a guide to caring for your newborn

L I V I N G A N D L E A R N I N G T O G E T H E R a guide to caring for your newborn © 2004 INTERMOUNTAIN HEALTH CARE C l in ica l Educat ion Ser v ices C A R I N G F O R Y O U R N E W B O R N 3 WHAT’S INSIDE: see page 4 YOUR BABY’S APPEARANCE Skin. . . . . . . . . . . . . . . . . . . . . . 4 Legs. . . . . . . . . . . . . . . . . . . . . . 5 Head and face. . . . . . . . . . . . . . . . . 6 Eyes. . . . . . . . . . . . . . . . . . . . . . 7 8 BASIC CARE ACTIVITIES Bathing . . . . . . . . . . . . . . . . . . . . 8 Fingernail care . . . . . . . . . . . . . . . . 8 Diapering. . . . . . . . . . . . . . . . . . . . 9 Circumcision and penis care. . . . . . . . 10 Umbilical cord care. . . . . . . . . . . . . 11 Feeding. . . . . . . . . . . . . . . . . . . . 12 Sleeping. . . . . . . . . . . . . . . . . . . 15 Interacting. . . . . . . . . . . . . . . . . . 16 17 COMMON PROBLEMS Diaper rash. . . . . . . . . . . . . . . . . . 17 Constipation. . . . . . . . . . . . . . . . . 17 Diarrhea . . . . . . . . . . . . . . . . . . . 17 Fever . . . . . . . . . . . . . . . . . . . . . 18 Choking on mucus or milk . . . . . . . . . 18 Colds and other illnesses . . . . . . . . . 19 Crying and colic. . . . . . . . . . . . . . . 20 Preventing Shaken Baby Syndrome . . . . 21 Jaundice . . . . . . . . . . . . . . . . . . . 22 Thrush and other yeast infections. . . . . 23 Change in behavior . . . . . . . . . . . . . 23 Rapid or slow breathing . . . . . . . . . . 23 24 NEWBORN SCREENING TESTS Bilirubin screening . . . . . . . . . . . . . 24 Hearing screening. . . . . . . . . . . . . . 24 Screening tests for hereditary diseases . 25 26 IMMUNIZATIONS 27 SAFETY GUIDELINES Poison safety. . . . . . . . . . . . . . . . . 27 Sleeping and crib safety . . . . . . . . . . 28 Car safety . . . . . . . . . . . . . . . . . . 30 Second-hand smoke. . . . . . . . . . . . . 34 Other safety guidelines. . . . . . . . . . . 35 37 SAFE RELINQUISHMENT ACTS 39 SUMMARY OF WHEN TO SEEK MEDICAL HELP INTRODUCTION Congratulations on the birth of your baby! Whether you’re a first time parent or a veteran, a newborn baby is always a wonder. This booklet provides an overview of some of the special characteristics you may notice about your newborn, and guides you through the basics of infant care. It will also help you recognize potential health concerns with your baby, and know when to seek medical help. Keep in mind that no booklet can replace the advice and care you receive from a doctor and other health care providers. We encourage you to consult with your baby’s doctor any time you have questions or concerns about your baby’s health. The symptoms may indicate an urgent problem. Call 911 or take your baby to the nearest hospital emergency room immediately. The symptoms may indicate a problem. Call your baby’s doctor now to determine the best course of action. CAC RE NOWOO G ET EMERGR EN C Y Note: Since the use of he/she and him/her can be distracting, this booklet alternates references to the baby’s gender. In this booklet, 2 icons are used to indicate when you need to seek medical care. CALL YOYY U R B A B B Y BB 'S DOCTOT R INSURING YOUR NEWBORN Be sure to call your health insurance plan to enroll your newborn within 30 days of bir th. Otherwise, his medical expenses may not be covered. C A R I N G F O R Y O U R N E W B O R N 4 YOUR BABY’S APPEARANCE Every new baby is unique and beautiful. Don’t be surprised, however, if your baby doesn’t look like the babies you see on television commercials or in magazine advertisements. Your baby may have lumps on his head, puffy or crossed eyes, a flat nose, a small chin, dry skin, or a rash. And don’t be alarmed if your baby jerks occasionally while sleeping, has mild nasal congestion, breathes unevenly, sneezes, hiccups, and spits up occasionally. Such characteristics are normal and only temporary unless your doctor tells you otherwise. This section discusses some of what you can expect to see in a normal newborn’s appearance, and what should cause you concern. SKIN Many parents’ first anxious questions relate to the appearance of their baby’s skin. “Is my baby too red?” “What are those marks on his skin?” “Why does she have pimples?” Here are some things you may discover about your baby’s skin: ■ Skin color: Skin color in newborns can vary greatly—from a pink and white or yellowish tone to the typical redness. Even from one moment to the next, skin color can vary depending on the activity level of the baby. Of course, family characteristics and racial factors will also influence the color of your baby’s skin. At birth, the skin of the normal newborn is reddish-purple in color and turns bright red when the baby cries. (During the first few days of life, the skin gradually loses this redness.) In addition, the newborn’s hands and feet may be cool and blue. By the third day, he may also appear slightly yellow. This condition is called jaundice . It is common in newborns, and only occasionally requires special treatment. (See page 22 for more information on jaundice.) ■ Rash: Your infant’s tender and sensitive skin commonly reacts to his new environment. Scattered, pinhead-sized, or somewhat larger papules (pimples) surrounded by a mild red zone may appear in various areas of the body when your baby is about 2 days old. These will disappear over time. The cause is unknown, and the rash requires no treatment. Skin color in newborns can vary greatly—from a pink and white or yellowish tone to the typical redness. C A R I N G F O R Y O U R N E W B O R N 5 CALL YOUR BABY’S DOCTOR if you notice any of the following: ■ Jaundice (a yellow appearance) that doesn’t go away, or spreads to cover more of the body (see page 22 for more information on jaundice) ■ A rash that concerns you—it could be an allergic reaction, an infection, or a symptom of an illness ■ Mottled and pale skin and a temperature that is higher or lower than normal ■ Cradle cap CALL YOYY U R B A B B Y BB 'S DOCTOT R ■ Acrocyanosis: A blue color of the hands and feet is called acrocyanosis. It is caused by a decrease in the circulation of blood to the skin of the hands and feet. This condition frequently occurs during the early hours of life. However, a baby should never be blue around the face and lips. If you notice that your baby’s face and lips have a blue color, or if she has dusky or blue skin, this may indicate a serious problem and requires immediate medical attention. ■ Mottling: A new baby’s skin can also look blotchy or mottled. This is especially noticeable if the baby is uncovered or cold. Mottling can also occur if your baby is ill. If your baby’s skin color becomes pale or mottled, take her temperature. If it is higher or lower than the normal range, call your baby’s doctor. ■ Cradle cap: Cradle cap is a scaly patch of skin that develops on the scalp. Brushing your baby’s hair daily and washing it frequently— every time you bathe him, or 2-3 times per week—may help prevent cradle cap. If cradle cap occurs, call your baby’s doctor. ■ Milia: The whitish, pinhead-size spots, mainly on and around the nose or the newborn’s chin are called milia. Although they appear as tiny pimples, it is important not to disturb or break them, or put acne medicine on them. Doing so could produce a rash or cause the skin to scar. Milia are a normal occurrence in newborns and usually disappear within a few weeks. ■ Stork bite marks: This is a fanciful term for the areas of pink or red often present in the newborn on the upper eyelids, forehead, and back of the neck. These marks are caused by blood vessels that are close to the surface of the skin. They usually fade by the end of the baby’s second year. These “birthmarks” occur in as many as half of all newborns, especially in those with fair complexions. LEGS At birth, the newborn’s legs are relatively short in proportion to the total body length. In some newborns, there is a significant separation of the knees when the ankles are held together, giving the appearance of bowed legs. This usually corrects itself. GET EMERGENCY CARE in the following cases: ■ Dusky or blue skin or lips CAC RE NOWOO G ET EMERGR EN C Y C A R I N G F O R Y O U R N E W B O R N 6 HEAD AND FACE Newborn babies rarely have nice round, perfectly shaped heads. Some babies have large heads, some have small. Some have round heads, and some have elongated heads as a result of squeezing through the birth canal. Here are a few of the variations you may notice with your newborn’s head: ■ Forceps marks: If your baby was delivered using forceps, marks left from the pressure of the forceps may be notice- able on your baby’s face, usually on the cheeks and jaws. Be assured that the marks will disappear quickly, usually within a day or two. After the marks fade, don’t be alarmed if you can feel hard little lumps along the cheekbones where the marks were located. These lumps will also disappear. ■ Molding: Molding of the skull bones as the baby moves down the birth canal is a common cause of temporary lopsidedness of the head. Usually the head will return to its normal shape by the end of the first week. Molding is not usually present after a cesarean or breech delivery. ■ Caput: A caput is a soft swelling of the skin on the baby’s scalp. It occurs as a result of the top of the baby’s head being pressed against the mom’s cervix throughout labor and delivery. The swelling usually disappears within the first few days of life. ■ Cephalohematoma: Cephalohematoma is a collection of blood in the baby’s scalp tissue. You will notice this as a bruise on top of your baby’s head. As with caput, cephalohematoma most commonly occurs when the baby’s head is forced through the birth canal. It differs from caput in that it tends to be more distinct and long-lasting. Cephalohematoma is not usually present until several hours after birth. It may take 2 weeks to 2 months for the baby’s body to reabsorb the excess blood and for the bruise to go away. Because the excess blood is absorbed from the center first, there may be a dent on the scalp for a while. Also, a baby with cephalohematoma may be more likely to develop jaundice. ■ Facial asymmetry: Your baby’s face may appear lopsided if crowding in the uterus caused the head to be held for some time in a sharply flexed position (with the shoulder pressed firmly against the jawbone). This unevenness disappears by itself in a few weeks or months. WHAT ARE THESE SOFT SPOTS ON MY BABY'S HEAD? The “soft spots” on your baby’s skull—where you can sometimes see a pulse beneath the skin—are called fontanels. Most babies have two of them, one on the top of the head and one a little farther back. These areas are where the bones of your baby’s skull haven’t yet grown together. This flexible arrangement allows the skull to compress during labor and to continue to grow during the early years of life. The rear fontanel usually closes within 4 months, while the front one doesn't close until the child is at least a year old. Don’t be afraid to touch these spots gently—they’re covered with a tough membrane to protect your baby's brain. C A R I N G F O R Y O U R N E W B O R N 7 EYES You’ll likely spend a lot of time looking into your newborn’s eyes. Here are some things you may notice: ■ Eye color: Babies aren’t born with their final eye color. Eyes at birth are usually grayish- blue in Caucasian infants and grayish-brown in infants of darker-skinned races. Pigment is slowly distributed to the eye and produces the final eye color of the baby by 6-12 months. ■ Sclera: The sclera (whites of the eyes) may have a bluish tint in the normal newborn because the membranes surrounding the eyeball are still very thin. If the baby is jaundiced, the sclera may appear yellow. ■ Tear ducts: The tear ducts in a newborn are small and do not function at birth. Tears are usually not produced with crying until the baby is 1 to 3 months old. ■ Cross-eye: Many newborns appear to have cross-eye because the upper eyelids of the newborn often show folds. This—in combination with the wide, flat bridge of the nose—can create an illusion of the baby having cross-eye. The illusion can be tested by looking at the reflection in the baby’s pupils to see if both eyes are focused on the same object. This condition tends to disappear with further development of the facial structures. ■ Uncoordinated eye movements: Uncoordinated eye movements are common in newborns. At times, it might seem that the eyes are operating independently. This is normal. Coordination of eye movements gradually occurs as the nerves and muscles of the eye develop. Fairly good eye coordination is usually apparent by the third or fourth month. In newborns, random and jerky movements are also normal. Your newborn baby can focus best at a distance of 8-14 inches—about the distance from her eyes to yours as you nurse or feed her. Babies also notice movement, light, patterns, and shapes. And as the first weeks go by, their ability to see and to focus improves. ■ Closed eyes: In addition to sleeping, a number of things can cause your baby to close his eyes—including bright lights, loud noises, and touching the eyelids, eyelashes, or eye. ■ Subconjunctival hemorrhage: One of the common results of birth may be the breaking of a small blood vessel on the white area (sclera) of the eye, creating a bright red spot. This bright red spot is called a subconjunctival hemorrhage. It is caused by a sudden increase in pressure in the eye as the baby passes through the birth canal. Since the blood is usually absorbed within 7 to 10 days, you can be reassured that the red spot is temporary and not a cause for worry. C A R I N G F O R Y O U R N E W B O R N 8 BASIC CARE ACTIVITIES Your newborn will depend on you for every aspect of her care. This section provides guidelines for some basic care activities. BATHING For the first year of life, your baby will only need to be bathed every 2-3 days. Sponge baths are a good way to help you and your baby become accustomed to the new routine. Limit bathing to sponge baths—not tub baths—until your baby’s umbilical cord drops off. There is no one right way to bathe a baby, but there are some basic guidelines to follow. As you become more comfortable with your baby, you can adapt these guidelines to fit your baby’s needs: ■ Bathe your baby in a warm, draft-free environment. ■ Have bath supplies ready before beginning the bath. ■ Keep the water temperature comfortably warm, not hot. Before placing your baby in the water, always test the temperature of the water with your elbow. ■ Wash the baby’s face first, using plain water and a wash- cloth. Wash your baby’s eyes from the inner corner to the outer, using different par ts of the washcloth for each eye. ■ Use a mild non-deodorant soap and a soft washcloth to wash the rest of the baby’s body, working downward toward the baby’s feet. Pay special atten- tion to folds and creases. ■ When washing the genitals, always wipe girls from front to back. When bathing a boy, never forcefully push back the foreskin on an uncircumcised penis. ■ To avoid heat loss, wash the baby’s hair last. ■ To help keep your baby warm after a bath, cover her head with a dry towel. ■ Do not routinely use lotions, oils, or creams on your baby. If the skin becomes too dry or star ts to crack, ask your doctor to prescribe a cream that does not contain any fragrances or alcohol. NEVER leave your baby (or toddler) unattended in the bath. A newborn can drown in just an inch of water. FINGERNAIL CARE Babies will scratch them- selves if their nails are too long. It may be easier to clip your baby’s nails when he is asleep, or with someone else’s help. Use clippers designed especially for babies, and be careful not to cut the finger tips. You may also use a soft emery board to file your baby’s fingernails. C A R I N G F O R Y O U R N E W B O R N 9 CALL YOUR BABY’S DOCTOR if you notice any of the following: ■ No bowel movement by 36 hours of age ■ Fewer than 4 stools in a 24-hour period on the four th day of age ■ Fewer than 4 wet diapers in a 24-hour period on the 4th day of age ■ Sudden changes in bowel movements in combination with irritability, poor eating, or other concerns CALL YOYY U R B A B B Y BB 'S DOCTOT R DIAPERING You should change your baby’s diaper frequently, as soon as it’s wet or soiled. Initially, you may feel clumsy diapering—but as with any new skill, you’ll get better with practice. Here are some tips: ■ Be ready. Before beginning to diaper, have the necessary items within easy reach. ■ Be safe. If you use a changing table, it should be sturdy and have a safety strap. Also be sure it has plenty of room to contain all the items you need to change your baby. Even with a safety strap, you should never turn your back while changing the baby. ■ Clean well. Gently and thoroughly clean the skin. • For girls: Wipe the genitals from front to back. For the first 4 weeks after birth, it’s not unusual for girls to have a white, milky discharge that may or may not be tinged with blood. • For boys: Clean under the scrotum. Do not push or pull the foreskin on an uncircumcised penis. ■ Watch those pins. If you use cloth diapers, watch out for open safety pins. Always point them outward, away from the baby. ■ Skip the powder. Baby powder may smell good, but it can irritate your baby’s lungs. If can also irritate the broken skin of a diaper rash. See page 17 for tips for preventing and treating diaper rash. NORMAL BOWEL MOVEMENTS A baby’s first bowel movements consist of a sticky black or greenish brown material called meconium. By the four th day of age, bowel movements should become the characteristic yellowish color produced by a milk diet. Color, consistency, and number of bowel movements will vary between babies. A breastfed baby tends to have loose, seedy yellow or mustard- colored movements that do not have a strong smell. Milk formula produces pasty and formed bowel movements, which are light yellow to brown, with a strong sour-milk odor. Some variations in color and texture can be normal if the infant seems healthy. You will soon be able to judge if a bowel movement seems unusual. Apparent straining during bowel movements is common. C A R I N G F O R Y O U R N E W B O R N 10 For more information, check out these websites: When you reach either of the following websites, type “circumcision” in the Search box in the upper right corner of the screen. www.ihc.com This site provides information produced by IHC, as well as health information from other trusted sources. www.medem.com This site includes award- winning clinical content from America’s leading medical societies. CIRCUMCISION AND PENIS CARE A circumcision is a procedure that removes a fold of skin, called the foreskin, from the head, or glans, of a baby boy’s penis. Circumcision is no longer performed routinely. It’s your choice whether to have your baby boy circumcised. The following information and resources can help you decide. Making a decision Circumcision is no longer considered medically