Newborn Care and Wellness Guide

Wash Your Hands Frequently

The best way to prevent spreading germs to your baby is by washing your hands often and thoroughly. Wash your hands before and after you care for your baby, especially before feedings and after diaper changes.

Avoid having visitors who have symptoms of a cold or the flu. Be sure to wash your baby's toys and pacifiers regularly in hot, soapy water or on the top shelf of the dishwasher.

Steps to Good Hand Washing

• Have paper towels or clean towels handy.
• Wet hands with warm water, and then add soap.
• Rub your hands together and lather. Wash your hands for 20 seconds (long enough to sing "Happy Birthday").
• Be sure to wash around your fingernails and the spaces between your fingers.
• Rinse with lots of warm, running water.
• Dry your hands completely with paper towels or a clean towel.
• Turn off the faucet with the towel.

Making your home safe for your baby helps prevent accidents. The following safety tips are recommended:

• Set up smoke detectors near bedrooms, the kitchen, and on each living level.
• Set your water heater at 120 degrees to prevent your baby from getting burned.
• Always test water temperature before placing your baby in a bath.
• Never leave your baby unattended when giving him or her a bath.
• Keep small objects that could cause choking out of the crib and away from your baby. In addition, cribs should never be placed near blinds that have cords.
• Remove pillows or quilted blankets from the crib until your baby is one year of age.
• Use safety latches on doors and cupboards.
• Use safety covers on all electrical outlets.
• Keep dangling wires out of your baby's reach.
• Do not allow anyone to smoke around your baby. Infants can easily be burned and should not breathe second-hand smoke, which leads to a higher risk of Sudden Infant Death Syndrome (SIDS) and asthma.
• Never eat, drink or carry anything hot when holding your baby.

You will need a variety of things to take care of your baby. The following are some of the key items you should have:

Car Seats

Your baby should be securely fastened in a car seat every time he or she rides in a vehicle. The American Academy of Pediatrics (AAP) recommends:

• All infants ride rear-facing starting with their first ride home from the hospital and until two years of age or until the child reaches the highest weight or height allowed by their car safety seat manufacturer. 
• Place the car seat in the back seat, not in the front.
• Secure the car seat with a seat belt or the LATCH system. Once installed, the car seat should not move more than one inch from side to side.
• Dress your baby in light layers so the harness straps lie flat and fit snugly on the baby’s body. Once secured in the car seat, place a blanket over the baby for warmth as needed.
• All parents can benefit from getting installation help from a Consumer Product Safety Technician to ensure that their child’s seat is properly installed.

At this time car seat installation services at Women & Infants are temporarily suspended.  Staff will provide each family with resources to help them properly install their car seat prior to discharge.

DO NOT USE a car seat if:

• There are no instructions
• It is not labeled with the date of manufacture, seat name, or model number
• It has been in a car accident (even a small fender bender)
• It is past the manufacturer’s expiration date (five to six years)
• It has cracks in the frame
• It is missing parts

Cribs

When choosing a crib for your baby, make sure it meets current safety standards as recommended by the American Academy of Pediatrics:

• Bars should be spaced no more than 2 3/8 inches apart.
• The mattress should be very firm and should not sag under your baby’s weight. It should fit snugly, with no space between it and the crib walls.
• Raised crib sides should be at least 26 inches above the mattress support in its lowest position. Periodically lower the mattress as your child gets taller.
• The headboards and footboards should be solid, with no decorative cutouts. Corner posts that could cause injury or snag clothing should be removed.
• Do not use cribs with drop rails. These are not safe.
• Crib bumpers (or bumper pads) may seem as though they can help protect babies from drafts and bumps, but they should not be used in cribs. There is no evidence that bumper pads can prevent serious injuries, and they pose a risk of suffocation, strangulation, or entrapment. In addition, older babies can use them for climbing out of the crib.
• Keep large toys and stuffed animals out of the crib, as your baby may use them to get a leg up and over the rail. Pillows, bulky comforters, and heavy blankets do not belong in a crib; a baby can smother under them.
• Place the crib away from windows, where direct sunlight and drafts can make your baby uncomfortable. A crib can become uncomfortably hot if placed too near a radiator. Also, make sure that there are no strings from blinds or curtains close by that can wrap around the baby’s neck.
• Once your child is about 3 feet tall, he should start sleeping in a bed. If you are worried about him falling out of bed, you may want to start with the mattress on the floor.
• Your baby should never sleep on a water bed, sheepskin, pillow, sofa, armchair, or other soft surfaces. Thick blankets, duvets, comforters, pillows, and large, soft, stuffed toys should never be used in babies’ cribs; a baby can easily be smothered if trapped under bulky bedding or when his face is pressed up against a pillow.
• Babies do not need extra support, such as from rolled blankets or commercial devices, to keep them on their backs. Cumbersome materials like these clutter up the crib and may be hazardous for a baby.

Bassinets/Cradles

For the first few weeks of a baby’s life, some parents prefer to use a bassinet or cradle because it’s portable and allows the baby to sleep in their bedroom. But keep in mind that babies grow fast and a cradle that’s sturdy enough for a 1-month-old may be outgrown by the next month.

• Make sure the bottom of the cradle or bassinet is well supported to prevent its collapse.
• The cradle or bassinet should also have a wide base so it won’t tip over even if someone bumps it.
• If it has folding legs, make certain that they’re locked straight whenever it is being used.
• In general, your baby should move to a crib around the end of the first month of life or by the time he weighs 10 pounds.

Infants should sleep in the parents’ room, close to the parents’ bed but on a separate surface (room sharing). The infant’s crib, portable crib, play yard or bassinet should be placed in the parent’s bedroom for at least 6 months but preferably a year.

Source: The American of Pediatrics, www.aap.org

Strollers

Strollers are a great way to travel with your baby. They allow the baby to nap comfortably while you get some fresh air and exercise. When choosing a stroller, look at the price, convenience, and practical features such as protection from the sun. A model that reclines flat for infants is helpful, so they can sleep and have comfortable head support.

A newborn baby may sleep 12 to 18 hours a day. Newborns usually sleep in naps with short wake times. It is normal for a baby to wake up two to three times during the night. When first born, babies often have their day and night reversed. It takes at least three to six weeks before you can begin to see your baby’s sleep pattern. Most babies will not sleep through the night until they are at least 12 pounds or three months of age.

On the first night you bring your baby home, don’t be surprised if he or she is more vocal and wakeful through the night. This is normal. Follow your baby’s cues and feed frequently. This is a transition period and will take some time and patience before you all adjust. During this time:

• Think about offering a pacifier at nap time and bedtime. This helps to reduce the risk of sudden infant death syndrome (SIDS). If you are breastfeeding, wait until breastfeeding is going well before offering a pacifier. This usually takes about 3 to 4 weeks.
• Do not let your baby overheat during sleep. Dress your baby in as much or as little as you would wear. Consider using a wearable blanket or sleeper instead of a blanket.

Babies need short periods of tummy time, too. Tummy time should always be supervised and is a good way to help your baby develop normal muscle strength in the neck and chest. Tummy time also helps prevent your baby from developing flat spots on the head.

The ABCs of safe sleep

A (Alone)

• Keep your baby close to where you and others sleep, but not in the same bed. Infants should sleep in the parents’ room, close to the parents’ bed but on a separate surface (room sharing). The infant’s crib, portable crib, play yard or bassinet should be placed in the parent’s bedroom for at least 6 months but preferably a year.

Source: The American of Pediatrics, www.aap.org

B (On their backs)

• The American Academy of Pediatrics strongly recommends that healthy infants sleep on their backs at nap and nighttime to reduce the risk of Sudden Infant Death Syndrome (SIDS).
• Rotate your baby’s head from side to side with each nap.

C (In a crib)

• Place your baby to sleep in the same room where you sleep, but not the same bed.
• Use a firm sleep surface.
• Keep soft objects, loose bedding, or any objects that could increase the risk of entrapment, suffocation, or strangulation out of the sleeping area.
• Keep your baby's room at a comfortable temperature between 68° and 72°F.
• Dress your baby in a wearable blanket to keep warm. Do not let your baby get too hot during sleep.
• Maintain a smoke-free environment at all times.

What does a safe sleep environment look like? Download the brochure in English or Spanish.

Circumcision is a surgical procedure in which the skin covering the end of the penis is removed. Circumcision is usually performed by a doctor in the first few days of life. An infant must be stable and healthy to safely be circumcised. Scientific studies show some medical benefits of circumcision. However, these benefits are not sufficient for the American Academy of Pediatrics (AAP) to recommend that all infant boys be circumcised. Parents may want their sons circumcised for religious, social, and cultural reasons. Since circumcision is not essential to a child's health, parents should choose what is best for their child by looking at the benefits and risks.

Many parents choose to have their sons circumcised because "all the other men in the family were circumcised" or because they do not want their sons to feel "different." Others feel that circumcision is unnecessary and choose not to have it done. Some groups, such as followers of the Jewish and Islamic faiths, practice circumcision for religious and cultural reasons. Since circumcision may be more risky if done later in life, parents may want to decide before or soon after their son is born if they want their son circumcised.

As noted above, research studies suggest that there may be some medical benefits to circumcision. These include the following:

• A lower risk of urinary tract infections (UTIs). A circumcised infant boy has about a 1 in 1,000 chance of developing a UTI in the first year of life; an uncircumcised infant boy has about a 1 in 100 chance of developing a UTI in the first year of life.
• A lower risk of getting cancer of the penis, although this type of cancer is very rare in both circumcised and uncircumcised males.
• A slightly lower risk of getting sexually-transmitted diseases (STDs), including HIV and the AIDS virus.
• Prevention of foreskin infections.
• Prevention of phimosis, a condition in uncircumcised males that make foreskin retraction impossible.
• Easier genital hygiene.

Just as there are reasons parents may choose circumcision, there are reasons why parents may choose NOT to have their son circumcised:

•  As with any surgery, circumcision has some risks. Complications from circumcision are rare and usually minor. They may include bleeding, infection, cutting the foreskin too short or too long, and improper healing.
• The belief is that the foreskin is necessary to protect the tip of the penis. When removed, the tip of the penis may become irritated and cause the opening of the penis to become too small. Rarely, this can cause urination problems that may need to be surgically corrected.
• Some people believe that circumcision makes the tip of the penis less sensitive, causing a decrease in sexual pleasure later in life. This has not been proven by any medical or psychological study.

Almost all uncircumcised boys can be taught proper hygiene that can lower their chances of getting an infection, cancer of the penis, and sexually-transmitted diseases.

When done without pain medicine, circumcision is painful. There are pain medicines available that are safe and effective. The American Academy of Pediatrics recommends that they be used to reduce pain from circumcision. Local anesthetics can be injected into the penis to lower pain and stress in infants. Talk to your pediatrician/obstetrician about which pain medicine is best for your son. Problems with using pain medicine are rare and usually not serious.

What should I expect for my son after circumcision?

After the circumcision, the tip of the penis may seem raw or yellowish. There will be a gauze dressing, and it should be changed with each diapering to reduce the risk of the penis becoming infected. A medicated ointment should be used to keep the gauze dressing from sticking. It takes about seven to 10 days for the penis to fully heal after circumcision.

Are there any problems that can happen after circumcision?

Problems after a circumcision are very rare. However, call your pediatrician right away if:

• Your baby does not urinate normally within six to eight hours after the circumcision.
• There is persistent bleeding.
• There is redness around the tip of the penis that gets worse after three to five days.
• Your baby develops a fever.

It is normal to have a little yellow discharge or coating around the head of the penis, but this should not last longer than a week. See your pediatrician if you notice any signs of infection such as redness, swelling, or foul-smelling drainage.

What if I choose not to have my son circumcised?

If you choose not to have your son circumcised, talk to your pediatrician about how to keep your son's penis clean. The foreskin usually does not fully retract for several years and should never be forced. The uncircumcised penis is easy to keep clean by gently washing the genital area while bathing. You do not need to do any special cleansing, such as with cotton swabs or antiseptics.

Later, when the foreskin fully retracts, boys should be taught how to wash underneath the foreskin every day. Teach your son to clean his foreskin by:

• Gently pulling it back away from the head of the penis.
• Rinsing the head of the penis and inside fold of the foreskin with soap and warm water.
• Pulling the foreskin back over the head of the penis.

Source: The American of Pediatrics, www.aap.org

It is best to use a digital thermometer to check your baby's temperature. A “normal" temperature varies with the child's age, activity, and time of day. A fever usually is a temperature of 100.4 degrees Fahrenheit or higher.

Taking a Rectal Temperature

Rectal temperatures are the most accurate. A rectal temperature reading is taken in your baby’s bottom. A normal rectal temperature is 97.7 to 99.7 degrees. Call the baby’s health care provider if your baby’s rectal temperature is less than 97.5 degrees or greater than 100.4 degrees. Be sure to mention if you took the temperature rectally or under the arm.

How to Take a Temperature Rectally

• Put petroleum ointment at the end of the thermometer bulb.

• Lay your baby on his/her belly or side on a firm surface.

• Hold your baby still and gently insert the thermometer one-half inch into the rectum until the digital thermometer displays a reading.

Taking an Axillary Temperature

Axillary temperatures are the least accurate, but you can use this method to screen a child of any age. An axillary temperature is taken under the arm. A normal reading is 97.7 to 99.5 degrees. Call your baby’s health care provider when he or she has a fever of 100.4 degrees Fahrenheit or higher. Be sure to mention if you took the temperature rectally or under the arm.

How to Take an Axillary Temperature

• Take your baby's shirt off.

• Hold the thermometer at a 45-degree angle and place the bulb in the baby’s armpit.

• Hold your baby’s arm snugly against his or her side until the digital thermometer displays a reading.

When Your Baby is Sick

It is normal to be concerned about your baby's health. When newborns are sick, they don't always give you a lot of signs. Because you are just getting to know your baby, it may be difficult to notice a change in behavior. Trust your instincts. If you think your baby is sick, call his or her health care provider. Although usually harmless, call your baby's health care provider if the baby has any of the following symptoms:

• Rectal temperature of 100.4 degrees or higher.
• Unusual crying or irritability.
• Sleeping too little (less than 12 hours a day) or too much (more than 22 hours a day).
• Forceful or projectile vomiting.
• More stools or stools that are different in color or odor.
• Disinterest in eating, either refusing to feed or feeding poorly.
• Weakness and no energy to cry.
• Jaundice.

The umbilical cord is clamped immediately after birth. The clamp is removed before the baby goes home from the hospital. The cord stump should fall off in seven to 14 days. When it falls off, a small amount of blood or wetness is normal. At home, you should:

• Keep the cord clean and dry. The drier the cord, the sooner it will fall off.
• Clean the cord with warm water and soap only if visibly soiled and pat dry.
• Do not give your baby a tub bath until the cord falls off and the area looks healed. This will take 7 to 10 days. Give him or her a sponge bath instead.
• Roll the diaper as low as you can so that when the baby kicks, the diaper does not hit the cord.

Call your baby's health care provider if you notice:

• A bad smell coming from the cord.
• Redness around the cord.
• A yellow or greenish discharge.
• Bleeding.
• A cord that remains soft and moist.

Most people have heard about jaundice; when the baby's skin is yellow, but may not understand why it happens or what to do about it.

When babies are born, they have a lot of red blood cells. These extra red blood cells break down into bilirubin (pronounced billy-ru-ben). A newborn baby's liver is not mature enough to get rid of this bilirubin so it builds up in the baby's body and causes the skin and the whites of the eyes to turn yellow. If the bilirubin level gets too high, it can hurt your baby's nervous system.

Finding out that your baby has jaundice can be scary but it is very common, and most times does not cause any problems. Ask your doctor or nurse if you have any questions or concerns about jaundice in your baby. You can also call the Warm Line at 1-800-711-7011. The Warm Line is staffed by registered nurses who will answer questions you may have about your baby. The Warm Line is open Monday thru Friday, from 9 a.m. to 9 p.m., and from 9 a.m. to 5 p.m. on Saturday and Sunday.

Are there different types of jaundice?

There are two types of jaundice. Normal jaundice happens in about half of all full-term babies and in about 80 percent of babies born early (before 37 weeks). Jaundice may last longer in babies born early.

Pathologic jaundice is caused by an illness or other medical problem like an infection. Sometimes the baby's blood type is different from the mother's and that causes problems such as jaundice. Other causes can be liver or intestinal problems or being born too early.

When will I see the color change?

Jaundice usually starts to show on about day two or three of life. Bilirubin levels reach the highest level at about day three or four in a term baby. The levels in a late pre-term baby (born at 35 to 37 weeks) will peak between day five and seven. Jaundice usually disappears in about one week but can last longer in babies who are born early.

The yellow is first seen in the eyes and face, and then it spreads down the body. If the baby is yellow just in the face, it is okay. If the baby is yellow to the belly button or you cannot wake the baby for a feeding, call the baby's doctor or the Warm Line (1-800-711-7011).

How can I tell if the baby is getting jaundiced?

In natural lighting, press on the baby's skin with your fingertip. When you raise your finger, the skin should be white. If it is yellow, your baby is jaundiced to that point. In babies whose skin color is darker, you need to watch the white of their eyes and the palms of their hands for the yellow color.

How will they test for jaundice?

A small bit of blood will be taken from your baby's heel and tested to see how much bilirubin is in the blood.

How does my baby get rid of the bilirubin?

The bilirubin collects in the baby's stool. When the baby has a bowel movement, the bilirubin goes out. If the baby doesn't have a bowel movement, the bilirubin goes back into the body and levels get higher. So we want babies to have bowel movements. It is very important to feed them. They do not need water. Water will make them urinate, but not have a stool. They need calories (food) to make them move their bowels.

If you are breastfeeding, make sure you feed the baby eight to 12 times in 24 hours. If you are bottle-feeding, feed the baby six to eight times in 24 hours.

How do they treat jaundice?

Treatment may include:

• The baby is fed breast milk or formula (not water or sugar water). This helps the baby to have a bowel movement and get the bilirubin out of his/her body.
• The baby is sometimes put under special lights to help break the bilirubin down. All the baby's clothes are taken off and the eyes are covered to protect them. Your baby's doctor will decide if this is necessary.
• If jaundice appears in the hospital, some babies will go home with instructions to follow up with blood tests.
• If you have any questions about jaundice, ask your baby's health care provider, nurse, or call the Warm Line (1-800-711-7011).

Does breastfeeding cause jaundice?

If a breastfed baby is jaundiced, it is often because he or she is not nursing enough and not having a stool. Breastfeeding on cue day and night may help prevent jaundice. Breast milk is a natural laxative and feeding your baby frequently will help remove the jaundice. Sometimes a breastfed baby can become jaundiced when he or she is two or three weeks old. This may be due to something in the breast milk that prevents the bilirubin from being removed. Treatment is not usually needed. If there are no other causes for the jaundice, continue breastfeeding. It may take as long as three months for the levels to return to normal.

When the weather permits, it is fine for you and your baby to enjoy the fresh air. Because a baby's skin is tender, however, avoid direct sun exposure during his or her first year. 

To protect your baby's skin from the sun, you can:

• Keep the baby in the shade or covered before six months of age. Do not use sunscreen for the first six months.
• Use a bonnet or hat to keep the baby's head and ears covered.
• After six months of age, apply sunscreen with an SPF of 15 or higher every time you bring the baby outside. Reapply every 60 to 90 minutes. The sunscreen you use should be PABA-free and made specifically for babies.
• Take your baby with you into a store. Do not leave him or her in a parked, closed car even for a few minutes. Heatstroke can occur and even lead to death. Heatstroke can also occur if the baby is overdressed in the heat.
• Dress your baby in warm clothing in the cold weather, remembering to cover his or her head. Use the rule of one – put on the same number of layers that you are wearing, plus one additional layer.

If your baby gets sunburned, call his or her health care provider. A mild burn for an adult could be serious for your baby. Babies can burn even on overcast days.