Kristen Gleason

Newborn Care
General Instructions

Newborns can be picked up by gently sliding one hand under the neck and shoulders and
the other hand under the buttocks or between the legs. Then, gently lift the newborn. This
provides support for the head. Good head control does not develop until 3-4 months of
age.
The best positions to hold your baby are in a cradling position, upright with his/her head
over your shoulder with your hands beneath the buttocks and bottom of the head, or
resting over your forearm with the babys head in your hand and feet under your arm
(football hold).
Never leave the baby alone anywhere except the crib.
Watch for excessive mucus. If present, use the bulb syringe (see below) to remove mucus
from the mouth and nose.
Never leave baby unattended on a high surface, always have at least one hand in contact
with baby when on a changing table or other raised area.

Bulb Syringe Suctioning

Babies must be able to breathe through their noses for the first few months of life. They
keep their noses clear by coughing or sneezing.
During the first few days of life, babies have more mucus and may need help clearing it by
gentle use of a bulb syringe.
If suctioning is needed, compress the bulb syringe in one hand and place the tip of it into
the nostril. Be careful not to block the nostril with the syringe.
Allow the syringe to slowly refill with air. This ensures the suctioning is gentle and will not
damage the delicate nose tissues.
Squeeze the syringe over a tissue or paper
towel to clear it and compress it again before
reinserting to suction the other nostril.
If the mouth needs to be suctioned (you can
suction the mouth if your baby spits up is
gagging), put the bulb syringe into the side
of the mouth. Suctioning in the center can
cause your baby to gag and will not work.
Clean the bulb syringe every day and after
use by washing it in warm, soapy water and
rinsing in clean warm water.
You can also rinse the bulb syringe in white
vinegar water solution and then in clean
water. This will help prevent bacteria from
growing inside.
Always keep the bulb syringe near your
baby so that it is right there when you
need it!

Kristen Gleason

Safe Sleep

Evidence shows the safest way for babies to sleep is on their backs,
not on their sides or their stomachs.
Babies should be placed alone on a firm crib or bassinet mattress, never in
bed with parents or on a soft surface such as a couch or waterbed.
Keep the babys sleep area clear of blankets, pillows, crib
bumpers, stuffed animals, or other objects.
Following these safe sleep practices will reduce the risk of sudden
infant death syndrome (SIDS).
Other ways to reduce SIDS risk include keeping the babys crib or bassinet
in your
bedroom, avoiding overheating baby, not smoking (babies of parents who smoke are at a
higher risk for SIDS), and giving baby a pacifier while sleeping.

Kristen Gleason

Kristen Gleason

Swaddling

Wrapping your baby in a blanket, or swaddling, helps keep the baby keep the proper body
temperature and provides a feeling of security.
Swaddling can help quiet a crying baby and may help the baby fall asleep by reducing the
amount of arm movement and allowing better rest.
Place a blanket on the crib or other flat, secure surface in the shape of a diamond.
Fold the top corner down slightly and place the newborn with his or her head at the upper
edge of the blanket.
Wrap one corner around the front of the baby and tuck it under the opposite side of the
body.
Pull the bottom corner of the blanket to the chest level, then wrap the other corner around
and tuck under the opposite side.
Your nurse can demonstrate this technique for you.

Breastfeeding
Basics

Breast
milk is
produced
according to
demand. The
more
often baby is
brought to the breast, the more your body will produce. Establish your milk supply by
feeding frequently (every 1 to 3 hours).
You need to be sure to drink enough fluids so that your body can produce enough breast
milk.
You may feel a tingling sensation with let-down of milk flow. This can be triggered by your
babys sucking, presence, or cry; by thinking of your baby; by stimulation of the breasts
such as with warm water in a shower; or during orgasm. You can wear absorbent pads in
your bra to protect your clothing from breast milk that may leak during letdown between
feedings.
When you are ready to feed your baby, get into a comfortable position with your arms
supported.
Turn your babys entire body towards you with his or her mouth near your nipple. Keep
babys ear, shoulder, and hip in line with each other.
Lightly brush babys mouth with the nipple to stimulate the rooting reflex and help baby to
latch.
Babys mouth should go straight onto the nipple. Most of the nipple should be in the
babys mouth. If baby is latched onto the tip of the nipple, detach the baby and try
latching again. If baby sucks on only the ends of the nipples, this will cause you pain and
make it harder for baby to get milk.
It may take up to 3 minutes for let-down to occur after starting a feeding. Be patient.
Allow baby to suckle at the first breast until it is emptied.

Kristen Gleason

To break suction, insert a finger in the corner of babys mouth near the nipple.
Burp baby before changing breasts.
Burp baby again after feeding is complete.

Breastfeeding, Continued

Keep track of which side you started on, and start the next feeding on the opposite breast.
You can use a safety pin on your shift as a reminder.
Wash nipples with warm water and dry thoroughly after feedings to protect your skin.
Use different positions at the breast at each feeding to protect your nipples and ensure
your breasts are emptied.
Avoid supplementing by pumping or feeding formula until your supply is well-established.
Check with your doctor before taking any medications while breastfeeding because many
will cross into your breast milk and could harm your baby.

Formula Feeding Basics

Formula may be ready-to-feed (use it directly from the can or bottle), concentrated (must
be diluted with water before feedings), or powder (mix with water). Follow instructions on
the container for preparing formula.
Start with 3 oz in each bottle. Newborns usually eat 1-3 oz every 2 to 4 hours.
Prepare a fresh bottle for each feeding. Do not add new formula to old bottles.
Do not feed baby partially-used bottles after they have been out for an hour or more at
room temperature.
If you make bottles in advance, keep them refrigerated.
After opening a can of concentrated or ready-to-feed formula, it is good for 48 hours. Do
not feed formula to baby after this time.
When traveling, keep formula and water separated. Premeasure water and formula, then
mix when ready to feed.
You can try feeding bottles to baby right out of the refrigerator, but most babies prefer
warm formula, which is more similar to breast milk.
To warm a bottle, run it under hot tap water or place it in a bottle warmer or a pan of
heated water.
Always test the temperature of formula before feeding by placing a few drops on your
wrist.
If using a microwave to warm formula, be very careful. Use the defrost setting and
carefully check mix and test the temperature of formula before feeding. Milk can be
superheated and plastic bags may burst.

Bottle Feeding

To feed baby, hold baby close and establish eye contact. Keep babys back straight to help
with digestion.
Quiet baby before feedings.
Keep baby partially upright, avoid feeding while baby is on his or her back.
Never prop a bottle. Baby could choke and is also at a higher risk for ear infections if fed
from propped bottles.
Only drops of milk should flow out of the bottle. Adjust to ensure proper flow.

Kristen Gleason

Keep the nipple filled with milk to decrease the amount of air swallowed.
Watch for signs that baby is not hungry anymore. He or she may stop sucking or turn his
or her head away.
Burp baby after each ounce eaten and at the end of the feeding.

Kristen Gleason

Burping Baby

Position baby so his or her head rests on your shoulder

You may also place baby face down on your lap or sit baby on your lap with his or her chin
and chest supported.
Gently pat or stroke babys back.
You will learn the best position to burp your baby and whether your baby is a slow or quick
burper.
It is normal for baby to regurgitate a small amount of milk or formula. Keep a burp cloth
available.

Umbilical Cord Care

Your babys umbilical cord stump will gradually dry and will fall off within 7-14 days of
birth.
Keep the cord dry and exposed to air or loosely covered with clean clothing.
Fold diapers below the umbilical cord to help the cord dry and keep away from wet or dirty
diapers.
Check the cord every day. The cord should look dry and will darken and shrivel up as it
gets ready to fall off.
Oozing of greenish or yellow material, bleeding, and redness around the cord should be
reported to your pediatrician.
Never pull the cord or try to loosen it.
Clean around the base of the cord with a cotton swab or cotton ball 2-3 times a day or with
each diaper change.
Do not give your baby tub baths until the cord falls off. Sponge baths should be done until
this time.
There may be a small drop of blood when the cord falls off; this is normal.

Bathing Your Newborn

You should give your baby sponge baths until the umbilical cord stump falls off.
For a sponge bath you will need a small basin of warm water, washcloths, towels, receiving
blankets to rest baby on, a hair brush, mild unscented baby soap
Bathe baby in a warm, draft-free room.
Test the temperature of the water on your inner wrist to make sure it is warm, not hot.
Babies should be bathed daily in warm, humid weather and twice a week in dry weather.
Keep one hand on baby at all times during the bath.
Start at the babys head while baby is still clothed. Using a wet washcloth without soap,
wipe one eyelid from the inner corner to the outer corner. Then change the spot on the
washcloth to a clean area and do the same on the other eye.
Wash the outside of babys ears using your index finger covered in the washcloth.
Wash the rest of babys face.
Using a small amount of soap, wash the rest of babys body. Start with the neck, paying
special attention to the creases. Dry each area you have washed completely before
continuing to prevent baby from getting chilled.
Remove babys shirt and wash chest, arms, and hands.

Kristen Gleason

Hold baby off the table and support him or her to wash the back.
Dry baby and wrap the upper body in a towel or blanket before washing the legs and feet.
Wash baby girls genitalia from front to back.
In uncircumcised boys, do not retract the foreskin. Never force the foreskin back it will
retract normally over time. This can take 3-5 years.
Keep circumcised boys off their bellies to protect the healing area. Use water only to clean
around the circumcision.

Bathing, Continued

Dry and wrap up baby, then wash hair. Apply a small amount of soap and use a hair brush
to work it in. Rinse, dry, and brush hair. Make sure babys hair is completely dry, then
apply a clean cap to keep the head warm.
Brush while shampooing once a week and brush dry hair daily to help prevent cradle cap.

Tub Bathing

The newborn can be bathed in a tub after the umbilical cord stump falls off.
Your baby can be bathed safely and efficiently with just the arms, legs, and chest
underwater. The face, ears, eyes, and neck can be washed and dried as with a sponge
bath before undressing him or her for a tub bath.
You may use a large, clean sink, a plastic container, or a store-bought infant tub. Place a
washcloth in the bottom of the tub to prevent slipping.
Hold your infant securely at all times. Never leave baby
unattended in a tub. Drowning can occur very quickly in a small
amount of water.
You may wish to put a cotton sock over one of
your arms to help
prevent baby from slipping.
After the bath, lift the newborn out of the tub
in a
cradle position and dry thoroughly, then wrap
in a dry blanket. It is best to double-blanket and
place a hat on baby and hold for about 10 minutes until
baby is
completely dry.
After this, dress the baby and apply a clean, dry hat and blanket.

Nail Care

Your babys nails may be long and sharp. During the first few days, they may be stuck to
the skin of the fingers, so cutting them is not recommended.
o Use newborn socks or mittens to protect baby against scratching him or herself.
Within a week, the nails will separate from the skin and often break off.
If they are long after this time, the nails may be gently filed with a newborn file. This is
done most easily while baby is sleeping.

Diapering

Your baby should have at least 6-10 wet diapers per day after the first few days.
Urine should be a yellow (straw to amber) color without foul odor.

Kristen Gleason

Formula-fed babies usually have 1-2 stools a day.

Breastfed babies have 6-10 small, loose yellow stools per day. They may have only one
stool every few days after about a month of breastfeeding.
Stool will progress through these stages: 1) meconium (thick, tarry, dark green); 2)
transitional (thin, brown to green); 3a) breastfed babies: yellow/gold, soft or mushy stools;
3b) formula-fed baby: pale yellow, pasty, formed stools

Kristen Gleason

Circumcision Care

If your baby is circumcised, careful attention must be paid to this area until healing is
complete.
Squeeze warm water over the circumcision with each diaper change to rinse the area off,
then pat dry.
Apply a small amount of A&D ointment to a gauze strip and wrap around the penis with
each diaper change. When you run out of the gauze strips provided, you can just apply a
small amount of A&D directly to the tip of the penis.
Fasten the diaper loosely over the penis.
Avoid placing the baby on his stomach since the area is still sensitive while healing.
Check for foul-smelling drainage, bleeding, or swelling with each diaper change.
Light, sticky yellow film may form over the head of the penis. This is part of the normal
healing process.
If baby stops having wet diapers, call your pediatrician.
If a Plastibell was used for the circumcision, let it fall off by itself. This usually takes about
8 days. If it does not fall off after 8 days, contact your pediatrician.

Waking Baby

You may choose to use these techniques to wake your baby when getting ready for a
feeding, during a feeding if baby is sleepy or falls asleep, or to change babys feeding
schedule.
Loosen clothing, change babys diaper
Hand express breast milk onto babys lips
Talk with baby while making eye contact
Hold baby upright in a sitting or standing position
Stimulate babys rooting reflex (brush one cheek with your hand or nipple)
Gently rub babys hands and feet

Soothing and Quieting Baby

You may want to use these techniques to soothe your baby in the first few months after
birth if baby is overstimulated, to calm before feedings, or if baby is fussy.
NEVER shake a baby! This can cause permanent injury or death.
Check for a soiled diaper and change if needed.
Swaddle or bundle your baby.
Hold swaddled baby upright against your mid-chest supporting beneath babys bottom
and the back of his or her head.
Use slow, calming movements while holding baby.
Softly talk, sing, or hum.
Baby can feel your warmth and hear your heartbeat while held close, which is calming.

Kristen Gleason

Signs of Possible Illness

Temperature above 100.4 or below 97.8 F when measured under the armpit
Continuously rising temperature
Frequent vomiting over a 6 hour period, or forcefully vomiting more than once
Refusing two feedings in a row
Difficulty waking up, excessively tired
Quieting techniques are not effective to soothe baby, baby is inconsolable
Continuous high-pitched crying
Bluish discoloration of the skin (cyanosis)
Baby stops breathing for more than 20 seconds
Umbilical cord reddened
Crying when trying to pass stools, stools stop after a regular pattern has appeared
Belly is hard, appears bloated (distended)
Two green watery or black, loose stools in a row
No wet diapers for 18-24 hours or fewer than 6 per day after 4 days of age
Increasing yellowness (jaundice) of the skin, jaundice over abdomen and arms/legs
Rashes, pustules, or blisters on the skin (other than normal newborn rash)
Green, yellow, or excessive eye drainage

If any of these develop, call your pediatrician. Be prepared to tell the time since the symptoms
have started, related problems or activities, specifics about the problem, and the babys
temperature.

Taking Babys Temperature

It is only necessary to take your babys temperature if signs of illness are present.
It is easiest and safest to take your babys axillary temperature, which is done by placing a
thermometer underneath babys armpit.
Place the tip of the thermometer underneath babys armpit, then hold the outer part of
babys arm against his or her body.
Hold the thermometer in place 3-4 minutes or until it beeps.
Normal axillary temperature is between 97.7-99.3 F (36.5-37.4 C)
The rectal temperature is the most accurate, but it places baby at risk for tissue damage.
Some parents are comfortable taking rectal temperatures, but if you are not, axillary
temperatures are reliable and less risky. If you take a rectal temperature, insert
thermometer only to 1 inch.

Kristen Gleason

Car Seat Safety

Babies should always be placed in an approved, non-expired, infant car seat in the back
seat of the car, facing the rear.
Never place a baby in the front seat of a car.
The safest place is in the middle of the back seat.
Babies should rear face the car as long as possible, but at least until one year of age and
a weight of 20 lbs.
The American Academy of Pediatrics recommends keeping infants and toddlers rear-facing
until age 2, or until they reach the maximum height and weight for their seat. This better
supports the head, neck, and spine.
Children under age 2 are 75% less likely to die or be severely injured in a crash if they are
rear-facing.
You may wish to contact an approved car seat safety check site (possibly a sheriffs office
or other public agency, discuss with your nurses for information) to have it checked for
placement and learn more about car seat safety.

Kristen Gleason

Works Cited
Davidson, M., London, M., & Ladewig, P. (2012). Physiologic responses of the newborn to birth. In
Olds' maternal-newborn nursing and women's health across the lifespan (pp. 756-779). Pearson.

Image Sources:
Bulb Syringe:
http://www.waybuilder.net/sweethaven/MedTech/ObsNewborn/?iNum=20802
ABCs of Safe Sleep:
http://www.catawbacountync.gov/childsafety/safesleeping.asp
Safe Sleep Environment:
http://kerncares.org/2012/10/what-does-a-safe-sleep-environment-for-infants-look-like-2/
Swaddling:
http://www.littlehooligans.com/how_to_swaddle_adenandanais
Bathing:
http://www.infant-products.net/some-steps-to-bath-baby-with-bathrobe/
Axillary Temperature:
http://www.nhs.uk/Conditions/pregnancy-and-baby/Pages/how-to-take-your-babystemperature.aspx
Car Seat Safety:
http://carseatsmadeeasy.blogspot.com/