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Newborn care If you just recently came home with a newborn child from the hospital and are feeling excited, scared and more scared - well then you are very normal and came to the right place. Been there twice and believe that I did it twice. First off, if you have not had the opportunity for a face-to-face talk with your pediatrician regarding anticipatory guidance and routine neonatal care, my first suggestion would be to set that up. We want to avoid unnecessary visits to a crowded and germ-filled office and at the same time have some reassurance for what we are doing. All new parents need some backup when they get home. The information in this section will provide Mom and Dad with some basic newborn care guidelines. We will cover such topics as feeding, umbilical cord care, safety issues and when you need to call your pediatrician. Other backup, as in family and friends, are essential so that you can get a little sleep and some time out of the house on occasion. Easier said than done but try it with those you trust. Don’t feel guilty about placing restrictions on visitors though if you are not up for it. Best of health with your "new addition".
Feeding
Why is breast milk considered the healthiest for my baby? Breastfeeding is always the best nutritional choice and the least expensive as well. There are many reasons why breast milk is the best milk, including the following: Nutrients Human milk is rich in the nutrients that best promote brain growth and nervous system development. This is due mostly to certain types of fat (fatty acid chains) in human milk, which are not available in artificial formulas.
The sugar (carbohydrate) and protein in breast milk are also designed to be used easily and more completely by the human baby. Your milk is the perfect first food to help your baby achieve every aspect of ideal growth and development.
The American Academy of Pediatrics recommends that babies who are exclusively breastfed receive additional vitamin D. Your baby’s physician can recommend the proper type and amount of vitamin D supplement for your baby.
Anti-infective properties Babies who are fully or almost-fully breastfed, or breast milk-fed babies, have significantly fewer gastrointestinal, respiratory, ear, and urinary infections.
Antibodies in human milk directly protect against infection.
Easily digested Breast milk is the most easily digested food your baby can receive. Your baby uses less energy, yet breaks your milk down more completely into its basic ingredients, so the nutrients, anti-infective factors, and all the other ingredients in your milk are more available to fuel your baby’s body functions and to promote your baby’s growth and development.
What are some important breastfeeding tips I should know? - Calcium is important. You do not have to drink cow’s milk to make breast milk, as long as you drink plenty of water and get adequate amounts of vitamin D and calcium. Antacids, calcium-fortified orange juice and fish are good sources of calcium.
- Cow’s milk proteins can enter into breast milk, and this may be particularly important in families with strong milk allergy histories.
- If you need to skip a feeding, breast milk can be pumped and the milk refrigerated (or frozen) for later use. Breast milk lasts for up to three months in the freezer.
- However, there is nothing wrong with occasional supplementation with formula if pumping is not feasible or the supply of breast milk is insufficient. The only exception to this advice may be a strong family history of milk allergy, in which case a soy-based formula should be the first backup, if needed.
- Keep in mind that many substances the mother takes in, including herbs and drugs, may find their way into the breast milk. You should check with your pediatrician before taking any prescription medications, to avoid transmitting potentially harmful substances to the baby. You can also call your Poison Control Center at 1-800-222-1222.
- Most pediatricians will recommend breastfeeding for at least 6 months if possible.
If I chose to bottle feed, what should I know? - You do not need to sterilize anything, including the formula or the bottle. Your usual dishwashing method is sufficient.
- The baby’s bottle doesn’t have to be any warmer than room temperature, although some babies may prefer it warmed to body temperature.
- Do not bottle prop. The baby’s bottle must always be in the control of a human hand, so as to prevent potentially fatal choking and aspiration.
How often should I feed my baby? - Generally, it’s recommended that babies be fed on demand — whenever they seem hungry. Your baby may cue you by crying, putting fingers in his or her mouth, or making sucking noises.
- A newborn baby needs to be fed every 2 to 3 hours. If you’re breastfeeding, give your baby the chance to nurse about 10–15 minutes at each breast. If you’re formula-feeding, your baby will most likely take about 2–3 ounces (60–90 milliliters) at each feeding.
- Some newborns may need to be awakened every few hours to make sure they get enough to eat. Call your baby’s doctor if you need to awaken your newborn frequently or if your baby doesn’t seem interested in eating or sucking.
How do I know if my baby is getting enough to eat? - If you’re formula-feeding, you can easily monitor if your baby is getting enough to eat, but if you’re breastfeeding, it can be a little trickier. If your baby seems satisfied, produces about six wet diapers and several stools a day, sleeps well, and is gaining weight regularly, then he or she is probably eating enough.
Remember, babies younger than 4 months of age should not be given solid foods. Feeding solids too soon can lead to allergic reactions, constipation, gas, diarrhea, or excessive weight gain.
Also, do not give your infant honey due to the association with infant botulism.
Spit ups and Burping
When babies are very young, they often spit up a small amount of their last feeding. The medical term for this condition is gastroesophageal reflux. Usually, it is only a teaspoon or so of formula or breast milk, and does not cause much concern. However, if your child often vomits and is in pain or is not gaining weight properly, it is a serious condition. Your baby should be seen by your pediatrician if this occurs. What causes newborn babies to spit up? What can I do to keep my baby from spitting up? You can minimize mild spit up by burping a baby during the feeding, as well as immediately after the feeding. Babies often swallow air during feedings, which can make them fussy. Burping can help prevent this as well.
Try burping your baby every 2 to 3 ounces (60–90 milliliters) if you bottle-feed, and each time you switch breasts if you breastfeed. If your baby tends to be gassy, has gastroesophageal reflux, or seems fussy during feeding, try burping your baby every ounce during bottle-feeding or every 5 minutes during breastfeeding.
Before you burp the baby, place a cloth on your shoulder. Babies can be burped by holding the baby against your shoulder and gently patting the baby with your hand between the shoulder blades. Or position the baby in a sitting position while supporting their head and back, then gently pat the back.
You may also try placing your baby in an infant seat for 10-15 minutes after a feeding.
Also try feeding your baby more often, but in smaller amounts. Don’t wait until he or she is crying hard to feed her. Also, try feeding him or her after a bath rather than before.
How will I know if a formula disagrees with my baby?
You may see some of the following signs and symptoms: Talk to your doctor before changing your child’s formula. Unnecessarily changing an infant’s formula or making multiple formula changes can confuse the picture and make it more difficult to figure out which formula is best for your baby. Colic Just the word can send shivers down a parent’s spine. Colic is defined as excessive crying (at least 3 hours a day, for more than 3 days a week, for at least 3 weeks) in an otherwise healthy baby.
In general, it appears at around 2 - 4 weeks of age and usually ends by 3 months of age, although it may last for another month or so.
The cause of colic is unknown, although some theories exist.
For complete details on the crying infant and colic, including signs and symptoms that may indicate something more serious than colic and some interventions that may help, click on Colic.
Bathing your Baby
How do I bathe my newborn baby? You should give your baby a sponge bath until: the umbilical cord falls off (1–4 weeks)
the circumcision heals (1–2 weeks)
the naval heals completely (1–4 weeks) Sponge bath Pick a warm room and a flat surface, such as a changing table or counter. Undress your baby. Wipe your infant’s eyes with a washcloth dampened with water only, starting with one eye and wiping from the inner corner to the outer corner. Use a clean corner of the washcloth to wash the other eye. Clean your baby’s nose and ears with the washcloth. Then wet the cloth again, and using a little gentle, unscented soap such as Dove or Ivory, wash his or her face gently and pat it dry. Next, using baby shampoo, create a lather and gently wash your baby’s head and rinse. Using a wet cloth and soap, gently wash the rest of the baby, paying special attention to creases under the arms, behind the ears, around the neck, and the genital area. Once you have washed those areas, make sure they are dry and then diaper and dress your baby.
Tub bath Make sure the water in the tub is no more than 2 to 3 inches deep, and that the water is no longer running in the tub. Use one of your hands to support the head and the other hand to guide the baby in feet-first. Slowly lower your baby up to the chest into the tub. Use a washcloth to wash his or her face and hair. Gently massage your baby’s scalp with the pads of your fingers or a soft baby hairbrush, including the area over the fontanelles (soft spots) on the top of the head. When you rinse the soap or shampoo from your baby’s head, cup your hand across the forehead so the suds run toward the sides and soap doesn’t get into the eyes. Gently wash the rest of your baby’s body with water and a small amount of soap. Throughout the bath, regularly pour water gently over your baby’s body so he or she doesn’t get cold. After the bath, wrap your baby in a towel immediately, making sure to cover his or her head. Baby towels with hoods are great for keeping a freshly washed baby warm.
While bathing your infant, never leave the baby alone. If you need to leave the bathroom, wrap the baby in a towel and take him or her with you. A bath two or three times a week in the first year is sufficient. More frequent bathing may be drying to the skin.
Cord care, Circumcision and Vaginal Care
How do I care for my baby’s umbilical cord? Until the cord comes off and there is no evidence of any yellow or white material remaining in the center, the baby should not be immersed in water. Sponge baths are adequate until then.
Until it falls off, the cord stump will change color from yellow to brown or black — this is normal.
You can expect the cord to come off within two weeks or so. If that hasn’t happened, the pediatrician can dry the cord with silver nitrate at the two-week office visit.
The dead skin of the cord stump is normally gooey at its base. However, if the abdominal skin around the cord becomes at all red, especially if the baby is irritable, over-sleepy, or feeding poorly, you should call your doctor immediately. This can indicate a serious infection known as omphalitis (see photo named Omphalitis).
How do I care for my newborn’s circumcision site? Immediately after circumcision, the tip of the penis is usually covered with gauze coated with petroleum jelly to keep the wound from sticking to the diaper.
Gently wipe the tip clean with warm water after a diaper change, then apply petroleum jelly to the tip so it doesn’t stick to the diaper.
Redness or irritation of the penis should heal within a few days, but if the redness or swelling increases or if pus-filled blisters form, infection may be present and you should call your baby’s doctor immediately.
How do I care for my newborn’s uncircumcised penis? Wash the foreskin area with warm water, especially when changing dirty diapers. Remember, this male genital care is very important because of the association of urinary infections during the first four months of life with being uncircumcised.
How do I keep my newborn daughter’s vaginal area clean?
Wash the area between the genital lips gently, using only warm water. It is not to use soap because it can cause very small abrasions that predispose to urinary infection.
Note: Maternal hormones absorbed before birth may cause some bloody discharge from the vagina during the first month of life, as well as milk or yellowish discharge from the breasts.
Quality of stools How often should a newborn infant have a bowel movement? - Depends if you are breastfeeding or bottlefeeding. Baby’s who are breastfeeding can have very watery stools in the beginning. It is normal for a breastfed baby to have over 10 small, watery stools a day, usually very soon after feeding, as long as the stool is not so watery that it runs out of the diapers. Breastfed babies may go one to three days without a stool as they get older. As long as they are not straining, having hard stools, or vomiting, this is OK.
- In general, formula is more constipating than breast milk. Many bottle-fed babies normally have only one stool a day. If more than a day goes by without a stool, the baby probably isn’t getting enough fluid and should be given extra water. If the stool looks like little pebbles or is becoming hard, or if the child is straining, parents can add a small amount of apple or pear juice to the water, no more than one part juice to three parts water. If the stool is very runny in a bottle-fed baby, you should discuss with your pediatrician.
Skin Care and Newborn Rashes - Babies should be washed with gentle, unscented preparations such as Dove or Ivory.
- Unscented lotions after bathing are also acceptable.
- Baby wipes might bring about rashes caused by the chemicals and fragrances. Warm, wet washcloths at home are a good substitute, with baby wipes used only for traveling.
Are rashes common in newborns and how do I know when they need a specific treatment? All babies have rashes and changes in skin color at one time or another. Most are not seroius and resolve over a short period of time on their own. However, some rashes do require specific attention and treatment. Below is a partial list of rashes not to be a concerned about and some that require evaluation and/or treatment by your doctor. You can click on the individual rashes to go to the Newborn Rashes Photo Gallery or just click on Photo Gallery and scroll through the photos.
Benign, or "not to worry" rashes: - Epstein’s pearls
- Erythema toxicum
- Milia
- Miliaria crystallina
- Mongolian spots
- Neonatal acne
- Neonatal pustular melanosis
- Seborrheic dermatitis (Cradle cap)
Rashes that require evaluation and treatment: - Candidal diaper rash
- Irritant diaper dermatitis
- Infantile Eczema (atopic dermatitis)
- Thrush
- Rashes with a history of maternal infection of one of the following: genital herpes, rubella, varicella, syphilis, cytomegalovirus or toxoplasmosis
Diaper Care
Get ready Dads - this is a big time job! After each bowel movement or if the diaper is wet, lay your baby on his or her back and remove the dirty diaper. Use water and a washcloth or wipes to gently wipe your baby’s genital area clean. When wiping a girl, wipe her bottom from front to back to avoid a urinary tract infection.
How can I prevent a diaper rash in my baby?
Most rashes occur because the baby’s skin is sensitive and becomes irritated by wet diapers (see photo called Irritant diaper dermatitis). To help prevent diaper rashes, try these tips: Change your baby’s diaper frequently, and as soon as possible after bowel movements. After cleaning the area with mild soap and water or a wipe, apply a diaper rash or "barrier" cream. Creams with zinc oxide are preferable because they form a barrier against moisture. If you use cloth diapers, wash them in dye- and fragrance-free detergents. Let the baby go undiapered for part of the day. This gives the skin a chance to air out. If the diaper rash continues for more than 3 days or seems to be getting worse, call your doctor - it may be caused by a fungal infection that requires a prescription (see photo called Candidal diaper dermatitis).
Teething
How can I tell if my baby is teething?
If your baby is a few months old, chewing on his or her hands, drooling and unusually cranky, it may signal the arrival of baby teeth. Teething may begin as early as three months or as late as nine or 10 months. Rub your forefinger along the baby’s gumline. If you feel a bump in the gum or the top of a tooth, it’s begun. The first teeth to erupt are usually the lower middle two teeth, followed by the upper middle two teeth, but this pattern varies. Teething does not cause high fever, heavy diarrhea or vomiting so in this case you should contact your pediatrician. If you see a blue knot on the gumline this is OK as it is only a tooth erupting through a blood vessel. There may be a little bit of bleeding once the tooth does emerge. For pain with no other signs other than an emerging tooth, you can try teething rings, a cold wet cloth or acetaminophen (Tylenol) - See Dosing Chart.
Sleeping Patterns
If a newborn was more like a 2 year-old we would all be in trouble. Even though it may not seem like it, newborns can sleep 16 hours or more a day.
They won’t sleep through the night though - not yet. The digestive system of babies is so small that they need nourishment every few hours and should be awakened if they haven’t been fed for 5 hours (or more frequently if your doctor is concerned about weight gain).
When will my baby start sleeping through the night? Many babies sleep through the night (between 6–8 hours) at 3 months of age, but if yours doesn’t, it’s not a cause for concern.
Remember: To reduce the risk of Sudden Infant Death Syndrome (SIDS), place your baby on his/her back to sleep. Remove stuffed animals, pillows and fluffy bedding from the crib to prevent suffocation.
The Stuffy Nose
Newborn babies are not adept at mouth breathing so when they get a stuffy nose, their noisy breathing may not sound so good.
The way to deal with the problem is to first break up the mucus with 3-4 saltwater drops in each nostril and then use a small rubber aspirator. Squeeze the bulb of the aspirator before you begin, then aspirate each nostril six to eight times in rapid succession, squeezing the bulb each time before touching the nose.
Car Safety
You must have an infant car seat to take your baby home from the hospital.
The car seat should face backwards for the first year of life and first 20 pounds before facing front, to protect the newborn’s relatively weak neck.
Babies and children under age 12 should not be in the front passenger seat where airbags can injure them.
When do I need to call my doctor?
Here is a partial list of what should concern you enough with your baby to call your doctor:
- Rectal temperature of 100.4 F (38 C) or more or temperature less than 96°F (35•5°C). Rectal temps are the most reliable.
- Trouble breathing (chest drawing in, breathing fast, grunting)
- Apnea (stops breathing) - newborns have whats called periodic breathing in which they may not take a breath for 10 seconds or so - this is OK as long as there is no color change (blue spells), have labored breathing or sick in any other way.
- Irritability or persistent lethargy
- Poor feeding with or without signs of dehydration
- Seizures or stiffness
- Movement only when stimulated
According to a January 2008 article in The Lancet, a checklist of seven clinical signs and symptoms could help identify sick newborns, aged up to 2 months, with possibly severe illness who are brought to health facilities. For details, click on the Lancet article.
For more helpful tips and suggestions for your fridge, go to http://www.kidemergencies.com/ERchecklist.pdf
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