Introducing Your Baby to Solid Foods

STARTING SOLIDS

Introducing foods to your baby is exciting but also can be overwhelming, but it doesn’t have to

be! While there are not a lot of rules for feeding babies, there are some guidelines that are

important, particularly in helping your child avoid food allergies, learn the necessary fine motor

skills to eat and drink as well as maintaining optimal nutrition.

When should you start?

Babies should be exclusively breastfed or formula fed until 4-6 months of age and most babies

are not ready to eat until closer to 6 months of age.

They are ready to start solid foods when they can:

● Maintain truncal support and sit up in the high chair

● Extinction of the extrusion reflex (the tongue pushing out anything that is put in the mouth)

● Interest in food

How to start solids?

There are three basic approaches to feeding babies: spoon-feeding, baby-led weaning or a

combination of both. Babies are fed differently all over the world and there is not a “right”

way. Either method, the goal would be to have your baby self feeding finger foods by 9

months.

● Spoon-feeding: this is the traditional method in which you start with pureed foods that

you give on a spoon. This is typically done for a few months and then finger foods are

offered around 8-9 months.

● Baby-led weaning: skipping pureed foods and going straight to letting babies feed

themselves with finger food.

While either method is okay, below are a few recommendations:

● Start with once a day feeds for the first few weeks as it lets their gastrointestinal

system get adjusted and helps avoid constipation. Then you can slowly increase to a

goal of 3 meals per day by 8-9 months.

● Start with a “whole” food. Historically, it was recommended to start with rice cereal.

This is no longer recommended as there is minimal nutritional value and can start with

any food such as avocado.

● It is important to remember that initially this is just practice and babies do not need this

nutrition and it is a time to explore new flavors and textures and to learn new fine

motor skills. With time, you can increase volume and textures.

● Do not give up if your baby seems to not like certain food. It can take 10-15 tries of a

food to develop a taste for it.

● Try new foods in the mornings so you can observe if your baby shows any signs of

allergic reaction.

● When starting finger foods, start with small bites of soft mashed foods like avocado,

banana, baked sweet potato or scrambled eggs. Food should be easily mashed with

fingers or a fork.

● We do recommend that all parents take a CPR class prior to starting solids.

● Never leave your child alone while eating solids.

What about water and how to give?

When you start food, you start water. Just like with solids, initially babies do not need a lot of

water and this is for exposure, but we recommend offering with all meals

● Offer water in something other than a bottle, such as a sippy cup, open cup or straw

cup. This is another opportunity to practice a new fine motor skill. We love the Ezpz

tiny cup!

What about allergic foods?

Food allergies are fairly common with approximately 10% of children having food allergies.

The good news is that there are some landmark clinical trials that early and sustained allergen

introduction helps to prevent allergies, particularly by 6 months. Children with eczema and a

family history of food allergies have a higher risk of developing food allergies, so it is

particularly important for these children to be introduced to food allergens early and often. If

there are risk factors, speak to your pediatrician before introducing solids.

The top three food allergens that make up 85% of allergies are:

● Dairy, peanuts and eggs.

● The top nine also include: tree nuts, sesame, wheat, soy, fish and shellfish.

So how do you introduce allergens?

If your baby is ready to eat, you can give the allergens directly. For example, you can mix a

small amount of peanut butter into oatmeal. There are other ways to introduce the allergens,

such as Ready Set Food. RSF is a supplement that is added to either a bottle or pureed food and it slowly introduces peanut, dairy and eggs. This is a safe way to introduce allergens

particularly if babies are at higher risk and not quite ready to eat solids.

While not necessary for non-allergic foods, it is important to:

● Give the allergic food three days in a row before introducing another allergen, if no

reaction, it is important to keep it in their diet regularly for the next 4-6 months.

Allergists recommend offering three times per week.

● Monitor for allergic reactions. Typical signs of an allergic reaction include hives, rash, swelling around the lips or vomiting. If there is any concern, then you should stop the food immediately and contact a physician. If you are concerned about difficulty

breathing or severe lethargy then call 911 for immediate help.

● It is a good idea to have liquid Benadryl on hand in case of a mild reaction. There is a

dosing chart on our website.

Other foods to introduce:

● Iron-rich foods: A baby has iron reserves from pregnancy until about 4-6 months of

age. After that age, breast fed babies need to eat foods rich in iron to prevent

iron-deficiency anemia. Formula has some iron, but babies still need more in their diet.

○ Iron supplementation may be recommended for some babies.

○ Iron rich foods include: Beans, meats, leafy greens, iron-fortified grains and

peas.

○ Cooking food in a cast-iron skillet can also increase the iron content of foods.

● Healthy fats: healthy fats are important as their brains continue to develop.

○ Healthy fats include: avocado, nut butters, salmon and whole-fat dairy products.

Foods to avoid:

● Until ONE year:

○ Honey: there is a risk of botulism with ingested honey

○ Whole milk: while it is okay to give dairy, such as cheese and yogurt, it is not

recommended to replace breast milk or formula with milk until then. Milk is

hard to digest and can increase risk of iron-deficiency anemia and does not have

all the nutrients that breast milk and formula have.

○ Sugars and processed foods are to be avoided as much as possible to ensure optimal nutrition.

● Choking hazards:

○ Avoid raw vegetables, nuts, seeds, popcorn, whole grapes (or other round

foods) hotdogs. These are all choking hazards. These foods can all be given, but need to be modified (i.e. grapes cut lengthwise).

Resources:

Baby led weaning:

https://solidstarts.com/

https://www.drorganicmommy.com/

https://www.yummytoddlerfood.com/first-foods-for-baby/

Instagram: Dawn Winkelmann, M.S.,SLP @msdawnslp

General feeding:

http://Healthychildren.org/

https://www.ellynsatterinstitute.org/

Allergy info:

https://readysetfood.com/

CPR info:

The Pump Station: www.pumpstation.com

2020-2025 USDA Dietary Guidelines for Americans: What Families Need To Know

2020-2025 USDA Dietary Guidelines for Americans: What Families Need To Know

The new USDA Dietary Guidelines Report for 2020-2025 was recently released, providing evidence-based nutrition guidelines that help shape and promote the food choices made by millions of Americans every day. What’s really important for families is now  the first time ever, the guidelines are being given for pregnant women and infants 0-24 months of age. Given the importance of diet and nutrition in this age range, it’s exciting that there are specific recommendations dedicated to this group of Americans. After reviewing the report for the new 2020-2025 Dietary Guidelines for Americans (DGA), there are 3 key recommendations that are important for families to take into consideration:

1. No Added Sugar for Children Under 2: As part of the new guidelines for babies and toddlers, the 2020-2025 DGA is recommending no added sugar for infants and children under the age of 2. This helps to address the obesity epidemic that now affects nearly 5 million American children. In fact, the USDA reported that a majority of infants just in the 6-12 month age range had already consumed some amount of added sugars.

2. Diet Diversity Before the Age of 2: Feeding children a diverse diet in the first years of life can help positively influence their tastes and habits later in life. The guidelines recommend : “introduce children to a wide variety of healthy foods that are important in shaping healthy dietary patterns.”

3. Feed Egg and Peanut to Every Baby to Help Prevent Food Allergies: The new guidelines also recommend feeding babies peanut and egg starting at 4 months of age to prevent severe food allergies. This change was supported by clinical trials, showing that early introduction of allergenic foods is safe and can help significantly reduce a baby’s risk of developing food allergies. This important recommendation applies to all babies and risk groups, underlining the importance of early prevention to help prevent more than 200,000 food allergies annually. 

While it’s exciting that parents can follow recommendations to prevent up to 80% of food allergies, many parents have questions about how to introduce allergenic foods at home. Dr. Hamilton answers your commonly asked questions about early allergen introduction and Ready, Set, Food!, the only early introduction system that aligns with the new USDA guidelines to help prevent up to 80% of food allergies. 

Food Allergy Prevention Q&A with Dr. Robert Hamilton

When should I introduce allergenic foods to my baby?

The typical recommendation by the American Academy of Pediatrics is to begin food at about 6 months of age. I normally begin with foods like cereals, fruits, and vegetables, and then I finally get to the allergenic proteins such as milk, peanut, and egg at about 9 months of age. However, the new guidelines on food allergy prevention including the new USDA guidelines recommend introducing allergenic foods starting at 4 months of age. The good news is with a product like Ready, Set, Food! you can actually begin to introduce the proteins of eggs, peanuts, and milk much earlier on and I typically begin to do that at about 4 months of age with their all-natural and evidence-based bottle introduction system. 

Isn't it recommended to wait until 6 months to start solids?  

Studies show and the new USDA Guidelines recommend that earlier introduction of allergens at about 4 months of age (which by the way is totally safe to do) actually benefits the child more than delaying. I am now recommending Ready, Set, Food! to children as early as 4 months of age and they are tolerating it beautifully. For the new USDA Guidelines: https://readysetfood.com/blogs/community/new-usda-dietary-guidelines-introduce-peanut-and-egg-in-first-year-of-life-1

How long do I need to continue exposure to allergenic foods?

It should be an ongoing maintenance. Studies show that early introduction of course is good, but the real key is maintaining that stimulation or exposure over time. I typically tell parents to keep going until the child is able to eat the food itself, for example peanuts or peanut butter, regularly. 

Why do you recommend Ready, Set, Food!?

When I first became aware of the Ready, Set, Food! product, I became a big fan simply because there's nothing more problematic than to have a two or three year old child that has significant allergies, and especially to peanuts, eggs, and milk, which are the three most common childhood allergens. The ability to introduce these allergens at 4 months of age, maintain that for a relatively short period of time, and by doing that obviate 80% of food allergies - that is compelling. I now recommend starting children on Ready, Set, Food! as early as 4 months of age and I think this is going to make a real difference. I think this is a real game changer in the pediatric world. 

Updates from your team at Pacific Ocean Pediatrics

Updates from your team at POP

Dear patients and families,

We know this is a difficult and stressful time with a lot of changes happening day to day. We want to give you a few updates about what your team at POP is doing and recommending:

1. We have been allocated a VERY limited supply of COVID-19 tests at this time, so unfortunately we are not able to provide testing to every patient we would like to test. If your child has had direct contact with someone who has tested positive or your child has traveled internationally within the last 14 days AND is having symptoms of being sick, or is having difficulty breathing, please call our office to discuss. The turnaround time for this test is 3-4 days, so please self-quarantine the patient and household contacts during that time. 

2. For patients who have respiratory symptoms but who do not meet the above criteria, we are unable to provide testing for COVID-19 at this time. The allocation of testing is changing day to day, so we will update you once we are able to provide more tests (or direct you to where you can be tested). 

3. For patients who are currently healthy, we recommend social distancing and hand hygiene. Even though the evidence remains that children seem to have generally mild illness with COVID-19, it will take the efforts of our community to mitigate the severity of this outbreak. 

4. We may be contacting you to reschedule or postpone some well visit appointments as we make arrangements to keep our healthy patients separated from those who may be sick. We appreciate your patience with this. 

5. If you are struggling to find infant formula to feed your child, please let our office know, as we may be able to provide some samples to help you until you can locate some in stores. 

6. As always, our doctors are available on call for any urgent questions or concerns. As you can imagine, the phone lines are quite busy at this time, and we appreciate your patience as we try to respond to all of our patients’ needs. 

Sincerely,

Pacific Ocean Pediatrics

Pacific Ocean Pediatrics’ response to the Coronavirus (COVID-2019) Outbreak

Pacific Ocean Pediatrics’ response to the Coronavirus (COVID-2019) Outbreak:

The coronavirus epidemic, which is rapidly spreading around the globe, is the topic of conversation of many.  Below are some facts about coronavirus and our thoughts about what should be done and what we at Pacific Ocean Pediatrics are going to do to minimize the spread of this organism.

Historically, coronavirus is an organism that has been associated with the common cold, croup, asthma attacks and bronchiolitis.  Its name is derived from characteristic petal-shaped projections that give the virus a crown (or corona) appearance.

More recently, a handful of “novel” coronaviruses have mutated into more virulent organisms that have cause three significant epidemics: SARS (severe acute respiratory syndrome), MERS (Middle East respiratory syndrome) and now COVID-2019, which is the virus of current concern.

The current epidemic of COVID-2019 began circulating in Wuhan, China in December.  The molecular structure of the COVID-2019 is similar to two known bat coronaviruses and it is likely that this typically, non-human virus has jumped species into humans.

Transmission:

Like influenza, person-to-person transmission occurs through micro-droplets that are created when an infected person sneezes or coughs.  The virus can also be transmitted through fomites (like toys or furniture) when a micro-droplet lands on them and is then unknowingly picked up.  Transmission has been proven between individuals who are asymptomatic, but are found to be COVID-2019 positive.

Incubation Period:

The incubation period (the time between exposure of the virus and the beginning of symptoms) is thought to be up to 14 days, with an average of 5 days.  Family clusters of the disease have shown symptoms occurring between 3 and 6 days after exposure. 

Non-specific Symptoms:

Unfortunately for clinicians, symptoms of COVID-2019 are relatively non-specific and include fever, congestion, cough, runny nose and shortness of breath. Pneumonia is the most severe disease process associated with the infection and is the cause of the majority of deaths that COVID-2019 has caused, but studies from China have shown that most individuals infected with COVID-2019 have mild to moderate disease.

Children are generally handling COVID-2019 infection well:

Thus far into the epidemic, the majority of people who have died from COVID-2019 are elderly individuals, particularly men, who have underlying medical conditions.  Generally, COVID-2019 infection in children has been well tolerated with most cases being mild to moderate in nature.  We are unaware of any children who have succumbed of the disease to date.  This is, of course, good news for parents and pediatricians, but we are concerned that infected children could be a source of infection to other older members of our families. 

Disease Management:

Management of patients with COVID-2019 is early recognition of the disease and immediate isolation of the patient from other healthy individuals.  The diagnosis is suspected more in individuals who have recently travelled from China, South Korea, Italy or Iran, however, the number of countries where COVID-2019 has been found is now well over 60.

Here is the challenge both doctors and parents face with coronavirus.  Unlike influenza, where physicians have the means to rapidly detect the virus (through rapid, bedside testing), treat the infection (with Tamiflu or Xofluza) and prevent it (with the flu vaccine), NONE of these tools are readily available to us with COVID-2019.  Therefore, diagnosing the disease process is a matter of a reasonable guess. 

Yes, it is possible to rule out other common viruses by sending out respiratory panels on children who present with upper and lower respiratory symptoms, but extensive testing is not a great screening option due to the cost of these tests and inability to include all potential viruses.  Our hope and expectation is that specific COVID-2019 rapid testing will soon be available.  We have discussed this with our testing labs and their guess is PCR testing of nasal swabs for COVID-2019 will be available within weeks. 

Until we have these tools to combat COVID-2019, we have decided to implement the following procedures at POP:

THE POP PLAN REGARDING COVID-2019:

1.       When families call for a “sick” appointment, we have instructed our telephone receptionists to ask if you or your child have recently traveled to countries with high rates of coronavirus infection OR if you have been in contact with individuals who have traveled to these countries.

2.      We will be utilizing separate rooms to evaluate patients who we have fever and cough.  We are requesting that patients with these symptoms wait in their cars or on our outdoor balcony until our staff can further evaluate them.  In some cases, masks will be provided.

3.      We have instructed our nursing staff to thoroughly clean every room that children with symptoms consistent with coronavirus have been in.  This includes careful cleaning of tables, sinks, walls, doorknobs and other surfaces with a virus-eradicating Clorox wipes.

4.      All books and magazines have been removed from our exam rooms and lollipops and stickers will be distributed to children from the front desk.

5.      We appreciate your help in teaching your children hand-washing and proper cough techniques (cough into a tissue or elbow) to minimize spread of all respiratory viruses during the time and always.

Thank you for your patience during this time. 

We will keep you apprised of any policy changes at Pacific Ocean Pediatrics as this situation unfolds.

              Robert C. Hamilton, M.D., F.A.A.P.                                  Leian Chen, M.D., F.A.A.P.

              Noel H. Salyer, M.D., F.A.A.P.                                            Lily Marouf, M.D., F.A.A.P.

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.

https://www.cdc.gov/measles/travelers.html

Plan for Travel

Español (Spanish)

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 Diseases, Division 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!

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

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.  

Sincerely,

Robert C. Hamilton, M.D.

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Summertime!

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!

CAMP FORMS/SCHOOL FORMS:

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: office@pacificoceanpediatrics.com

Traveling Internationally Soon? Check Out the CDC's Recommendations

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

https://wwwnc.cdc.gov/travel/destinations/list

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

424-259-8580[O1] 

Westside Travel Medicine and Immunizations (Robert Winters, MD)

2001 Santa Monica Blvd Ste 665W, Santa Monica

310-315-1855

Terri Rock, MD

2021 Santa Monica Blvd Ste 335-E

310-829-7625

Introducing Peanut-Containing Foods To Prevent Peanut Allergy

https://www.youtube.com/watch?v=9pVNFWi0XvU&feature=youtu.be

When and how to introduce peanut-containing foods to your infant to prevent allergy risk.

New Parent Checklist & New Parent Tips

NEW PARENT CHECKLIST

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 office@pacificoceanpediatrics.com 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.

NEW PARENT TIPS

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. 

AAP First Aid Guide - Print and Post In Your Home!

Download PDF HERE

Download PDF HERE

4 Things Parents Need to Know About Human Papillomavirus (HPV)

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: www.nhtsa.gov.

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. 

Circumcision

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. 

Jaundice

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.