Vaccination is one of the greatest achievements of medicine and has spared millions of people the effects of devastating diseases. Before vaccines became widely used, infectious diseases killed thousands of children and adults each year in the United States.

Before 1985, Haemophilus Influenzae type b (Hib) caused serious infections in 20,000 children each year, including meningitis (12,000 cases) and pneumonia (7,500 cases). In 1998 (after Hib Vaccination), there were 54 cases of Hib disease. In the 1964-1965 rubella (German Measles) epidemic, there were 12.5 million cases of rubella. Of the 20,000 infants born with congenital rubella syndrome, 11,600 were deaf, 3,580 were blind, and 1,800 were mentally retarded as a result of the infection. In 1999 (after vaccination), there were 238 cases of rubella and 8 cases of congenital rubella. Before 1963, more than 3 million cases of measles and 500 deaths from measles were reported each year. More than 90% of children had measles by age 15. In 1999 (after vaccination), there were 86 cases of measles. In 1952, polio paralyzed more than 21,000 people. In 1998 (after vaccination), there were no cases of polio. In the early 1940s, there was an average of 175,000 cases of pertussis (whooping cough) per year, resulting in the deaths of 8,000 children annually. In 1999 (after vaccination), 6,031 cases of pertussis were reported. In the 1920s, there were 100,000 to 200,000 cases of diphtheria each year and 13,000 people died from the disease. In 1998 (after vaccination), there was only one case of diphtheria in the United States. As a result of the high level of immunization in the United States these diseases have declined to near zero.

Without protection from vaccines, the vaccine preventable diseases that have nearly been eliminated are likely to return to this country. Children who are not vaccinated against measles are up to 35 times more likely than immunized children to catch the disease. Ten years ago during a 3-year measles epidemic from 1989 to 1991, state health departments in the United States reported 55,622 measles cases, 11,251 hospitalizations, and 125 deaths. An investigation has shown that where this epidemic occurred, as few as 50% of preschool-aged children had received the measles vaccine. Thousands of children and adults will become sick, some will have long-lasting health problems, and some will die. Many other countries do not have the same levels of immunization that we have achieved in the United States and they continue to have disease outbreaks. Therefore, we must all remain protected by vaccines because dangerous diseases largely under control in the United States are only a plane ride away.

Vaccines are very safe and getting safer and more effective all the time as a result of medical research and ongoing review by doctors, researchers, and public health officials. Vaccines must meet the strict safety standards of the Food and Drug Administration (FDA) to ensure that they are safe and effective before they are approved. Scientific research and experience have shown that serious adverse effects from vaccines are extremely rare. The chance of serious complications from the diseases that vaccines prevent is many times higher than the chance of complications related to vaccines. As with all medicines, vaccines carry some element of risk. Doctors and public health professionals consider the balance of benefits and risks before recommending any vaccine. This balance is always subject to new information and can change when diseases are controlled or eradicated, or when there is new evidence about a vaccine or a vaccine-preventable disease that calls for a change in recommendations.

A 19-month-old child received nine immunizations in 2000 because she was behind in the recommended childhood immunization schedule. She had an underlying mitochondrial disorder. Mitochondria are the powerhouses of our cells, and mitochondrial disorders are extremely rare. She subsequently developed neurodegeneration, including some signs of autism spectrum disorder. The US Court of Federal Claims has agreed to pay the family from a federal fund that compensates people injured by vaccines.

The detailed investigation of this child with an underlying mitochondrial disorder may provide an important clue to understanding why rare complications occur with some vaccines. Moreover, future investigations might help identify a means to screen for such disorders, although because there are many different mitochondrial disorders and testing is invasive and expensive, screening is difficult. Other children with encephalopathy following vaccines have been compensated through the Vaccine Injury Compensation Program. What attracted public attention to this case was that it had been submitted as a test case by petitioners seeking compensation for children with autism following exposure to thimerosal (mercury) containing vaccines. The decision to award compensation in this case has nothing to do with the thimerosal that may have been present in the vaccines that the child received (in 2000, only two of the five vaccines this child received would have contained thimerosal; the others were already thimerosal free). The underlying mitochondrial dysfunction disorder in this case predisposes to neurodegeneration following significant stresses associated with infections, and possibly the multiple vaccines that this girl received. After the decision was made to award compensation, the case was withdrawn as a test case. Additional research is needed to determine if other children with autism, especially those with the regressive forms of autism, have the same or similar underlying mitochondrial dysfunction disorders.

If you had been in the center-stage spotlight and were suddenly displaced, would you like it? Neither does a three-year-old, or a child of any age, who suddenly feels unimportant. Sometimes even a father feels a little jealous about all the attention baby is getting . . . Perhaps rightly so. Maybe others in the family need to continue getting attention, affection and love after baby comes. Just suppose you are three-year-old betty: for all of betty’s life there have been just the right number of people at home — mom, dad . . . And betty. Then the word gets out — a competitor is on the way to share her house, her room, her yard, her toys — and even her mom and dad. To make matters worse, the intruder comes after a poorly explained absence of mother. For all betty knows, mother may disappear again and return with a mountain goat, giraffe, alligator, monster . . . Or another baby! Of course betty is going to resent competition. But by making her feel important, and part of the new event . . . Letting her anticipate the arrival of “her” new baby . . . And with some new privileges . . . And maybe with a promotion from “private” to “corporal” . . . And maybe by receiving the first words of greeting when grandma comes to visit . . . Along with some special solo time and attention from dad, and from mom . . . Maybe betty might even like the new baby . . . Some of the time. Well, that’s it for the first forty-one questions, but you can be sure that as the years go by, there will be forty-one thousand more . . . At least. Finding the answers is going to be fun and a real challenge — but that’s what life is all about.

It is important to separate the labial folds when washing a baby girl. Otherwise, the two sides may stick together forming “adhesions” that will have to be separated. (these adhesions have nothing to do with the hymen.) Incidentally, a little vaginal secretion and even bleeding sometimes occurs at a week or so which is no cause for concern. This is another quickly passing effect of mother’s hormones.

A newly born baby is a strange looking creature of lobster-red, coated with a protective white-greasy “vernix.” But good news . . . The looks quickly improve with age . . . Even a few minutes makes a difference, and soon the newborn really looks like the baby everyone has been waiting for.

No. A baby’s skin may from time to time appear mottled. This pink-and-white pattern may come and go without worry.

Are the fingernails long? Is baby scratching himself (or you)? If so, gently clip the nails. Filing the nails may be easier.

How much clothing do you as an adult need to be comfortable for today? That’s about enough for baby. Don’t make your baby hot and miserable by putting on too many layers of clothing and covers.

Yes, but the birth weight most always is regained within the first couple of weeks.

The umbilical cord, no longer being necessary, begins drying up right after being cut at birth. The remaining part will drop off in 2 - 4 weeks.

Clean around the cord at each diaper change with an alcohol swab. When the cord comes off, do this vigorously in the navel. A little moist secretion and a few drops of blood may be present. However, more drainage (especially with a bad smell) or redness around the cord base is cause for concern.

Yes, gently with plain water.

Maybe. It often is. To begin with, a baby’s head is large in proportion to the rest of the body and seems to sit on the shoulders without much of a neck. If a baby’s head were solid, birth would be very difficult. So actually, the head is made up of several bones which can do some giving-and-taking during birth. They don’t join together until later. Thus the head is shaped longer, rounder, or flatter depending on the baby’s position during birth. At first, the forehead is often quite flat and sloped toward the back. Ridges and bumps can be felt where the bones overlap a little. Quite a bit of natural reshaping occurs in the first few days. Don’t worry. Baby will look better in a day or so!

There are two soft spots (fontanels) which are places on the head where the bones have not yet come together. The posterior one is quite small and disappears rather soon, but the diamond-shaped fontanel on top of the head takes one to one-and-a-half years to close. Go ahead, touch it . . . And don’t be afraid to wash the area vigorously at bath time . . . You won’t hurt anything.

These light-pink blotches will eventually disappear, but it may take some time. There’s no worry or hurry.

Belly bands, tape and bindings are not advisable or helpful even if there is some pooching out of the navel.

Keep the area clean. A little petroleum jelly may be desirable to reduce irritation for the first two or three days. That’s about it. After the first week, the foreskin should be pushed back toward the body and washed every day to avoid adhesions.

A baby can distinguish light from dark and can see gross objects, but it will be some time before much focusing and consistent eye alignment occurs.

Yes. You will notice that the baby responds to loud voices and noises. By the way, quiet music is soothing to a baby.

Maybe not now. But it might make a lot of difference later. A little time choosing a name might avoid some teasing about a particular combination of initials or names. Is a name a “plus” or a “minus”? Will it be strange and difficult for future playmates to say? Think about nicknames. What about the spelling? Is there something about a name that may cause a youngster (or grownup) embarrassment or difficulty and confusion? A name lasts a long time. It’s worth thinking about.

For thousands of years people have been taking care of babies. But it's different now — much different. Childbirth is safer. Babies are healthier. And parenting is easier — that is, many of the mechanical things are easier. On the other hand, babies still cry, take time to feed, and require changing. Sure, there's lots to know and lots to do, but with love, common sense, and a few up-to-date guidelines, you are off to a great start.

Perhaps having a new baby is something like getting a new car. It's been a long wait. Now, everyone wants to look, listen, touch, lift, open, turn, and look again to be sure that the parts are there and working properly. More than likely, everything is in order. Say, this baby is really something. Did you know there are some 10,000,000,000 brain cells . . . And did you stop to think about the amazing heating, cooling, plumbing, pumping and even reproductive systems? Someone counted up 525 muscles and estimated there are billions of specialized cells in a single baby. That's more parts than in a car or in just about anything you could buy. The amazing thing is that everything works so well most of the time. But, look things over and ask about anything you happen to wonder about. That beats worrying about something that may mean nothing.

Sponge bathing is best at first. Then when the cord comes off, real baths are fun. Use a mild soap, noting that almost any soap might cause a rash. If it seems that one soap is a problem, switch. Washing baby off after messy diapers and also in a daily bath keeps baby sweet and clean. Babies do not need full baths every single day.

Probably for awhile. How long is hard to predict. Some babies skip night feedings sooner than others.

It all depends on what’s going on. Some mothers won’t let their babies cry for a single minute. They drop everything and run at the first whimper, which is not necessary. On the other hand, crying may mean “Hey, —I’m wet.” Or “How about changing this messy diaper?” Or “I’ve been swallowing some air and have a tummy-ache. Sit me up in your arms and burp me!” An overly filled, or empty stomach, may also cause crying, or maybe baby’s just tired and needs to cry himself to sleep. All babies are going to do some crying.

A daily fussy period is expected, often in the evening. First, be sure baby isn’t being overfed. Then if getting rid of swallowed air and other simple comforting measures don’t solve the problem, your doctor may want to prescribe something to settle baby down. Don’t forget that soothing music often helps calm baby and everyone else. Swaddling a baby or gentle movement may be helpful for infants less than 2-3 months of age.

Not much at first. In fact, a baby can do without any feedings for the first two days of life. So don’t push more than a baby seems to want, and don’t worry about giving enough. A couple of ounces at a time may be plenty, and not more than three or four ounces at a time for the first month. A good rule-of-thumb is to feed baby no more than one-ounce-per-hour since the last feeding.

A normal well-balanced diet with lots of liquids is best. Thirst guides most nursing mothers to want to drink about three quarts of fluid each day, one quart of which usually being milk (any kind . . . Even powdered skim). But if a mother is allergic to milk or doesn’t like it, she can still successfully produce plenty of milk without drinking any milk at all. Most anything can be eaten by a nursing mother, in moderation, noting that sometimes chocolate, onions, spices, tomatoes, berries, cabbage, turnips, broccoli, green peppers, and other things may cause baby to have a tummy-ache or loose stools. Go ahead and enjoy eating. These foods don’t have to be eliminated completely unless a problem comes up. Check before taking any medicines, as many do affect a nursing baby.

About three minutes on each breast for the first few feedings. Then five or six minutes (per breast) at a feeding should be plenty for the next few days. The baby gets protein-rich colostrum while the pure thin-bluish milk is getting ready to come in, which it will do at exactly the right time for your baby. Then the baby can nurse longer, often falling asleep when he has had enough. When the milk is flowing freely, a baby can nurse from both breasts or alternate ones . . . Emptying at least one breast per feeding. A complete breast-feeding may take as few as five minutes or up to twenty-five minutes. For the first few days the baby will want to nurse frequently and doesn’t get much at a single feeding. This is fine. Frequent nursing stimulates milk production. In the first few weeks a breastfed baby should get 8-10 feedings per day. As time goes on the baby will sleep longer between feedings.

If it has been 2-3 hours since the last feeding and baby is rooting around and sucking, baby is probably hungry. Not all crying means hunger; you will soon learn to differentiate cries.

The mark of success at one time was to see how big and fat baby could be. It isn’t. It’s easy to mistake hunger for fussiness or crying from a tummy too full of milk or swallowed air. Yes, a baby really can get too much milk . . . That can result in irritability, vomiting, diarrhea, and eventually a fat baby. Be sure swallowed air is burped-up during, after, and in-between feedings.

Certainly. Much progress has been made in producing excellent formulas for babies. And by the way, it’s not necessary to warm-up a bottle before feeding. Room temperature milk is just fine.

When baby stops nursing for a few moments, it’s time to burp-out a bubble of air from the stomach. Gentle patting with baby over the shoulder or moving to-and-from a sitting position helps the air find its way out. Whenever air is swallowed (at feeding times or in-between) burping is comforting. You may also rest the baby forward while supporting the neck/head between your index finger and thumb while patting on back with the opposite hand.

Most babies are very sleepy for the first few days. If baby does not waken for feedings, wake baby every 2-3 hours during the day and every 4-5 hours during the night. Eventually your baby will demand feedings on a regular basis.

Many mothers think their milk is “lost” . . . Not realizing that tense, firm breasts usually become soft in a few days. Variations in the feeling of fullness as a balance of milk is reached may be deceptive. Lots of milk can come from small breasts that don’t seem full at all.

You need to be comfortable and relaxed and the baby must be awake. Hold the baby’s body facing you and stimulate the baby’s lower lip with your nipple. As mouth opens, bring baby to breast and insert your nipple with as much areola as possible into baby’s mouth. With baby’s head in the crook of your arm and your hand holding baby’s buttocks, gently pull baby close to your body. Holding the baby in this position keeps the baby’s nasal airway open without your pulling the breast away from the nose.

Unless special instructions are given to you, follow the directions on the formula container exactly. (read the instructions carefully, as some formulas come supplied in several different ways.) Remember that once formula is opened it must be refrigerated.

Hold your baby snugly so baby experiences a warm and happy feeling. Touching the nipple to the lips of a hungry baby is usually enough to get the mouth open. Slip the nipple all the way in. Then hold the bottle so the nipple stays filled with milk. For many reasons never leave a baby with a bottle propped in his mouth.

No, most healthy new babies have periodic episodes of hiccupping which cause no difficulty at all.

If you want to nurse, you probably can. Just remember, breastfeeding is not a reflex for you or your baby. It is a process which must be learned and your success depends on receiving and utilizing correct information. Do not be discouraged by well-meant advice from friends and relatives.

The areola has lubricating glands which function best when no lotion or cream is applied to them. Do not use soap or other drying agents on your nipples. Air drying or blowing nipples dry with a hairdryer works well. Wear a well-fitted, comfortable bra. If leaking milk is a problem, wear nursing pads without plastic liners and change them often. If your breasts become dry or cracked, over the counter pure lanolin is an option. Lactation consultants are available in our practice to help you with your problems.

A newborn’s first few stools look like sticky greenish-black tar. Then the stools become greenish-yellow with a seedy consistency. Gradually the more typical yellow color is reached, with quite a bit of variation depending on what the baby is fed. For example, a baby fed only breast milk usually produces watery-soft golden-yellow stools with very little odor. The stools of babies on different prepared formulas have their individual characteristics and are usually not as strong-smelling as the yellow-brown stools of a baby on canned or fresh cow’s milk. Stools of formula fed babies tend to be harder/darker and less frequent than those of breast fed babies.

Most breastfed babies will have more than 3-4 stools per day. If in the first few weeks your baby has not stooled in 24 hours, baby should be weighed to insure baby is getting sufficient milk. As time goes on the number of stools per day decreases. Bottlefed babies will have several stools per day at first, but the number will usually decrease to 1 per day or 1 every other day or two after the first few weeks. Consistency and number of stools vary from baby to baby. It is normal for a baby to cry, push, turn red and draw up legs when passing a stool.