Pediatric Care

First Visit

   In general, the first visit for your baby in our office should be between day 3 - 5 of life. The reason for this is that the majority of problems related to feeding, jaundice (yellow skin), and heart disease appear. Infants will be seen by one of the staff neonatologists at New York Presbyterian or Lenox Hill Hospital at birth. We advise parents to call once the infant is born. Usually, the father is free to do this by calling and setting up an initial appointment. Discharge from the hospital for a normal vaginal delivery is usually 2 days. If a c-section is necessary, mother and infant may stay as long as 4 days. It is important to remember that our appointments run on time and infants are seen immediately when scheduled. Bring the following to your first visit:
  • Pink slip (state metabolic infant screening test, given at discharge)
  • Pampers
  • Question (all questions are valid)
  • Remember try to be relaxed and comfortable
We will make every effort to answer your questions and concerns.

Breastfeeding or Formula?
   The American Academy of Pediatrics recommends breastfeeding for all infants in the first year of life. Breast milk has all the components of nutrition, protein, iron, essential fatty acids and carbohydrates responsible for normal growth and development.
  In addition, breast milk has maternal antibodies which provide some assistance in warding off early infections of the respiratory and intestinal tracts. Most mothers enjoy the intimacy that only breast feeding can give.

   We encourage our mothers to breastfeed. However, many mothers in American culture quit by 2 months. They return to work, they want more freedom, or are just plain tired of doing it. It can be very demanding of the mother. If you decide to switch to formula feeding, we will help make the change and show you that formula fed babies do just as well physically, developmentally and emotionally as infants that are strictly nursed. There should be no guilt about making the switch to formula or deciding not to breastfeed. This is an individual decision all mothers should be allowed to make without pressure from parents, physician or medical associations.

   The average number of infections that an infant or toddler has is 6 - 12/yr regardless of feeding method. Healthier infants are seen in families where there are no smokers and children are raised at home and avoid daycare. Breastfeeding does not guarantee an infection free first year. Breastfeeding is an individual choice but probably the biggest one you have to make when your baby is born, so whether you breastfeed, breastfeed with formula supplementation or just use ready to serve formula. We will try to make you feel comfortable and satisfied with your decision.

When to Call the Doctor
   Instinctively, most parents know when their child is ill. The baby may reject feeding, activity is less, or the infant just appears more distressed and cannot be consoled when picked up. Calls regarding normal behavior or for reassurance should be left for office hours.
   Here is a partial list of situations under which you should call your doctor. Most of these circumstances will warrant a visit to the Pediatrician. Remember, if in doubt, pick up the phone and page 1-800-917-7055.

Infants 0 - 6 months:
  • Inconsolable irritability, crying
  • Rectal temperature greater than 100.4
  • Refusal to feed
  • Projectile vomiting
  • Diarrhea
  • Repetitive rhythmic movements of arms or legs
  • Cough, difficulty breathing
  For older infants and toddlers, all of the above apply. Pain can be a complaint of older toddlers and school age children, but be aware if any infant pulls at his ears, does not move an extremity, or screams inconsolably, he or she may be in distress. Call for EMS if you notice any of the following:
  • Cessation of breathing
  • Turns blue
  • Serious burns
  • Deep or penetrating wounds
  • Unconsciousness
  • Ingestion of foreign object or chemical
   Remember, Dr. Rappaport's pager number is 1-800 917-7055. Call backs are usually 10 - 15 minutes. If you have doubts about your child's behavior or suspect illness, it is better to call. Always have this number on hand.

SUDDEN INFANT DEATH SYNDROME (SIDS);
ACUTE LIFE THREATENING EPISODE (ALTE);
APNEA OF INFANCY ( AOI)

What is known:
SIDS

  • definition: sudden death of an infant between one week and one year of age.
  • no etiology found on postmortem examination, autopsy or history.
  • 95% before age 6 months with peak between 2 and 4 months of age.
  • greater risk if male; premature or small for gestational age; mother young, unmarried, low socio-economics, smoker, anemic, drug user, increased parity.
    higher incidence in colder months and between midnight and 6 A.M.
  • 5 times risk if sibling had SIDS, but no greater risk for identical twins or triplets; no Mendelian inheritance.
  • no reduction in incidence using home apnea-bradycardia monitor.
  • 50% reduction in incidence of SIDS using " Back To Sleep " recommendation of American Academy of Pediatrics. Infants should sleep on their backs, the stomach position only used if attended continually by a competent caretaker. Mattresses should be firm; no pillows; side positioning only with stable support.

ALTE

  • an acute life threatening episode requiring cardiopulmonary resuscitation, shaking, or mouth to mouth breathing to restore normal breathing.
  • infant appeared limp or blue (cyanotic) or very pale.
  • occurs twice as often as SIDS.
  • causes found in 30%: neurologic, cardiac, metabolic, respiratory, infectious, GE Reflux.
  • home monitoring with 4 channel electronics for EKG, apnea, O2 saturation and GE Reflux.

AOI

  • diagnosed when cause of ALTE cannot be found (50% of times).
  • home apnea-bradycardia monitoring advised with alarms for:
             bradycardia less than 80 beats/min. 1st mo. of life
                                           70 beats/ min. 1-3 mos. of life
                                           60 beats/ min. 3-12 mos. of life
                                           50 beats/ min. thereafter.
             apnea greater than 20 seconds.
  • no evidence that such home monitoring prevents SIDS.

    RECOMMENDATION: SLEEP ON BACK IF UNATTENDED.