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The role of the Registered Nurse or Newborn Care Provider is to feed, soothe, bathe, change & provide all other gentle care to baby through the night.

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Air Quality Info for Families

Experiencing poor air quality due to wildfires and polluntants is becoming more common. Newborns and their parents in all parts of the US may be affected. This blog, Air Quality Info for Families aims to ease parents’ minds by providing information on how to keep babies, children and themselves safe.

Air Quality Info for Families showing colored graph
Air Quality Info for Families

Newborns, Infants and Older Children

There are specific health risks for newborns and infants. Children up to age 18 are also more at risk for issues related to poor air quality. Here’s why:

  • Developing respiratory systems: Because babies’ lungs and respiratory systems are not mature, they are particularly sensitive to air pollutants. Poor air quality can worsen respiratory conditions and even hinder lung development.
  • Higher breathing rates: Babies have higher breathing rates compared to adults, which means they inhale a larger volume of air relative to their body weight. They have an increased intake of polluted air when air quality is poor.
  • Weaker immune systems: Newborns and infants have immature immune systems, making them more susceptible to the harmful effects of air pollution. Exposure to pollutants can increase the risk of respiratory infections, allergies, and other health problems.
  • Long-term health effects: Early exposure to high levels of air pollution can have long-lasting effects on a child’s health. Studies have shown that children exposed to air pollution during infancy and early childhood are at a higher risk of developing respiratory disorders, allergies, asthma, and other chronic health conditions later in life.

Sensitive Groups: Who Are They?

Sensitive groups in the Air Quality Index (AQI) are those who are more vulnerable to the adverse effects of air pollution. The specific sensitive groups recognized by the U.S. Environmental Protection Agency (EPA) include:

  1. Children under Age 18: Newborns, Infants, children and adolescents are considered sensitive, as their respiratory systems are still developing. Babies in particular also have higher breathing rates.
  2. The Elderly: Age-related changes in the body’s respiratory and immune systems can increase older adults’ vulnerability. Natural age related health issues such as weakened immune system also add to this vulnerability.
  3. Respiratory conditions: Individuals with asthma, chronic obstructive pulmonary disease (COPD), bronchitis, or other respiratory conditions are more sensitive to air pollution. Therefore, pollutants can exacerbate their symptoms.
  4. Cardiovascular conditions: Those with heart disease, congestive heart failure, coronary artery disease, or other cardiovascular conditions may experience worsened symptoms. They are also at increased risk of cardiovascular events due to poor air quality.
  5. Pregnancy: Pregnant individuals may be more sensitive to air pollution because it can affect both maternal health and fetal development. Exposure to pollutants during pregnancy has been associated with adverse outcomes. Preterm birth, low birth weight, and developmental issues are examples.
  6. Outdoor workers: People who work outdoors are exposed to higher levels of air pollution for longer durations. They may experience increased risks to their respiratory and cardiovascular health.

Air Quality Index by the Numbers

On your weather app, you’ll see air quality index noted by numbers. Here is how they break down.

green: good; 0-50

yellow: moderate: 51-100

orange: unhealthy for sensitive groups: 101-150

red: unhealthy; 151-200

purple: very unhealthy; 201-300

maroon: hazardous; 301 and higher

3 year old girl looking at the sky while wearing sunglasses
air quality info for newborns and kids

Air Quality Info for Families: How to Protect Babies and Families

Stay Inside: try to remain in a well-ventilated, clean environment, avoiding outdoor activities that could expose them to polluted air.

Limit Physical Exertion: breathing heavy causes us to intake more air; try to limit this.

Get a Good Mask:  As airnow.gov notes: N95 respirator masks can provide protection from wildfire smoke. Cloth masks will not work.

Take Indoor Breaks: If you must be outside, frequent breaks indoors in places where the air is clean can help.

Air Purifiers: Purchase an air purifier for your home for extra protection. Consumer Reports has a comprehensive list of indoor air purifiers.

For more information on the AQI and how it affects our health, visit airnow.gov.

Sleep Coach Your Toddler

updated, May 26, 2023 – There’s so much baby sleep advice about newborns and postpartum families. How do infants sleep through the night? When will my baby get on a routine or nap better? But parents of toddlers sometimes also have these same questions. Our team of night nurses, nannies and postpartum doulas assure parents that even if your young child hasn’t sleep through the night, it’s not too late to sleep coach your toddler.

Twin toddlers and older brother getting ready to jump on beds
Sleep Coach Your Toddler

Getting Ready to Sleep Coach Your Toddler

A question we’re often asked at LMS is if we’ll soothe toddlers back to sleep if they wake through the night. Even though the night nannies are there to provide newborn care, the answer is yes we will of course try to care for toddler siblings! BUT, our experience has been that overwhelmingly when the older kids wake up they want MOMMY or DADDY! These little ones aren’t waking up because they’re hungry or need a diaper change. They need cuddles from you. Understanding this goes a long way in the sleep training process.

Pave the Way with Communication

  • Explain the changes to your toddler in an age-appropriate manner. Let them know that they are growing up and that the new sleep routine is for big kids! Provide positive reinforcement for their progress and remind them during the day., what will happen at night. You can say something like: “Remember, if you wake up tonight, I’ll come in and lay you back down to sleep but I won’t lay in the bed with you.”
  • Some parents also use reward charts. For example, if the child stays in their room for 3 nights in a row, they get to choose a new toy from the dollar store. You know what your child will respond to best.
  • Have a family meeting and include toddler in the planning and explain the expected behaviors that are expected such as: staying in bed at night, not coming out of bed until their wake-up clock says it’s time, etc. Review the expectations each night night before bed.  If you’re using a reward chart be sure to explain it and make it a fun part of the process.

It’s a Learned Skill

Your toddler must learn the skill of putting himself to sleep without help. But you can teach the skill without making him cry-it-out by communicating and then gradually intervening less and less through the night. Here’s how:

Slingshot Method

Use a gradual change method that gradually pulls you away from the child while they are falling asleep. Our night nanny and postpartum doula team call this the Slingshot Method. We find this to be most gentle for toddlers. In order to implement Slingshot Method, toddlers should be in their beds calm, but awake. You can do whatever wind down or rocking method you usually do, just be sure they’re still awake when put in the bed.

Next, simply gradually remove yourself from the room.

  1. During the first few nights, stay next to the bed after laying her down and reassure with your voice and touch. If toddler is standing up, gently place them back in a laying down position. You can try patting toddler’s back or singing to keep them from getting back up, but try not to carry them. Yes, you will most likely have to place them back down in the lying position 10-20 times. You’re teaching them the new way to go to sleep which is probably pretty frustrating to them. But you’re also there so they can feel safe and secure.
  2. Continuing on to the next nights, sitting a little further away. If they continue to fuss, you can get up and reassure with touch but try to wait a bit longer between each time. Yes, this is very hard when they are screaming, just keep calm.
  3. During the next few nights, sit even further away from her bed near the doorway. You can get up and touch and reassure if needed.
  4. Eventually you will be in the doorway and then not in the room at all.

Do the above steps slowly and gradually do this so that it is less traumatic for your child. You’re saying “I’m here to help
you get calm, but it is your job to fall asleep.”

Does this mean you must stop co-sleeping? Nope. It’s completely normal for little ones to go through stages of wanting to sleep in the big bed. Like grown-ups, they may feel anxious or nervous about things. They lack the words to talk it through but they do know that being in the cozy bed with parents is comforting.

Sleep Coach Your Toddler – What if they keep getting out of bed and into my bed?

Here is where consistency is key. If your little one comes into your room and they’re not sick or in need of care you will quietly bring them back to their bed and tuck them in. They might follow you out again and you’ll calmly bring them back to their bed. Like sleep training in the crib, you might do this 10-15 times -and that is hard– but if you stay consistent your little one will learn that staying in their bed is the rule for overnights unless they are sick or need help.

tweet about how to sleep coach your toddler
I mean…

Don’t Begin on Empty

Make sure on the day that you begin sleep coaching that your child has a full “sleep tank”; they’ve had a good nap during the day- if that means that you need to take her for a walk in the stroller, or for a car ride, then do it. Do whatever you need to do to get sleep, and make sure that the nap ends 4-5 hours before her bedtime. This is a major component to sleep coaching, daytime sleep = nighttime sleep!

I have a plan, now what?

Soothing Bedtime Routine:

This is an important part of sleep coaching. It’s important to let them get their energy out and switch gears from wakeful to sleepy. Toddlers need help with a soothing routine, just as babies do so a bath and reading books for example provides a good step-down to sleepiness. Just like all babies and adults, when toddlers are drowsy, they’re more likely to fall asleep. 

What Time is Bedtime?

Pay attention to your toddler’s sleep cues. They are not that different from baby sleep cues. Is he rubbing his eyes and yawning at 6:45pm? Then it’s time to start his bedtime routine. If you miss these cues, kids can become over tired, and their brains begin to release cortisol. This happens because the brain thinks, “oh, I need to stay awake, better pump out the hormone that helps!” When this happens, it becomes more and more difficult for them to settle down and fall asleep.

Two year old boy outdoors in striped short and jean shorts
Tips to help toddlers sleep through the night – photo: Rameez Remy on Unsplash

Sleep Coach Your Toddler – what about when I have a newborn too?

In a perfect world, toddlers would be sleeping through the night before the new baby arrives. But we all know that the perfect world gets turned upside down pretty often in early parenting! Here are some strategies to help maximize sleep for your baby, your toddler and hopefully you:

  • Divide and Conquer – This is the man-to-man defense phase of parenting! One parent gets the toddler to sleep and the other handles the infant. Getting both children to bed at the same time can help both children wind down properly, giving the toddler a better chance at uninterrupted sleep.
  • Gradual adjustments– If your toddler is used to certain sleep habits, such as being rocked to sleep or having a parent present, gradually transition them to new sleep associations. For example, you can slowly reduce the amount of time you spend rocking them or move from sitting beside their bed to sitting farther away over a few nights.
  • Hire help – This is a great time to hire a mother’s helper or neighborhood babysitter who can look after your newborn while you concentrate on your toddler’s bedtime routine for a few hours each night. This special uninterrupted time can help pave the way for restful nights.

Once you begin, try your best stick to sleep training. Don’t go back to old habits like lying down beside your child until they are asleep, as this sends a mixed message. And that’s not fair to your toddler! It’s hard when you’re in the thick of sleep deprivation, but try to remember that your child is seeking reassurance when they wake up in the night.

Other Articles you Might Find Helpful:

Night Nannies Answer Infant Sleep FAQ’s

Getting Your Baby to Sleep Through the Night

Essential First Aid Skills for New Parents

There are so many unknowns to parents of newborns and infants! Being prepared in case of an accident or other emergency will not only help your baby, but also help you.  Having the skills to help your newborn, twins or any infant in distress will not only give them the best chance of healing, but allow you to stay calm. Essential First Aid Skills for New Parents are detailed below.

Essential First Aid Skills for New Parents described by newborn care nurses
Baby Nurse (RN) caring for newborn with mom

Essential First Aid Skills for New Parents

Know How to Treat a Burn:

Burns are unfortunately a common childhood injury. Depending on the severity of the burn, they are categorized as first, second, or third-degree burns. 

  • First Degree Burns: use cool water (not ice) to treat first degree burns and apply aloe cream to the area. Do not apply any other ointments or home remedies. The Mayo Clinic suggests, keeping the area clean with a sterile gauze pad for 24 hours. Take care not to use adhesive bandages on young children since they can be choking hazards.
  • Second and Third Degree Burns (more severe): Seek medical assistance immediately and try to elevate the burned area. While waiting for help, remove baby’s clothes, apply cool water for five minutes and then cover the area with a clean dry cloth. If the burn is chemical in nature, rinse the burn persistently before taking off his/her clothes. Then remove clothing from the burned area and continue flushing the burn.

Be able to stop excessive bleeding:

In many cases, the best way to stop bleeding is to use clean gauze and apply firm pressure. If a cut won’t stop bleeding after 5-10 minutes of applied pressure, or the cut is very wide or deep, it’s time to seek professional help by visiting an ER. Continue to apply pressure to the area while in transit to the ER.

It is okay to give your older baby an age-appropriate dose of acetaminophen (Tylenol) for the pain, but never give ibuprofen (Motrin,) which can sometimes increase bleeding. For very severe bleeding cases where blood is spurting out (arterial bleeding,) call 911 right away. While waiting for help, continue to apply pressure and elevate baby’s legs to increase the flow of blood to the heart and brain.

Essential First Aid Skills for New Parents Save a Choking Baby:

If an object gets lodged in baby’s airway, all parents should know what to do. Please note, if baby has a strong cry or is coughing hard, do not perform this procedure. Strong cries and coughs can often push the object out without any additional intervention. But, if your baby is not coughing or crying, follow these steps, as outlined by the American Heart Association:

  • Place baby face down on your forearm, using your thigh or lap for support. Hold the infant’s chest in your hand and jaw with your fingers. Point baby’s head downward so it is lower than the body.
  • With the palm of your free hand, give up to 5 quick slaps between the infant’s shoulder blades.
  • Turn the baby on his/her back and use two fingers to give up to 5 chest thrusts if the object does not come out.
  • Continue the cycle of back blows and chests thrusts until the object becomes dislodges.
  • If the infant loses alertness, give CPR, shout for help and call 911.
  • Remove the object from baby’s mouth if at any point the object becomes dislodged and can be seen.
Choking First Aid for Infants
Choking First Aide for Infants

Essential First Aid Skills for New Parents – Poisoning

Part of babyproofing your home and the homes of others looking after baby means keeping harmful substances out of reach. If baby ingests something poisonous, or even if you just suspect they may have been exposed, call Poison Control or 911 immediately.

Put Poison Control in your phone contacts 1-800-222-1222. Contacting Poison Control is free and confidential.

It may be tempting to induce vomiting if your baby has ingested something harmful. But inducing vomiting in a baby should never be done without the explicit guidance of a healthcare professional.

In the past, parents were counseled to induce vomiting in a child that ingested something harmful using Ipecac syrup. This is no longer recommended. We learned that Ipecac syrup caused side effects such as prolonged vomiting, diarrhea, dehydration, and damage to the gastrointestinal tract.

Identify & Treat a Fever:

If your newborn or infant has a fever, it’s important to monitor their temperature. For babies making eye contact and responding to you, drinking fluids and/or playing, there’s probably no cause for alarm. However there are times when it’s vital to call the doctor.

Call your child’s primary care physician if:

  • Your newborn up to 3 months old has a rectal temperature of 100.4°F (38°C) or higher.
  • Your infant age 3 – 6 months old, has a temperature of 102°F (39°C) or higher
  • Infant age 3-6 months has a lower temperature but is acting unusually irritable, sluggish or uncomfortable
  • Baby age 7- 24 months has a 102°F temperature for longer than 24 hours or has additional symptoms such as cough, or diarrhea

In addition to fevers, Registered Nurse and Newborn Care Provider Liz reminds us: “Newborns temperatures will more commonly drop when septic or fighting serious illness, temps below 97.0 should be taken just as seriously as a high fever.” A doctor or 911 should be called.

List of infant temperature to know if too high or low
Infant Fevers: When to Call the Doctor

As always, if you feel something just isn’t right with your baby, call the pediatrician or even visit the ER.

In an emergency, if your baby is unresponsive and not breathing normally, call 911 and begin CPR. Below are general CPR instructions but these do not take the place of learning proper CPR. Parents and caregivers should take a class and get certified.

  1. Place baby on a firm, flat surface
  2. give 30 chest compressions using two fingers in the center of the chest.
  3. Follow it with two rescue breaths, covering the baby’s mouth and nose with your mouth while maintaining a tight seal.

The above is not a substitute for actual CPR training. Attending a class is the only way to understand proper technique and practice skills.

What Should I ask a Night Nurse?

Newborns and their parents have different needs than families with older kids. Postpartum care, breast and bottle feeding and infant sleep safety are just a few of the areas that make overnight newborn care different. If you’re wondering, What Should I ask a Night Nurse? to find a great postpartum care, this blog is for you!

Question 1: Are you a Nurse?

The terms Night Nurse and Baby Nurse have been used for many years, but they are not always technically correct! Nurse is a legally protected term in most of the US and may only be used by Registered Nurses (RN) and Licensed Practical Nurses (LPN) or Licensed Vocational Nurses (LVN). Just like every tissue is not a “Kleenex” not every baby nurse is an RN or LPN! If you’re interviewing someone using this title, it’s a good idea to clarify their actual credentials.

Postpartum caregivers may use different titles such a postpartum doula, night nanny or newborn care provider. These terms are not protected and anyone can use them. While the spirit of care is the same, the level of education and focus can vary widely. However, all of these are non-medical caregivers. For example, a trained postpartum doula may be expected to prepare meals and provide care to older children, while a newborn caregiver may focus just on the baby. It’s good to clarify expectations before care begins.

Question 2: What’s Your Experience?

What Should I ask a Night Nurse?

Experience can look different in newborn baby care and it’s important to know that there’s no required state registry or requirements for newborn caregivers. We’ve compiled a list of basics that professional postpartum or newborn care providers should have:

  • First Aid and CPR Certification – this should also be a given for anyone in home health or child care. These expire after 2 years; an unexpired cert shows a commitment to understanding and practicing safety protocols.
  • Continuing Education Courses – Recommendations for baby care change over time, so continuing education is vital. Reputable agencies such as a daycare centers or online sources offer updated information in feeding, soothing and safety.
  • References – This is perhaps the most important question of all! Can you speak with multiple parents who can provide honest feedback? Are the references recent? And are the references excellent…or just okay?
What Should I ask a Night Nurse? Two Newborn caregivers smiling.
What Should I ask a Night Nurse?

Question 3: Do You Have a Background Check?

There is no single national database that contains all criminal records in the United States. Criminal records are maintained at the local, state, and federal levels by law enforcement agencies and each agency is responsible for maintaining and providing access to its own records, subject to applicable laws and regulations. (Source: FBI website) In other words, records from one state might not be shared with another.

While no background check is perfect, using a highly-rated background checking service along with references can give you a good picture of a caregiver’s character. If the night nanny has a clinical license, you can also investigate their history on the Board of Nursing.

Question 4: What are your care and feeding philosophies?

Hiring a night nurse or newborn caregiver whose values and philosophy match yours can make service a true partnership. Here are some things to think about:

  • Do you have specific opinions about infant sleep training? How about attachment parenting? Is it important that your caregiver have these same beliefs?
  • How about breastfeeding vs. bottle feeding? Are you a “fed is best” parent or do you prefer to have a lactation counselor who will on coach you through potential nursing challenges?

Having a postpartum caregiver who understands and supports your philosophy as a parent allows for consistency of care and ultimately the most comfortable relationship for your family. As a follow up, you may wish to ask your night nurse or doula to share soothing techniques for baby.  Someone who can explain many safe ways to comfort single babies, preemies and twins is not only demonstrating experience, but also shows that they are attentive and alert to babies’ needs.

5. Question 5: Are you vaccinated?

We know some folks have big, big feelings about vaccines. We get this but it’s important to note that babies 6 months and under are a vulnerable population due to their developing immune systems and inability to receive vaccinations. Because of this, caregivers should take basic precautions to protect vulnerable newborns and infants. (NIH, 2019 and AAP 2021).

In addition to the flu vaccine, it’s recommended that all postpartum doulas and newborn care providers have proof of Hepatitis B, MMR (Measles, Mumps and Rubella) and TDaP (Tetanus, Diphtheria and Pertussis, also known as Whooping Cough). These are the childhood vaccines we all receive.

There are so many wonderful newborn care providers out there and while references and background checks are the most important part of the interview, the peace of mind of safety, good health and demeanor can be what defines a great partnership for your family.  As we always say, someone may be an expert in babies, but you are the expert on your baby!

Newborn Breathing Patterns: What’s Normal?

Updated April 30, 2023 He just stopped breathing for 8 seconds… is that normal? She was breathing regularly, then started breathing really fast… is she okay? It’s completely normal to have these worries, as it’s frightening to see your little one stop breathing for any length of time. So how do we know what’s typical and when it’s time to call the doctor? We break it all down here in Newborn Breathing Patterns: What’s Normal?

Newborn Breathing Patterns: What’s Normal?
Newborn Breathing Patterns: What’s Normal? image credit: RTD Photography

Your newborn breaths differently than you! This is because up until birth,baby’s lungs were filled with amniotic fluid. They didn’t need to breathe on their own because oxygen was received from the placenta! Adapting to breathing breathing air instead of fluid happens right away of course but the lungs and airway passages are underdeveloped compared to an adults.

Normal breathing patterns for newborns can vary depending on their age, activity level, and sleep state but there are general guidelines to keep in mind.

Here’s a breakdown of normal newborn breathing patterns:

40-60 breaths per minute

You can assess your newborn’s breathing by looking at their abdomen. Your infant’s abdomen rises and falls with each breath.  The normal rate is 40-60 breaths per minute in the healthy, full-term infant (counted for a full minute), and will vary depending on whether she or he is sleeping, awake, active, or crying.  (More info in this study on UptoDate)

Apnea

A baby born preterm, or before 37 weeks gestation, is at risk for apnea. Apnea is a pause in breathing for more than 20 seconds. For any parent, this is a very long time! The good news is that pauses that are 5-10 seconds long are completely normal.  These short pauses also called periodic breathing is commonly seen in preterm infants.  After 15 seconds, the baby needs stimulation to resume breathing such as rubbing his or her back, arms, or legs, suggested in this article on KidsHealth.org.  If your baby is prone to Apnea, the hospital will monitor this closely and may prescribe an apnea monitor upon leaving the hospital so you will know if baby ever needs stimulation.

Skin Color and Newborn Breathing

Another good indication that your baby is breathing well is his or her skin color.

  • Pink skin = good perfusion of tissues = good breathing.
  • Blue hands, feet, and around the mouth are actually normal in newborn babies too.   This is called acrocyanosis and is often seen the first few days of life while newborns transition to life outside the womb.
  • Blue INSIDE the mouth is not normal and suggests that baby is not breathing well. 911 should be called immediately if this occurs at home. More on this below.
Newborn Breathing Patterns: What’s Normal
Newborn Breathing Patterns: What’s Normal?

Luckily, breathing issues will resolve on their own as your baby’s brain and spinal cord mature and muscle tone strengthens. You can help your baby breathe best by laying baby on his or her back on a firm, flat crib or bassinet to ensure baby’s airway is open.

Obligate Nose Breathing

Babies are obligate nose breathers which just means they breath through their nose primarily. This is because they ae born with relatively small nasal passages and underdeveloped lungs compared to adults. It’s important to keep the space around their faces clear and have a bulb syringe on hand to clear any congestion.

Most babies start to develop the ability to breathe through their mouth around 3-4 months of age, as their airways and lungs continue to mature. Like adults, they will still prefer to breathe through the nose.

What is Obligate Nose Breathing?

Respiratory Therapist Heidi Christianson, owner of LMS Idaho explains:

Respiratory Therapist Heidi C. explains what obligate nose breathing means.

Grunting and Noisy Breathing

Parents might surprised by how LOUD their babies can be! Newborns often make noises while breathing, including during sleep. Grunting, snorting, or whistling are perfectly normal. These noises are usually harmless and may be due to their small nasal passages. Grunting in particular may also be due to normal digestion. Remember that the hard work of eating, digesting and ultimately passing breastmilk or formula is new to your baby’s system.

Sometimes grunting can be a sign of gastroesophageal reflux (GER), a common condition where stomach acid flows back up into the esophagus and makes baby uncomfortable. If grunting is accompanied by spitting up, irritability, and poor weight gain and you’re concerned, contact your pediatrician.

Newborn Breathing Patterns: What’s Normal? – Respiratory Distress

Below are signs of respiratory distress that while rare, require immediate medical attention:

  • Rapid breathing – breathing faster than usual, taking more than 60 breaths per minute.
  • Flaring nostrils – Flared nostrils during breathing show that baby is working harder than normal to breathe.
  • Retractions – The skin between the ribs or under the ribcage may be sucked in with each breath.
  • Grunting – Sounds of grunting with each breath, instead if just once in a while.
  • Wheezing – Baby may consistently make a high-pitched whistling sound when they breathe.
  • Cyanosis – The baby’s skin, lips, or nails may turn blue or grayish in color. This is different than acrocyanosis which is temporary and normal as newborns circulatory systems adjust to life outside the womb.
    • A new presentation of cyanosis is a sign of low levels of oxygen in the blood. New cyanosis is serious.
    • Persistent cyanosis is a sign of an underlying medical problem.
  • Lethargy: Weak or unresponsive, with little energy to cry or move.

How to administer Choking First Aid to infants in an emergency.

Babies are born with relatively small nasal passages and underdeveloped lungs compared to adults. Overwhlemingly this is not cause for concern but parents and infant caregivers should always contact the child’s pediatrician if they’re concerned about baby’s health.

LMS night nurse Kathleen Hager, RN, BSN who specializes in perinatal care of preemies, twins & triplets contributed to this article.