2025 – PAGE 177 – NEONATOLOGY

CRYING

Two to three hours of crying per day is normal initially. By three months of age, babies cry approximately 1 hour/day.

MNEMONICS: Use 1-2-3 and 3-2-1 to remember that at months 1, 2, and 3, babies usually cry a maximum of 3, 2, and 1 hours per day.

COLIC

(DOUBLE TAKE) Colic is defined by LOTS OF THREES! The infant will have a normal exam and normal lab values. Look for a baby who has been crying > 3 hours/day at least 3 times/week for at least 3 weeks. The age should be between 3 weeks and 3 months. This should resolve by 3 – 4 months of age. Recommend that the parents recruit help from family/friends so that they can get breaks.

PEARL: If a child presents like this after 4 months of age, do an aggressive workup.

MNEMONIC: Remember the “3’s”: > 3 hours per day, > 3 times per week, > 3 weeks and resolves by 3 months of age.

SLEEP

Babies sleep 18 hours/day when first born.

PEARL/SHORTCUT: After that, you can approximate the average number of hours a baby should be sleeping per day by subtracting 1 hour from 18 for each month they age. This shortcut holds true until about 4-5 months of age. From approximately 5 months to 3 years of age, children need 12-14 hours of sleep.

SUN SAFETY

The vast majority of a person’s lifetime sun exposure occurs before the age of 18. Since sun damage is cumulative, sun safety is important almost immediately. Both UVA and UVB exposure lead to aging of the skin, skin cancers, and sunburns.

• Infants < 6 months of age have poor perspiration and are not mobile enough to get themselves out of hot spots like you can. So avoid all direct sunlight for this age group.
• Infants > 6 months of age should use SPF 15 sun block (blocks UVA & UVB) and be kept out of the midday sun.

AUTOMOBILE AND CAR SEAT SAFETY

Automobile and car seat safety guidelines vary depending on a child’s age and weight.

• REAR-FACING CAR SEAT: From birth to 24 months of age, babies should be seated in the back seat at a 45-degree angle. They should be seated in the middle and face the rear of the car. This should be continued until the child is over 24 months or until he or she outgrows the car seat’s weight and height limits (as labeled by the manufacturer). After that, the car seat may face forward.
• FORWARD-FACING CAR SEAT: When they graduate from the rear-facing seat, they can be in a front-facing car seat with a harness until they outgrow the car seat’s weight and height limits as labeled by the manufacturer (usually around 4 years of age).
• BOOSTER SEAT: Around 4 years of age or 40 lbs., kids outgrow the car seat and will need a belt-positioning booster seat. They stay in that until a regular seatbelt fits.
• SEATBELT: Children may use a regular seatbelt while still sitting in the back seat once it fits properly. This is usually when they reach 4 feet 9 inches or around the ages of 8–12.
• FRONT SEAT: Children may sit in the front seat once they become teenagers (regardless of weight).