The following tests and procedures are recommended or required in most hospitals in the United States.

Apgar Evaluation The Apgar test is a quick way for doctors to figure out if the baby is healthy or needs extra medical care. Apgar tests are usually done twice: one minute after birth and again five minutes after birth. Doctors and nurses measure five signs of the baby's condition. These are: * heart rate; * breathing; * activity and muscle tone; * reflexes; * skin color.

Apgar scores range from 0 to 10. A baby who scores 7 or more is considered very healthy. But a lower score doesn't always mean there is something wrong. Perfectly healthy babies often have low Apgar scores in the first minute of life.

In more than 98 percent of cases, the Apgar score reaches 7 after 5 minutes of life. When it does not, the baby needs medical care and close monitoring.

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Your Baby's First Hours and Newborn Screening Tests Eye Care Your baby may receive eye drops or ointment to prevent eye infections he or she can get during delivery. s.e.xually transmitted infections (STIs) including gonorrhea and chlamydia are a main cause of newborn eye infections. These infections can cause blindness if not treated.

Medicines used can sting and/or blur the baby's vision. So you may want to postpone this treatment for a little while. Some parents question whether this treatment is really necessary.

Many women at low risk for STIs do not want their newborns to receive eye medicine. But there is no evidence to suggest that this medicine harms the baby.

It is important to note that even pregnant women who test negative for STIs may get an infection by the time of delivery. Plus, most women with gonorrhea and/or chlamydia don't know it because they have no symptoms.

Vitamin K Shot The American Academy of Pediatrics recommends that all newborns receive a shot of vitamin K in the upper leg. Newborns usually have low levels of vitamin K in their bodies. This vitamin is needed for the blood to clot. Low levels of vitamin K can cause a rare but serious bleeding problem. Research shows that vitamin K shots prevent dangerous bleeding in newborns.

Newborns probably feel pain when the shot is given. But afterwards babies don't seem to have any discomfort. Since it may be uncomfortable for the baby, you may want to postpone this shot for a little while.

Newborn Metabolic Screening Doctors or nurses p.r.i.c.k your baby's heel to take a tiny sample of blood. They use this blood to test for many diseases. All babies should be tested because a few babies may look healthy but have a rare health problem. A blood test is the only way to find out about these problems. If found right away, serious problems like developmental disabilities, organ damage, blindness, and even death might be prevented.

All 50 states and U.S. territories screen newborns for phenylketonuria (PKU), hypothyroidism, galactosemia, and sickle cell disease.

But many states routinely test for up to 30 different diseases. The 569 Pregnancy and Birth Sourcebook, Third Edition March of Dimes recommends that all newborns be tested for at least 29 diseases.

You can find out what tests are offered in your state by contacting your state's health department or newborn screening program.

Hearing Test Most babies have a hearing screening soon after birth, usually before they leave the hospital. Tiny earphones or microphones are used to see how the baby reacts to sounds. All newborns need a hearing screening because hearing defects are not uncommon and hearing loss can be hard to detect in babies and young children.

When problems are found early, children can get the services they need at an early age. This might prevent delays in speech, language, and thinking. Ask your hospital or your baby's doctor about newborn hearing screening.

Hepat.i.tis B Vaccine All newborns should get a vaccine to protect against the hepat.i.tis B virus (HBV) before leaving the hospital. HBV can cause a lifelong infection, serious liver damage, and even death.

The hepat.i.tis B vaccine (HepB) is a series of three different shots.

The American Academy of Pediatrics and the Centers for Disease Control (CDC) recommend that all newborns get the first HepB shot before leaving the hospital. If the mother has HBV, her baby should also get a HBIG (hepat.i.tis B immune globulin) shot within 12 hours of birth. The second HepB shot should be given 1 to 2 months after birth. The third HepB shot should be given no earlier than 24 weeks of age, but before 18 months of age.

Complete Checkup Soon after delivery most doctors or nurses also: * measure the newborn's weight, length, and head; * take the baby's temperature; * measure that baby's breathing and heart rate; * give the baby a bath and clean the umbilical cord stump.

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Chapter 71.Newborn Health Concerns What is infancy?

Infancy is generally the period from birth until age two years. It is a time of a lot of growth and change for children and families.

This information is provided with full-term infants specifically in mind. It is not meant to provide all the information you need to care for your infant. Preterm infants (those born before the mother has been pregnant about 38 weeks) often have special needs.

What is jaundice?

Jaundice is an illness that can cause a baby's skin, eyes, and mouth to turn a yellowish color. The yellow color is caused by a buildup of bilirubin, a substance that is produced in body during the normal process of breaking down old red blood cells and forming new ones.

What causes jaundice?

Normally the liver removes bilirubin from the body. But for many babies, in the first few days after birth the liver is not yet working at its full power. As a result, bilirubin level in the blood gets too high, causing the baby's color to become slightly yellow. This is called jaundice.

Excerpted from "Infant Health," by the National Inst.i.tute of Child Health and Human Development (NICHD, www.nichd.nih.gov), part of the National Inst.i.tutes of Health, July 20, 2008.

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Pregnancy and Birth Sourcebook, Third Edition If your baby has jaundice, it usually does not mean that your baby has liver problems or a "bad liver." In most cases, it just means that the baby's liver is slower in removing bilirubin from the blood during the first few days after birth.

How is jaundice treated?

Although jaundice is common and is often not serious, all babies with jaundice need to be seen by a health care provider.

Many babies need no treatment for jaundice. Their livers start to catch up quickly, usually within a few days after birth, and begin to remove bilirubin normally.

For some babies, however, doctors prescribe photo-therapy-treatment using a special lamp-to help break down the bilirubin in their bodies. In some cases, high levels of bilirubin could cause brain injury.

If your baby has jaundice, ask your health care provider how long his or her jaundice will last after leaving the hospital, and schedule a followup appointment as directed. If your baby's jaundice lasts longer than expected, or an infant who did not have jaundice before starts to turn yellowish after going home, contact your health care provider right away.

How can I help my child with sleep?

Helping a child learn to fall asleep and stay asleep is one of the more challenging parts of infant care. Newborns tend to sleep or drowse for 16 to 20 hours a day. Their "internal clocks" are not yet set, so they sleep a lot both during the day and night. Newborns also have small stomachs, so they need to be awake for regular feedings.

After a few months, babies usually begin to sleep in longer stretches at night and are awake for longer periods during the day. Practicing bedtime routines and putting your baby into the crib before he or she falls asleep can help build better sleep patterns.

What is sudden infant death syndrome (SIDS)?

SIDS is the sudden, unexplained death of an infant younger than one year old. It is the leading cause of death in children between one month and one year of age. Health care providers don't know exactly what causes SIDS, but they do know certain things can help reduce the risk of SIDS.

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Newborn Health Concerns How can parents reduce the risk of SIDS?

The best way to reduce the risk of SIDS is to always place babies on their backs to sleep for naps and at night. Babies who sleep on their backs are less likely to die of SIDS than babies who sleep on their stomachs or sides. Placing your baby on his or her back to sleep, for naps and at night, is the number one way to reduce the risk of SIDS.

What are some ways to keep my baby safe?

Keeping your baby safe is one of the most important jobs for parents. The U.S. Consumer Product Safety Commission publishes a book-let called The Safe Nursery that provides information on a variety of potential hazards and ways to help keep your infant safe.

What about safety for my infant in the car?

In addition to safety at home, car seat safety is an important part of taking care of your child. Each car seat is different so it is important to carefully review and follow the manufacturer's instructions.

What about child care for infants?

For many parents and families, child care comes from someone other than the child's mother. To understand how this type of care influences child development, the NICHD started the Study of Early Child Care and Youth Development (SECCYD) in 1991.

The major goal of the study was to examine how differences in child care experiences relate to children's social, emotional, intellectual, and language development, and to their physical growth and health. The study examined how quality, quant.i.ty, and type of child care setting affect children's development.

Specific findings from the study include the following: * Higher quality care was a.s.sociated with better child outcomes.

* The number of hours in care mattered in terms of child outcomes to some degree.

* The child care type or setting (child care home, child care center, etc.) had different effects on children at different ages.

* Parent and family characteristics were more strongly linked to child development and child outcomes than any aspect of child care.

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Pregnancy and Birth Sourcebook, Third Edition The study also developed a positive caregiving checklist that parents can use to examine the quality of care their child is receiving.

Do preterm infants have special care needs?

Preterm infants, also known as preemies, are babies born before the mother has completed 37 weeks of pregnancy (or on or before 259 days from the first day of the last menstrual period). Preterm infants often have special needs, even after they leave the hospital. Infants born only a few weeks preterm (between 34 and 37 weeks, or "late preterm") often have special needs during the first two years of age.

Preterm infants may need to spend time in a neonatal intensive care unit (NICU) at the hospital until they are big and strong enough to go home. Preterm babies may also need special care even after leaving the NICU.

You should talk to your health care provider about your infant's specific care needs.

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Chapter 72.Infant Feeding Chapter Contents.Section 72.1-Breastfeeding ....................................................... 576 Section 72.2-Formula Feeding ................................................. 578 575.

Pregnancy and Birth Sourcebook, Third Edition Section 72.1 Breastfeeding Excerpted from "Breastfeeding: Frequently Asked Questions,"

by the Office of Women's Health (www.womenshealth.gov), part of the U.S. Department of Health and Human Services, March 2009.

Why should I breastfeed?

Breastfeeding is normal and healthy for infants and moms. Breast milk has disease-fighting cells called antibodies that help protect infants from germs, illness, and even sudden infant death syndrome (SIDS). Breastfeeding is linked to a lower risk of various health problems for babies, including: * ear infections; * stomach viruses; * respiratory infections; * atopic dermat.i.tis; * asthma; * obesity; * type 1 and type 2 diabetes; * childhood leukemia; * necrotizing enterocolitis, a gastrointestinal disease in preterm infants.

In moms, breastfeeding is linked to a lower risk of type 2 diabetes, breast cancer, ovarian cancer, and postpartum depression. Infant formula cannot match the exact chemical makeup of human milk, especially the cells, hormones, and antibodies that fight disease.

For most babies, breast milk is easier to digest than formula. It takes time for their stomachs to adjust to digesting proteins in formula because they are made from cow's milk.

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Infant Feeding How long should I breastfeed?

It is best to give your baby only breast milk for the first six months of life. This means not giving your baby any other food or drink-not even water-during this time. Drops of liquid vitamins, minerals, and medicines are, of course, fine, as advised by your baby's doctor. It is even better if you can breastfeed for your baby's first year or longer, for as long as you both wish. Solid iron-rich foods, such as iron-fortified cereals and pureed vegetables and meats, can be started when your baby is around six months old. Before that time, a baby's stomach cannot digest them properly. Solids do not replace breastfeeding. Breast milk stays the baby's main source of nutrients during the first year. Beyond one year, breast milk can still be an important part of your child's diet.

How can I find support for breastfeeding when I go back to work?

Before you deliver, talk to your employer about taking as much time off as you can. This will help you and your baby get into a good breastfeeding routine and help you make plenty of milk. Also, talk with your employer about why breastfeeding is important, why pumping is necessary, and how you plan to fit pumping into your workday, such as during lunch or other breaks. You could suggest making up work time for time spent pumping milk. If your day care is near your workplace, try to arrange to go there to breastfeed your baby during work time.

If you can't breastfeed your baby directly during your work breaks, plan to leave your expressed or pumped milk for your baby. The milk can be given to your baby by the caregiver with a bottle or cup.

Do I still need birth control if I am breastfeeding?

Breastfeeding can delay the return of normal ovulation and menstrual cycles. But, like other forms of birth control, breastfeeding is not a sure way to prevent pregnancy. You should still talk with your doctor or nurse about birth control choices that are compatible with breastfeeding.

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Pregnancy and Birth Sourcebook, Third Edition Section 72.2 Formula Feeding Excerpted from "Infant Formula," by the U.S. Food and Drug Administration (FDA, www.fda.gov), April 3, 2006.

What is an infant formula?

The Federal Food, Drug, and Cosmetic Act (FFDCA) defines infant formula as "a food which purports to be or is represented for special dietary use solely as a food for infants by reason of its simulation of human milk or its suitability as a complete or partial subst.i.tute for human milk."

How is infant formula regulated in the United States?

Because infant formula is a food, the laws and regulations govern-ing foods apply to infant formula. Additional statutory and regula-tory requirements apply to infant formula, which is often used as the sole source of nutrition by a vulnerable population during a critical period of growth and development.

Does FDA have nutrient specifications for infant formulas?

Yes, FDA has requirements for nutrients in infant formulas. These nutrient specifications include minimum amounts for 29 nutrients and maximum amounts for 9 of those nutrients. If an infant formula does not contain these nutrients at or above the minimum level or within the specified range, it is an adulterated product unless the formula is "exempt" from certain nutrient requirements. An "exempt infant formula" is "any infant formula which is represented and labeled for use by an infant who has an inborn error of metabolism or low birth weight, or who otherwise has an unusual medical or dietary problem."

How do parents know what formula to feed to their infant?

A wide selection of different types of infant formulas is available on the market. Parents should ask their infant's health care provider if they have questions about selecting a formula for their infant.

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Infant Feeding Do infants fed infant formulas need to take additional vi- tamins and minerals?

Infants fed infant formulas do not need additional nutrients unless a low-iron formula is fed. If infants are fed a low-iron formula, a health care professional may recommend a supplemental source of iron, particularly after 4 months of age.

FDA's nutrient specifications for infant formulas are set at levels to meet the nutritional needs of infants. In addition, manufacturers set nutrient levels for their label claims that are generally above the FDA minimum specifications and they add nutrients at levels that will ensure that their formulas meet their label claims over the entire shelf-life of the product.

Do "house brand" or generic infant formulas differ nutri- tionally from name brand formulas?

All infant formulas marketed in the United States must meet the nutrient specifications listed in FDA regulations. Infant formula manufacturers may have their own proprietary formulations but they must contain at least the minimum levels of all nutrients specified in FDA regulations without going over the maximum levels, when maximum levels are specified.

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Chapter 73.Bonding with Your Baby Bonding is the intense attachment that develops between parents and their baby. It makes parents want to shower their baby with love and affection and to protect and nourish their little one. Bonding gets parents up in the middle of the night to feed their hungry baby and makes them attentive to the baby's wide range of cries.

Scientists are still learning a lot about bonding. They know that the strong ties between parents and their child provide the baby's first model for intimate relationships and foster a sense of security and positive self-esteem. And parents' responsiveness to an infant's signals can affect the child's social and cognitive development.

Why Is Bonding Important?

Bonding is essential for a baby. Studies of newborn monkeys who were given mannequin mothers at birth showed that, even when the mannequins were made of soft material and provided formula to the baby monkeys, the babies were better socialized when they had live mothers to interact with. The baby monkeys with mannequin mothers were more likely to suffer from despair, as well as failure to thrive.

"Bonding with Your Baby," February 2008, reprinted with permission from www.kidshealth.org. Copyright 2008 The Nemours Foundation. This information was provided by KidsHealth, one of the largest resources online for medically reviewed health information written for parents, kids, and teens. For more articles like this one, visit www.KidsHealth.org, or www.TeensHealth.org.