Questions at the Door

Vitamins, water, and a daily bath: what I tell mothers about the first year

The most important questions in my clinic are asked standing up.

The medicine has been explained. The mother has gathered the bag, the feeding bottle, the spare diaper and the baby, and she is already at the door when she turns around.

"Doc, the vitamins?"

Then the water. Then the bath. Not one of them is about the illness that brought her in. They are about the ordinary days after it, and that is why they matter. The fever will pass. The milk, the heat and the folds of the neck will still be there tomorrow.

So here are my answers, for every mother who reached the door before she remembered to ask.

Vitamins: optional, but good

A healthy baby who is feeding well does not need a shelf of supplements. Milk was made to be enough.

Optional, though, is not the same as useless. A multivitamin drop is a small and inexpensive kind of insurance, especially once the baby starts eating and becomes choosy about what goes in. If you can give it, give it.

There is one exception worth knowing by name. Breast milk is the best food a baby can have, but it is low in vitamin D. A breastfed baby should get a vitamin D drop, 400 units a day, starting in the first weeks of life. Ask for it at the first check-up if no one brings it up.

Water: it depends on the age

This is the one I am firmest about, and the answer changes halfway through the first year.

Before six months, milk is the water. Breast milk is almost nine-tenths water. Formula is already mixed with water, and it should be mixed exactly as the can says, never thinner to make it last longer. A young baby given extra water fills a small stomach with something that has no food in it, and then drinks less milk. In larger amounts, plain water can dilute the salt in a baby's blood to a dangerous level. So even in this heat, under six months, feed more often instead. That is how a young baby drinks.

From six months, water becomes mandatory. This is when solid food begins, and this is when the constipation complaints begin with it. Milk is the baby's food. Lugaw and mashed squash are food. Food without enough water hardens in the gut, and the baby strains and cries over every hard stool.

So once the baby is eating, the water follows the milk. When the milk is finished, the water bottle comes next, a few sips at a time, and again after meals. Somewhere between half a cup and a full cup a day is enough at this age. With the kind of heat we have now, that small habit is what keeps a baby from drying out.

Watch the diapers. Fewer wet ones than usual, a dry mouth, crying without tears, or a sunken soft spot on the head means the baby needs to be seen today, not tomorrow.

A bath every day

If the baby is not sick, yes. Every day.

Think about where the milk goes. A baby does not drink neatly. Milk runs from the corner of the mouth onto the cheeks, down the chin, and settles into the folds of the neck, where it stays warm and damp for hours.

Bacteria love milk. They love it as much as the baby does. Left there, it sours, the skin turns red and raw, and an irritation becomes an infection. The two- and three-year-olds with their chocolate drinks are no different. Sweet milk on the chin is a feast.

Lukewarm water, a mild soap, and a few minutes are enough. Open every fold, under the chin, behind the ears, the creases of the neck and thighs, and dry each one properly. Until the umbilical stump falls off, a sponge bath will do.

About the kisses

This is the hardest advice to give, because it sounds unkind.

Everyone wants to kiss a baby's cheeks. The lola, the titas, the neighbor who came by to see the new arrival. But the mouth is full of bacteria, and a baby's skin is thin, delicate, and easily irritated. A day of visitors can leave a rash wherever the kisses landed.

There is a more serious reason. A cold sore on the lip is caused by the herpes virus, and in a newborn that virus can spread through the body and reach the brain. Anyone with a sore on the lip should not kiss a baby at all. Not the cheek, not the hand, not once.

It is perfectly polite to ask visitors to wash their hands and kiss the top of the head, or the feet. Most people understand once you say it.

What it comes to

Vitamins if you can. Water at the right age. A bath every day. Kisses on the feet.

None of it is written on the prescription.

All of it is part of the treatment.