these months, and we are filling out dozens of camp, pre-school, elementary and college forms per day. It's definitely better than flu season but still a bustling office!


Your school and camp will most likely require that your child(ren) is up-to-date on all of his/her immunizations and will request proof of current health and vaccines. 

In order for our office to complete a school/camp form for our patients, he/she must have had physical exam within the past 12 months. 

Please consider making your appointment 3-4 weeks ahead of the form due date as it necessitates time from our nursing staff to complete form, and our well-check up appointments fill up very quickly. 

We hope you enjoy a safe and adventure-filled summer!

Much love,

P.O.P. Staff

Give us a call at (310) 264-2100 to schedule an appointment and send over all forms to FAX: (310) 264-2108 or EMAIL:

Maternity Coverage for Dr. Chen


The lovely Dr. Chen will begin her maternity leave on Friday, March 31, 2017! We are thrilled that she’ll be adding another baby boy to her family!

She leaves big shoes to fill during her absence, and we are delighted to welcome Dr. Harvey Harris as a temporary Pediatrician to cover for Dr. Chen. Dr. Harris boasts an impressive pediatric work history. We trust he’ll take great care of our patients.

Dr. Harris completed his undergraduate program at UCLA and his medical schooling at Stanford. He then completed his internship at Jewish Hospital of St. Louis, his residency at University of Illinois Research and Educational Hospital, and his mini-fellowship at the University of North Carolina. He also served in the military as a First Lieutenant and Captain with the U.S. Air Force. He was with Buenaventura Medical Group until they were bought out by Kaiser in 2006. In the years following, Dr. Harris worked in both private and clinic practices in California and Army Medical Centers in North Carolina and Washington state. He has been married to his wonderful wife Jessica for 57 years and has two children and six grandchildren.

Dr. Harris will be with us May 2, 2017 - July 28, 2017. 

Traveling Internationally Soon? Check Out the CDC's Recommendations

Check the CDC's website for recommended vaccines for international travel.

We can do all your routine vaccines at our office, and we even do Typhoid (not always covered by insurance). If you need Yellow Fever, we refer out to Travel Medicine doctors. 

Nava Yeganeh, MD (UCLA)

1131 Wilshire Blvd Ste 202, Santa Monica


Westside Travel Medicine and Immunizations (Robert Winters, MD)

2001 Santa Monica Blvd Ste 665W, Santa Monica


Terri Rock, MD

2021 Santa Monica Blvd Ste 335-E



New Parent Checklist & New Parent Tips


Congratulations on your new baby! There are many items to check off your lists these days, but we want to make sure these important items do not get forgotten!

  • Confirm that we are in-network with your insurance. We accept Anthem BlueCross PPO (see below for specifics)*, Aetna PPO, BlueShield PPO, Cigna PPO, HealthNet PPO and UnitedHealth Care PPO. Use our tax ID # to confirm: 95-4598042 or email us a photo of your insurance, and we’ll run an eligibility check.
  • At time of delivery, please inform the hospital of your preferred physician. Our office will receive a call when your baby is born, and one of our physicians will visit you within 24 hours of your child’s birth. (Please note that our doctors only see newborns at hospitals where they have privileges: Providence St. Johns SM, UCLA SM or Cedar Sinai. If you deliver at another hospital, you'll be seen by an in-house pediatrician and will be instructed to book an appointment with our office 2-3 days after hospital discharge.) No prior registration is necessary! All new patient paperwork can be completed at first office visit.
  • Please add your new baby to your insurance policy. If this is not completed within 30 days from baby’s birth, your insurance will not be eligible and will not retroactively pay for office visits. Insurance ineligibility is a bummer! If you are working through a HR contact, be sure to follow-up and confirm that your baby is added to the policy.
  • At your first visit (typically within 2-3 days after hospital discharge), please be prepared to schedule your 2, 4, 6 and 8 week visits to reserve preferential dates, times and physician.
  • Don’t forget to get Tdap and flu vaccines for your baby’s caretakers and close family.
  • Program (310)-264-2100, (310)-264-2101, (310)-264-2102, (310)-264-2103, (310)-264-2104, (310)-264-2105 and into your phone so you know it’s us when we call or email. Please note that after-hours and weekend calls from doctors will at times come from blocked numbers.

*We only accept the following from Anthem BlueCross: Employer provided - Advantage, BlueCard, BlueCross/ BlueShield, Google EPOs, and Prudent Buyer plans. We are not contracted with Anthem BlueCross Select PPO, Pathway PPO or Tiered PPO plans.


  1. Reference our Immunization Schedule to know when baby’s next appointment should be scheduled. Please schedule appointments based on child(ren)’s birth date (except for first 5 visits. These are based on weeks)

  2. If your baby is 0-3 months, give us a call for any fever with a rectal temperature 100.4 ̇.

  3. Mild reactions to vaccines are normal - low fever (under 102 ̇), irritability, swelling and redness, however,

    please give us a call if you feel the reaction is out of range of normal. Reference your handy vaccine pamphlet

    for more info!

  4. We strongly recommend that you utilize your yellow immunization card. It is a legal document and should be

    kept up-to-date.

  5. Bring insurance card to every visit.

  6. At times the parking lot can be full. There is parking available next door at bank parking lot or metered

    parking on Broadway Avenue. Please give us a call if you’re running behind.

  7. Keep us up-to-date on all demographic changes, ie, cell numbers, addresses, insurance changes.

  8. We are here for you 24/7! 310-264-2100. If you call our number in the evening, at lunch or over the weekend, press 0 to leave a general message or for an urgent matter press 4 to contact the doctor directly. 

Newborn: Going Home After Hospital

When is our first visit to Pacific Ocean Pediatrics? How often are his/her checkups?

Your first visit to our office should be within 1-2 days following your discharge from the hospital. The purpose of that visit is to check the baby’s weight and to make sure that the baby is not significantly jaundiced, as well as to answer any questions you may have. Following that, your baby’s next well child exam will be when he or she is 2 weeks old, to make sure he or she has regained his birthweight.

Is it okay for family members to visit?

Absolutely! We encourage it! It is important to realize however, that the newborn immune system is very fragile, and every baby that develops a fever in the first month of life is admitted to the hospital and placed on IV antibiotics. We tell you this so that you might have a healthy sense of caution with all visitors, including family. Everyone should wash their hands before touching the baby and sick family members should not come to visit the baby in the first few months of life.

Is it okay to go outside with our newborn? Are there any places we should avoid?

Yes, it’s okay to go outside with your newborn. The places you should avoid are places in which there is a lot of direct sunlight, places in which the baby might get overheated, and places where there are closed confined spaces with circulating air (i.e. an airplane).

When is it okay to travel with a newborn?

We recommend no air travel in the first 2 months of life, as there is too big of a risk of the infant developing an infection from the close quarters with strangers.

What are important things to have on hand at home?

A rear facing car seat, a thermometer, a breast pump, a bulb suction, a swaddling blanket, burp clothes, a pacifier, and of course plenty of diapers!

How can I make the transition of a new baby as easy as possible for my older child?

Older siblings can sometimes have a hard time welcoming in a new baby into the family. It is normal for an older sibling to experience some developmental regression and become transiently more clingy to mom and dad. When making your first introduction to the baby, it is recommended that the baby be in his or her crib and not in the arms of either parent. Similarly, when guests and visitors come to the hospital and the home, they should first go to the older sibling before making a fuss over the baby. Any gifts brought for the baby should be presented to the older child as a “tool to help them be a big brother/sister.” There are also several good books available that you can get to ease your child’s transition to becoming a big sibling. Of note, your older child should get in the habit of washing hands EVERY time before touching the baby and should never be left alone with the baby.

What recommendations do you have for pet dogs and cats?

Pet dogs and cats are fine, but they should never be left alone with the baby. It may be a good idea to bring your pet some of the new baby’s blankets from the hospital to get him or her used to the baby’s scent.

What position should the car seat be in on the journey home?

Always place your baby in a car seat, rear-facing, in the back seat. For more information on car seats or to find a car seat inspection o ce in your area, go to the National Highway Tra c Safety Administration website:

What other safety issues I should be concerned about?

• Never jiggle or shake your baby. Consider taking an infant CPR class.
• Set water heater to 120 F. Don’t drink hot liquids or cook over a stove while holding baby.
• Ensure smoke and CO detectors are working.
• Never leave your baby unattended in the car, in the bath or on elevated surfaces. 

Newborn Emergencies

When should I call a doctor?

We never want you to be worried at home, so if any issue is causing you concern, there is always a doctor on call for you. Specific instances in which we would like you to call would be: any temperature over 100.4 degrees Fahrenheit, increased lethargy, the baby is not arousable, less than 2 wet diapers in 24 hrs, projectile vomiting, or poor feeding. Non-urgent issues can be addressed at your well child visits or you can schedule another appointment to talk about these issues.

What is the best way to take my baby’s temperature? How often should I do it?

The most accurate way to take a baby’s temperature is rectally. The silver tip should just disappear out of sight in the rectum and then the thermometer should be held in place for about a minute. It is best to put a little Vaseline or lubricant jelly on the tip of the thermometer to ease it into the rectum. You only need to take the baby’s temperature if he or she feels warm to the touch or is not acting like himself. The temperature does not need to be taken every day. If your baby is less than one month old and has a temperature of 100.4 or greater, he or she needs to be seen by a doctor immediately.

I think my baby is congested. Do I need to give her medication?

Babies often sneeze or sound congested. It is not because they have a cold, but rather because their nasal passages are so small that there is very turbulent airflow through the nose. If the congestion is mild, intermittent, and not interfering with feedings and your baby seems comfortable,you do not need to do anything at all. For more bothersome symptoms, you can try using over the counter nasal saline drops (1 or 2 drops to each side of the nose every 4-6 hours as needed) and/or a bulb suction. If your baby has significant congestion, nasal drainage, fever or a persistent cough, you should discuss your concerns with your doctor.

My baby has a rash that looks like flea bites all over her body.

There are many newborn rashes and most of them are completely benign and will resolve on their own. If there is any rash that you notice at night, point it out to the doctor when we come for our morning rounds. The most common rash, described above as looking like “flea bites” is known as erythema toxicum neonatorum and is not an infection, is not harmful, and resolves spontaneously at about 7-10 days of age. 


Is circumcision medically indicated?

There was a time when circumcision was thought to protect against urinary tract infections and sexually transmitted disease. The most recent literature suggests that within a first world country like the United States, there is no significant protection against either, and therefore no medical indication for the procedure. This being said, circumcision is an important cultural and religious event for many families and we absolutely support our parents that choose this option for their child.

Who performs the circumcision?

The circumcision can either be performed by your obstetrician or by your pediatrician. In our o ce, Dr. Hamilton frequently performs circumcisions, both in our o ce and in the hospital.

How do we care for the circumcision in the days after the procedure?

Vaseline, Vaseline, Vaseline. The important part of post-circumcision care is not allowing the newly exposed glans of the penis to rub up against the rough diaper without some protection. We recommend putting Vaseline on the circumcision site for every diaper change for 5 days.

We want our baby do have a bris. Is there anything special we should know?

Many of our patients have had beautiful circumcisions performed by their moyle at their celebratory bris ceremony. We would simply recommend that you set up an appointment with our o ce in the week following the bris for us to examine the surgical site. 

Newborn Pooping/Peeing

When should my baby pee/poop for the first time?

More than 95% of babies pee and poop for the first time in the first 24 hours of life.

What is meconium? When can we expect it to change to “normal” newborn poop?

Meconium is the first newborn stool and it looks like a sticky black tar. Over the first couple of days, you can anticipate that it will transition first to a greenish brown transitional stool and then to a yellow, seedy, mustardy color, the stool of a breastfed baby.

How often do newborns normally make urine in a day?

Once your milk comes in, the baby should be making between six to eight wet diapers per day. (For the first couple of days of life, babies typically produce much less than 6, but should still be voiding at least once per 24 hour period). Once the milk has been established, it would be concerning if the baby were not able to produce at least 2 wet diapers in a 24 hour period. If this were to happen, it would be a reason to call our o ce.

How often do newborns normally poop in a day?

The number of times a baby poops in a day is extremely variable. Seven times a day and once every seven days can both be normal, as long as the stool is soft and has no blood in it.

My baby has had a few diapers of pink urine. Is this dangerous?

These are called urate crystals, and are a normal finding in newborn urine in the first couple of days of life. If they were to persist beyond the first couple of weeks of life, the baby’s urine may need to be tested for an underlying problem. 


What is jaundice? Is it dangerous?

Jaundice refers to a yellow discoloration of the skin and of the whites of the eyes. It is normal in newborns after the first day of life and is related to elevated levels of a substance known as bilirubin, which the newborn liver is unable to process into a form that the body would ordinarily excrete in the urine. Jaundice can be dangerous if the bilirubin levels become significantly elevated without treatment. In the United States, we rarely see any complications from jaundice because we treat it so conservatively. We will be monitoring your baby for jaundice both during your hospital stay and at your first visit to our o ce. If your baby looks significantly jaundiced, we may order a blood test to determine how high the bilirubin really is.

What conditions would make it more likely for my baby to develop jaundice?

Babies are more likely to be jaundiced if their blood type is a di erent type than their mothers, if they are not feeding well, if they are premature, and if there is a family history of a previous sibling with high levels of jaundice.

Are there treatments for jaundice?

Jaundice is easily treated in the hospital. Sometimes all they need is a little supplementation with formula, as one of the ways they can get rid of bilirubin faster is through stooling, and the more they eat, the more they stool. If the bilirubin level is high enough, babies are placed under blue lights (“bili” lights) at a special ultraviolet frequency that processes the bilirubin through the skin in the same way that the mature liver would do it in the body, enabling the baby to excrete it in the urine. 

Newborn Hygiene

How often do I bathe my baby?

Newborns do not get very dirty, and do not need baths every day. The frequency is often based on personal preference but is usually every 2-3 days.

What is the proper way to bathe a newborn?

Until your baby’s umbilical cord falls o (usually in the first 2 weeks of life), it is important that the umbilical stump not be submerged in water. This means that you should give your baby sponge baths only, until 1 day after the stump falls off.

How do I clean the umbilical cord?

Until your baby’s umbilical cord falls off (usually in the first 2 weeks of life), you should give your baby sponge baths only. When the cord starts to dry and detach, you may notice some dried blood or mucus; this is normal. There is nothing special you need to do to clean your baby’s umbilical cord, although it is fine to use a cotton swab with some water or alcohol to clean off the mucus as the cord is detaching. Let us know if there is any redness, discharge or foul odor around the umbilical stump site as it could be a signal of infection. After the umbilical cord falls off, you may bathe your baby in a small tub.

When/how do I cut his/her fingernails?

Newborn nails are soft and pliable but can cause scratches on sensitive skin. If your child was born with long nails and they are causing scratching of the skin, they can be cut right away with a baby nail clipper. Don’t expect the nail to “snap” like an adult nail- the cartilage is simply much too soft. Another alternative is putting “mittens” on their hands until you feel comfortable cutting them.

How should I clean the diaper area?

Your baby’s skin is delicate. Use a dabbing motion when cleaning the diaper area. For girls, wipe front to back. The best way to clean the diaper area during a diaper change is with warm water and soft paper towels or cotton balls. If you want to use wipes, wait until at least 2 weeks of age. Invert the container between use so the top wipes are moist and less rough. If you see redness in the diaper area, stop using wipes and switch back to water. Always let the diaper area air dry for a few minutes before putting on a new diaper. When the skin is dry, you can use Vaseline or a barrier cream (such as Aquaphor, A&D, Desitin, or Butt Paste) to prevent rashes from developing. Barrier creams prevent babies’ skin from contacting their stool, which can lead to skin breakdown and yeast infections.

Should I try to retract my infant’s foreskin if we do not circumcise?

One should never force the foreskin back. The foreskin covers the tip of the penis and is not retractable at birth. With time the foreskin will become more and more retractable and is typically completely retractable around 5-7 years of age but may take even longer. Forcibly pulling on the foreskin can cause pain and damage to the area.

Newborn Sleeping

How many hours a day should my newborn be sleeping?

Newborns sleep for the vast majority of the day, usually in the range of 18 to 20 hours a day.

What is the proper position for a newborn to sleep in? Are sleep positioners necessary?

The proper position for a newborn to sleep is on his or her back. Although during your hospitalization, some nurses may place the baby on his or her side, this is not recommended when you bring the baby home. Placing a baby on his or her back for sleep is one of the few methods you have to protect your baby against Sudden Infant Death Syndrome, or “crib-death.” Since the American Academy of Pediatrics instituted the “Back to Sleep” campaign, the incidence of SIDS has dramatically decreased. Recently the AAP issued a warning about sleep positioners as they have been found to place babies at higher risk of su ocation. Therefore, we recommend against the use of them.

How do I reduce the risk of Sudden Infant Death Syndrome?

Sudden Infant Death Syndrome (also known as SIDS or crib-death) is a rare syndrome that causes unexplained death in an otherwise healthy child in the first year of life. The most reliable method to protect your baby against SIDS is placing the baby to sleep on his or her back, as above. Other ways to protect an infant against SIDS include: eliminating any second hand smoke, avoiding over bundling and overly heated bedrooms, and removing extra blankets and stu ed animals from the crib or bassinet. Some research has shown that having a fan in the room has also can decrease the incidence of SIDS.

Do you recommend swaddling?

Swaddling can be a great way to comfort a crying child, and many of our patients respond very well to it. That being said, there are some babies who do not like being swaddled and even in the newborn period will find a way to kick themselves out of the tight wrapped blanket.
Is it okay for our family to co-sleep in the same bed?

The American Academy of Pediatrics recommends no co-sleeping with parents because of the increased incidence of Sudden Infant Death Syndrome. That being said, many cultures and other countries embrace co-sleeping as an important part of family life. It is important for you to analyze the risks and the benefits of co-sleeping before you make your decision. If you decide to co- sleep, it is very important to ensure that there are not excess blankets that could cover the baby’s face.

When is it okay to let my baby cry?

There is no right answer to this question. In the newborn period, you are getting to know your child and his or her needs. Crying can mean many di erent things: hunger, an uncomfortably wet diaper, a desire to be held, or simple irritability. In these first few weeks, it is best to assume that your baby is trying to tell you something and only “let the baby cry” if all of the above possible causes of distress have been ruled out. If you feel like your baby is in pain or discomfort, it is best to call your physician to rule out any other reasons your baby may be crying. 

Newborn Feeding/Weight Gain

How often should I breastfeed?

The frequency of breastfeeding is di erent for every newborn and your baby will determine his/her own feeding schedule. Most newborns end up feeding about every 2-3 hours (and it can be more frequent than that!). In the first two weeks of life, the baby should not go any more than 4 hours without feeding (at least until the baby regains his or her birthweight), and should feed at least 8-12 times in 24 hours. If your baby is sleepy, you may have to undress him or her, tickle the feet or rub the back to wake him or her for feeds. With time, you will find that your baby will fall into his or her own schedule during the day and night. Babies may have periods in the day when they cluster their feeds, feeding every hour, and this is normal.

How long will it take for my milk to come in? Is there anything I can do to make my milk come in faster?

Mature human breastmilk usually comes in about 72 hours after delivery. The breasts swell and become engorged with milk. With second and third pregnancies, milk can come in slightly earlier. Until the mature milk comes in, mothers produce an early milk called “colostrum” which provides for all of the baby’s nutritional needs. The best thing for you to do to “help” the mature milk come in is to allow your baby to suckle on the breast. The sensation of suckling at the breast produces release of a hormone in the brain which tells the glands in the breast to initiate milk production. Although there are a number of other remedies, such as Fenugreek and Mother’s Milk Tea, these are typically used to stimulate breastmilk production once the milk has already come in, not to hasten its arrival.

Is it okay to supplement with formula or sugar water until my milk comes in? What do you recommend?

It is not necessary to supplement with formula or sugar water from a nutritional standpoint. However, some parents find that their babies are more fussy and irritable until the mature milk comes in and are soothed by a few ounces of formula to “tide them over.” We would recommend not introducing formula until breastfeeding has become well established, but we support parents who decide to supplement while in the hospital. We would recommend that if the baby is going to be receiving significant amounts of supplementation (more than 2 ounces per day), that this should be formula and not sugar water. It is also important to remember to always put the baby to the breast first in order to stimulate milk production before supplementing with formula. If you give your baby formula, always follow package directions when preparing it. You do not need to boil water before preparing formula.

My baby has lost 10 ounces since he/she was born. Is this okay?

Babies normally lose up to 10 percent of their birth weight in the first week of life and regain it in the second. We will be monitoring the baby’s weight both in the hospital and in our o ce. Our goal is for your baby to have regained his/ her birth weight by the 2 week o ce visit.

How much spit up is normal?

Many babies spit up when they feed, and it is usually normal. If your baby spits up often, keep his or her head raised for at least 30 minutes after feeding. Spitting up small amounts is harmless as long as your baby is gaining weight and is not in pain. Spitting up usually ends by age six to nine months. If the spit up becomes projectile and is associated with every feed, that would be abnormal and might require some tests to work up the problem. Other symptoms that may indicate that your baby has reflux are: irritability after feeding and arching of the back. Make sure you are burping with each feed as this will help to expel some of the air the baby may have swallowed. After feeds, gently burp the baby by holding the baby on your chest, upright and gently patting or stroking the back. Do this for 2 to 5 minutes. Your baby may not burp after every feeding.

Who should I contact if I am having a difficult time with breastfeeding?

During your hospital stay, you should take advantage of the nurses and the lactation consultants provided by the hospital. Once you are home, you are always free to bring breastfeeding questions to our o ce, but for issues that require more time and expertise, we wholeheartedly recommend the lactation consultants at the Pump Station. Our patients with difficult breastfeeding issues have had an incredible response to the assistance given by their consultants and the various services provided by the Pump Station: We also have names of lactation consultants that make house calls. Please call our o ce for more information.

What are the advantages to breastfeeding over formula feeding?

Breastfeeding has many distinct advantages over formula feeding for the baby, including but not limited to enhanced immune system, decreased incidence of food allergies and eczema, lower obesity rates, and fewer ear infections. The American Academy of Pediatrics recommends breastfeeding for the first year of life. This being said, we understand that breastfeeding is not the best decision for every family and we support parents that decide to opt for formula instead.

Are there any contraindications to breastfeeding?

There are very few contraindications to breastfeeding. If you are taking a medication, please let us know before breastfeeding, so that we can verify that is safe for lactation. Of note, Tylenol and Advil (which is not recommended during pregnancy) are both safe medications to take while breastfeeding. Real contraindications to breastfeeding include: active herpes lesions on the breast, mother positive for HIV, and certain antibiotics.

Are there any foods that I need to avoid while breastfeeding?

A breastfeeding mother has a great deal more freedom than a pregnant woman. Many of the foods that are o -limits in pregnancy are okay while breastfeeding, if eaten in moderation: alcohol, ca eine, and mercury-containing fish included. If a large amount is consumed, it may be wise to “pump and dump” the expressed breast milk from when the next feed is due, and give the baby some stored breastmilk for that particular feed. A breastfeeding woman should focus on eating a well balanced diet, drinking lots of fluids, and remaining on her prenatal vitamins. We are currently recommending that breastfeeding mothers take a DHA/ARA containing fatty acid supplement, which has shown thus far to have a positive benefit on neurologic development.

If I decide not to breastfeed, what formula is best?

Choosing a formula can be overwhelming for a new mom as there are literally hundreds to choose from. Most babies will do just fine with the basic, modified cow’s milk formulas: Enfamil, Similac, or Good Start. The AAP recommends that any formula you use be iron-fortified. If your baby develops symptoms of a dairy protein allergy, your pediatrician may recommend a hypoallergenic formula such as Nutramigen or Alimentum. These formulas should also be given to newborns when there is a family history of significant allergies in the parents or siblings. Some babies may show signs of gassiness, and it may be recommended to try a sensitive formula, such as Similac Sensitive, Enfamil Gentlease, or Good Start Soothe. Again, it is best to speak with your pediatrician prior to switching formulas as they can help guide you in your decision. 

Newborn Hospital Protocol

How long can we expect to stay in the hospital?

The typical hospital stay is the same at St. John’s, Santa Monica/UCLA and Cedars-Sinai Medical Centers. After a vaginal delivery, new mothers stay in the hospital for 2 days after delivering their baby. Following a cesarean delivery, a 4 day hospital stay is recommended by obstetricians.

How often will we see a pediatrician while in the hospital?

Your baby’s first exam will take place within 24 hours after you deliver, usually between the hours of 6am and 9am. The first exam is a thorough exam in which the doctor will examine the baby’s eyes, heart, lungs, extremities, and reflexes. For the remainder of your hospital stay, the pediatrician will visit daily (typically in the mornings before o ce hours) and monitor the baby’s feeding, weight loss, and physical exam. If you have any questions for the doctor, please write them down and we would be happy to answer them when we stop by.

What is the reason for the Vitamin K shot after birth?

Some babies are born with low levels of vitamin K, which is a very important factor for blood clotting. Babies who are born with low levels of vitamin K can develop what is known as “hemorrhagic disease of the newborn,” a dangerous life-threatening condition in which babies have uncontrollable bleeding. A single shot of Vitamin K prevents this disease, and is given to all babies born in the United States. Oral vitamin K is not a viable alternative, because it takes too long to reach sufficient levels in the baby’s body to protect them against the disease.

Why is the erythromycin ointment applied to my baby’s eyes?

Erythromycin is an antibiotic ointment that is applied to the eyes of all newborns to prevent chlamydia and gonorrheal eye infections. Although the vast majority of women are screened for these diseases during their pregnancies, these sexually transmitted diseases have a tendency to be “silent” and women can carry them without knowing it. For this reason, all babies are treated and protected in the United States, especially because the consequences of leaving these eye infections untreated are so terrible: blindness and permanent visual damage.

What is the newborn screen and what diseases does it test for? When do we get the results?

The newborn screen is a mandatory blood test that is performed on every baby in the United States prior to discharge from the hospital. It screens for a number of di erent genetic (inheritable) diseases which require early intervention, including: phenylketonuria, sickle cell anemia, hypothyroidism, and a group of rare disorders that are known as “inborn errors of metabolism.” The results will be mailed to our o ce and we should have them by your baby’s 2 week well child visit. If you are following up with a di erent o ce, be sure to have them call us so we can fax over the results to your pediatrician.

Will my baby get a hearing screen?

Every baby gets a hearing screen before leaving the hospital. Both ears will be tested and the results will either be “pass” or “referred.” If the results show the baby is “referred” in one or both ears, it does not mean that your baby has a hearing deficit. The test performed in the hospital is a screening test and will pick up some “false positives,” babies with normal hearing that falsely test positive for a hearing deficit. If your baby is referred, we will refer you for a more accurate hearing test after your first visit to our o ce.