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Newborns

About newborns…

Skin
At birth your baby's skin is usually covered with a cheesy substance called vernix that protects the skin.  This easily washes away during the first bath.  Any that remains is absorbed through the skin during the next days after birth.  Newborns may have fine, downy like hair on their face, ears, arms and back.  This also soon disappears. Usually your baby's skin will appear dry, even peeling or cracking around the wrist or ankles.  Lotions may make their skin drier and more likely to crack.  Use a little petroleum jelly (Vaseline) on just the areas that appear to be cracking.
  
Rashes
Newborns often have rashes-some that are red or white pimple like-that go away within a few days.  If your baby has a rash that does not go away, gets worse or is blister-like, talk you your baby's doctor. 

Head
The head is the largest part of your baby's body during the first year of life.  Often to fit through the birth canal the head has to mold or change shapes.  Newborns have soft spots (fontanelles) on the tope of the head that allow for this normal change.  Within a short period of time, your baby's head with be round and smooth.

Crying
Crying is your baby's way of communicating.  They may cry when they want to be held or comforted, when they need a diaper change, when they are hungry, when they are sleepy, or in pain.  Soon you will recognize the sound of the difference in the way your baby cries.  At times you will know just what to do to calm your baby and other times it may seem like nothing works.  If you become frustrated, ask someone to give you a break and care for the baby.  Never shake your baby.  Shaking is not a solution and can harm your baby.  If you are alone, place your baby in their crib making sure they are safe and leave the room till you feel calm.  If the cries continue for long periods of time and you are concerned, call you baby's doctor or the Special Delivery Hotline 270-659-2229.   

Mucus
Baby's air passages are filled with fluid before delivery.  Most of the mucus is removed during delivery and by suctioning the baby with the bulb syringe after birth.  Some may still remain and cause your baby to gag, spit up mucus or sneeze.  Use the bulb syringe if your baby seems to gag or choke on mucus or milk, or if the nose seems full of mucus.  First press the bulb to squeeze out all of the air, and then gently slide the tip of the syringe in to the side of the mouth or at the opening of the nose and release.

Jaundice
Jaundice, or a yellow discoloration, of your baby's skin is common and usually harmless.  You may first notice that your baby's eyes and face appear yellow.  Jaundice is one way your baby gets rid of bilirubin that sometimes builds up as newborns breaks down old blood cells. They also get rid of bilirubin in their urine and their stool.  Frequent feeding is important.  Breastfed babies need to eat 10-12 times a day.  Formula fed babies need to eat at least every 3-4 hours.   After going home, if you notice that the yellow discoloration is increasing and extends below your baby's belly button, call your baby's doctor.  Sometimes jaundice needs to be treated with phototherapy.  In phototherapy, the baby is placed under special lights (bili lights) without clothes.  Their eyes are covered to protect them from the light.  If your baby requires phototherapy, it may be done in the hospital or at home.  If your baby is hospitalized for phototherapy, you are encouraged and welcome to stay with them.

Caring for your newborn…
Caring for a new baby is both a wonderful and sometimes trying responsibility.  Especially if this is your first baby, you may have lots of questions about what to do.  Your nurse will help you learn to care for your baby before you go home.  Take advantage of the help and ask questions when you are unsure. Some recommended ways of caring for babies have changed during the past several years.  It may not be the same as how your mother cared for you or you cared for your last baby.

Diapering
Your baby will have frequent wet and dirty diapers during the first weeks of life.  Stools will be dark, thick, and tar like during the first week.  Breastfed babies will have soft yellow stools beginning at 5 to 7 days.  Formula fed babies will have formed brown to yellow-brown stools.  Changing your baby's diaper and cleaning their bottom with warm water at each change will often prevent skin rashes or infections.  Packaged wet wipes are convenient for trips away from home, but may dry out your baby's skin if used every day. 
To clean a baby girl, separate the folds and wash front to back.  Use a clean part of the cloth for each wipe. For baby boys, use a wet cloth to clean his penis, scrotum and underneath the scrotum first.  Then clean around the rectal area last.  If your baby boy is newly circumcised, drip water on his penis and gently blot.  Position the penis downward in his diaper.  Fold the upper edge of the diaper below the umbilical cord until healed.
Powders, lotions, and baby oils should be avoided. 
If your baby's bottom becomes red or irritated:

• Change diapers more often
• Be sure to clean diaper area with each change
• Avoid wet wipes or soaps that may be irritating
• Allow diaper area to air dry.  If may be helpful to let baby sleep with the diaper down.
• Use an ointment such as Desitin or Vaseline after cleaning and drying.
• Check with your baby's doctor if rash is not better in 3-5 days.

Care of the Umbilical Cord
The dried stump of the umbilical cord will usually fall off in 10 to 14 days after birth.  Until then, use a cotton swab (Q-tip) or cotton balls with rubbing alcohol several times a day to clean around the base of the cord.  This will help prevent infection and help it to dry faster.  This is not a painful procedure, but you baby may cry because it feels cold.  If the cord is bleeding, if around the cord is red, swollen, or has a strong foul odor, call you baby's doctor.

For Boys Only
Uncircumcised Care:  If your baby's penis is not circumcised, no special care is needed.  Do not try to pull back on the foreskin.  It will separate in time.  Forcing it to retract may cause harm, pain and or bleeding.  Simply wash the penis often with mild soap and water.   Over the next several years the foreskin will gradually become looser.  Without forcing it to retract, this area should also be washed with mild soap and water often allowing the foreskin to slip back into place after cleaning.  Call your baby's doctor if he has pain or discomfort when urinating or if the stream of urine becomes just a trickle.

Circumcision Care:  After circumcision the penis will be wrapped in gauze covered with petroleum jelly (Vaseline).  Continue to rinse with warm water to clean and use a generous amount of petroleum jelly on the penis for the next 7 to 10 days while it is healing.  If the penis dries and sticks to the diaper, use warm water to soften before pulling the diaper off. The penis will be red and a yellow film will form around the head of the penis.  This is normal and is part of the healing process.  Call your baby's doctor if it is unusually red after the first 3 days or if bleeding that won't stop after applying pressure with a moist cloth.

Plastibell circumcisions require no special care.  The plastic ring will fall off in 4 to 8 days.  A small amount of drainage is normal.  If you notice swelling, the plastic ring slips over the shaft of the penis, or the ring has not fallen off in 8 days, call your baby's doctor.

Sleeping
Newborns may sleep as much as 16 hours a day, only waking for feeding every 2 to 3 hours.  As your baby grows they will have longer periods of awake time. 

Tips on baby sleeping:

• Use a firm mattress. A soft mattress can result in infant suffocation.
• There should be no gaps between the mattress and the frame of the crib or bed. Infants and small children can become wedged in gaps.
• Bedding should fit tightly around the mattress. Avoid soft bedding and other items, including comforters, pillows, featherbeds, stuffed animals, etc. These can be cause infant suffocation.
• Avoid strings or ties on all nightclothes (both baby's and parents'). These pose a strangulation risk.
• Keep baby's face uncovered to allow ventilation.
• Put baby on his or her back to sleep. Babies sleeping on their backs are less likely to become victims of SIDS.
• Adults should avoid smoking. Exposure to tobacco, both before and after delivery, is associated with a higher risk of SIDS death in babies.  If you want to know more about how you can stop smoking, call Jean Nunn or Judy Compton at 651-4450 (TJ Samson Community Hospital)
• Avoid overheating the room in which the baby sleeps and avoid overdressing the baby. Overheating is associated with an increased risk of SIDS.
• Babies who are breastfed have less risk of SIDS.
• Avoid placing a crib near window treatment cords or sashes. These pose a strangulation risk.

 Cribs

• When baby learns to sit, lower the mattress level so that he or she cannot fall out or climb over the side.
• When baby learns to stand, set the mattress level at its lowest point and remove crib bumpers.
• When baby reaches a height of 35 inches or the side rail is less than three-quarters of his or her height, move the baby to another bed. Babies can fall from their cribs if the side rails are not at the right level in relationship to the mattress surface.
• Crib bumpers should have at least six ties, and these should be no longer than 6 inches in length. Bumper ties that are too long can pose a strangulation risk.
• Hang crib mobiles well out of reach and remove them when baby starts to sit or reaches five months of age, whichever comes first. Mobiles become strangulation or choking hazards if baby can reach them.
• Remove crib gyms when baby can get up on all fours. Babies can become entangled in these and risk strangulation.

About Bed-Sharing

• Adults using alcohol or other drugs, those taking over-the-counter or prescription medications that may cause them to sleep too soundly, and those suffering from extreme exhaustion should not sleep with their baby. Such adults may not be aware of the baby in the bed, creating a risk of the baby being rolled over on and suffocation.
• Head/foot board railings should have spaces no wider than those allowed in safety-approved cribs. As with cribs, these spaces can become places for baby to become entrapped and suffocate.
• Don't use bed rails with infants under one year. Babies can become wedged between the mattress and the side rail, resulting in suffocation.
• Don't allow older children in bed with an infant less than one year old. Very young babies are at a greater risk of being rolled over on and suffocation by older children.

More……

• Do not sleep with your baby in a waterbed. The surface of a waterbed can prevent ventilation if a baby moves to a facedown position.
• Do not sleep with baby on sofas or overstuffed chairs.
• Do not put baby to sleep alone in an adult bed. (Both of these practices put baby at risk for wedging, entrapment, and suffocation.)

Resources: 1. American Academy of Pediatrics policy statement, "Changing Concepts of Sudden Infant Death Syndrome: Implications for Infant Sleeping Environments and Sleep Position (RE9946)," www.aap.org/policyrRe9946.html, March 2000.
2. American Academy of Pediatrics, Caring for Your Baby and Young Child, Birth to Age 5 (New York: Bantam Books, 1998), 16-17.