A Guide To Caring For Your Newborn - Baby Your Baby
L I V I N GA N DL E A R N I N GT O G E T H E Ra guide to caring for your newborn
2 0 0 4 I N T E R M O U N TA I N H E A LT H C A R E C l i n i c a l E d u c a t i o n S e r v i c e s
CARINGFORYOURINTRODUCTIONNEWBORNWHAT’S INSIDE:see pageCongratulations on the birth of your baby!4Whether you’re a first time parent or a veteran,YOUR BABY’S APPEARANCESkin. . . . . . . . . . . . . .Legs. . . . . . . . . . . . . .Head and face. . . . . . . . .Eyes. . . . . . . . . . . . . .a newborn baby is always a wonder.This booklet provides an overview of some ofthe special characteristics you may notice about8your newborn, and guides you through thebasics of infant care. It will also help yourecognize potential health concerns with yourbaby, and know when to seek medical help.Keep in mind that no booklet can replace theadvice and care you receive froma doctor and other health care17providers. We encourage you toconsult with your baby’s doctorany time you have questionsor concerns about yourbaby’s health.24.4567Bathing . . . . . . . . . . . . . .Fingernail care . . . . . . . . . .Diapering. . . . . . . . . . . . . .Circumcision and penis care. . .Umbilical cord care. . . . . . . .Feeding. . . . . . . . . . . . . . .Sleeping. . . . . . . . . . . . . .Interacting. . . . . . . . . . . . . 8. 8. 91011121516Diaper rash. . . . . . . . . . . . . .Constipation. . . . . . . . . . . . .Diarrhea . . . . . . . . . . . . . . .Fever . . . . . . . . . . . . . . . . .Choking on mucus or milk . . . . .Colds and other illnesses . . . . .Cr ying and colic. . . . . . . . . . .Preventing Shaken Baby SyndromeJaundice . . . . . . . . . . . . . . .Thrush and other yeast infections.Change in behavior . . . . . . . . .Rapid or slow breathing . . . . . .171717181819202122232323BASIC CARE ACTIVITIESCOMMON PROBLEMSNEWBORN SCREENING TESTSBilirubin screening . . . . . . . . . . . . . 24Hearing screening. . . . . . . . . . . . . . 24Screening tests for hereditar y diseases . 25INSURING YOUR NEWBORNBe sure to call your health insurance plan to2627enroll your newborn within 30 days of bir th.Otherwise, his medical expenses may notbe covered.CANCYGEGEIn this booklet, 2 icons are used to indicate when you need to seekmedical care.EMERRENOW3739The symptoms may indicate an urgent problem.Call 911 or take your baby to the nearest hospitalemergency room immediately.CALLURYOB A B Y'SDOCTO RSAFETY GUIDELINESPoison safety. . . . . . .Sleeping and crib safetyCar safety . . . . . . . .Second-hand smoke. . .Other safety guidelines.Note: Since the use of he/she and him/her can be distracting, thisbooklet alternates references to the baby’s gender.TIMMUNIZATIONSThe symptoms may indicate a problem. Call your baby’sdoctor now to determine the best course of action.3.SAFE RELINQUISHMENT ACTSSUMMARY OF WHEN TO SEEKMEDICAL HELP.2728303435
CARINGFORYOURNEWBORNYOUR BABY’S APPEARANCEEvery new baby is unique and beautiful. Don’t be surprised,however, if your baby doesn’t look like the babies you see ontelevision commercials or in magazine advertisements. Yourbaby may have lumps on his head, puffy or crossed eyes, aflat nose, a small chin, dry skin, or a rash. And don’t bealarmed if your baby jerks occasionally while sleeping, hasmild nasal congestion, breathes unevenly, sneezes, hiccups,and spits up occasionally. Such characteristics are normaland only temporary unless your doctor tells you otherwise.This section discusses some of what you can expect to seein a normal newborn’s appearance, and what should causeyou concern.Skin color in newborns canvar y greatly—from a pinkand white or yellowish toneto the typical redness.SKINMany parents’ first anxious questions relate to the appearance of theirbaby’s skin. “Is my baby too red?” “What are those marks on hisskin?” “Why does she have pimples?” Here are some things you maydiscover about your baby’s skin: Skin color: Skin color in newborns can vary greatly—from a pinkand white or yellowish tone to the typical redness. Even from onemoment to the next, skin color can vary depending on the activitylevel of the baby. Of course, family characteristics and racialfactors will also influence the color of your baby’s skin.At birth, the skin of the normal newborn is reddish-purple incolor and turns bright red when the baby cries. (During the firstfew days of life, the skin gradually loses this redness.) In addition,the newborn’s hands and feet may be cool and blue. By the thirdday, he may also appear slightly yellow. This condition is calledjaundice .It is common in newborns, and only occasionally requiresspecial treatment. (See page 22 for more information on jaundice.) Rash: Your infant’s tender and sensitive skin commonly reacts tohis new environment. Scattered, pinhead-sized, or somewhat largerpapules (pimples) surrounded by a mild red zone may appear invarious areas of the body when your baby is about 2 days old.These will disappear over time. The cause is unknown, and therash requires no treatment.4
CARINGYOURNEWBORNAcrocyanosis: A blue color of the hands and feet is calledacrocyanosis .It is caused by a decrease in the circulation of bloodto the skin of the hands and feet. This condition frequently occursduring the early hours of life. However, a baby should never be blueCAaround the face and lips. If you notice that your baby’s face and lipshave a blue color, or if she has dusky or blue skin, this may indicate EMERTNCYGEGE FORRENOWa serious problem and requires immediate medical attention.GET EMERGENCY CAREin the following cases:Mottling: A new baby’s skin can also look blotchy or mottled. This Dusky or blue skinor lipsis especially noticeable if the baby is uncovered or cold. Mottlingcan also occur if your baby is ill. If your baby’s skin color becomespale or mottled, take her temperature. If it is higher or lower thanthe normal range, call your baby’s doctor. Cradle cap: Cradle cap is a scaly patch of skin that develops on theCALLB A B Y'Severy time you bathe him, or 2-3 times per week—may help preventcradle cap. If cradle cap occurs, call your baby’s doctor. Milia: The whitish, pinhead-size spots, mainly on and around thenose or the newborn’s chin are called milia . Although they appearas tiny pimples, it is important not to disturb or break them, or putacne medicine on them. Doing so could produce a rash or cause theskin to scar. Milia are a normal occurrence in newborns and usuallyDOCTO RCALL YOUR BABY’S DOCTORif you notice any of thefollowing: Jaundice (a yellowappearance) thatdisappear within a few weeks. URYOscalp. Brushing your baby’s hair daily and washing it frequently—doesn’t go away, orspreads to cover moreStork bite marks: This is a fanciful term for the areas of pink orof the body (see pagered often present in the newborn on the upper eyelids, forehead,22 for more informationand back of the neck. These marks are caused by blood vessels thaton jaundice)are close to the surface of the skin. They usually fade by the end ofthe baby’s second year. These “birthmarks” occur in as many as half of all newborns, especially in those with fair complexions.A rash that concernsyou—it could be anallergic reaction, aninfection, or a symptomLEGSof an illnessAt birth, the newborn’s legs are relatively short in proportion to thetotal body length. In some newborns, there is a significant separationof the knees when the ankles are held together, giving the appearance Mottled and pale skinand a temperature thatof bowed legs. This usually corrects itself.is higher or lower thannormal 5Cradle cap
CARINGFORYOURNEWBORNHEAD AND FACENewborn babies rarely have nice round, perfectly shaped heads. Somebabies have large heads, some have small. Some have round heads, andsome have elongated heads as a result of squeezing through the birthcanal. Here are a few of the variations you may notice with yournewborn’s head: Forceps marks: If your baby was delivered using forceps,marks left from the pressure of the forceps may be noticeable on your baby’s face, usually on the cheeks and jaws.Be assured that the marks will disappear quickly, usuallywithin a day or two. After the marks fade, don’t bealarmed if you can feel hard little lumps along thecheekbones where the marks were located. These lumpswill also disappear. Molding: Molding of the skull bones as the baby movesdown the birth canal is a common cause of temporarylopsidedness of the head. Usually the head will return to itsnormal shape by the end of the first week. Molding is notusually present after a cesarean or breech delivery.WHAT ARE THESE SOFTSPOTS ON MY BABY'SHEAD? Caput: A caput is a soft swelling of the skin on the baby’s scalp. Itoccurs as a result of the top of the baby’s head being pressedagainst the mom’s cervix throughout labor and delivery. Theswelling usually disappears within the first few days of life.The “soft spots” on your baby’sskull—where you can sometimessee a pulse beneath the skin—arecalled fontanels. Most babieshave two of them, one on the Cephalohematoma: Cephalohematoma is a collection of bloodin the baby’s scalp tissue. You will notice this as a bruise on topof your baby’s head. As with caput, cephalohematoma mostcommonly occurs when the baby’s head is forced through the birthcanal. It differs from caput in that it tends to be more distinct andlong-lasting. Cephalohematoma is not usually present until severalhours after birth. It may take 2 weeks to 2 months for the baby’sbody to reabsorb the excess blood and for the bruise to go away.Because the excess blood is absorbed from the center first, theremay be a dent on the scalp for a while. Also, a baby withcephalohematoma may be more likely to develop jaundice.top of the head and one a littlefarther back. These areas arewhere the bones of your baby’sskull haven’t yet grown together.This flexible arrangement allowsthe skull to compress duringlabor and to continue to growduring the early years of life. Therear fontanel usually closes within4 months, while the front onedoesn't close until the child isat least a year old. Don’t beafraid to touch these spotsgently—they’re covered with atough membrane to protectyour baby's brain. Facial asymmetr y: Your baby’s face may appear lopsided ifcrowding in the uterus caused the head to be held for some time ina sharply flexed position (with the shoulder pressed firmly againstthe jawbone). This unevenness disappears by itself in a few weeksor months.6
CARINGFORYOUREYESYou’ll likely spend a lot of time looking intoyour newborn’s eyes. Here are some things youmay notice: Closed eyes: In addition to sleeping, anumber of things can cause your baby toclose his eyes—including bright lights, loudnoises, and touching the eyelids, eyelashes,or eye.Eye color: Babies aren’t born with their finaleye color. Eyes at birth are usually grayishblue in Caucasian infants and grayish-brownin infants of darker-skinned races. Pigment isslowly distributed to the eye and producesthe final eye color of the baby by 6-12months. Subconjunctival hemorrhage: One ofthe common results of birth may be thebreaking of a small blood vessel on thewhite area (sclera) of the eye, creating abright red spot. This bright red spot is calleda subconjunctival hemorrhage . It is caused bya sudden increase in pressure in the eye asthe baby passes through the birth canal.Since the blood is usually absorbed within7 to 10 days, you can be reassured thatthe red spot is temporary and not a causefor worry.Sclera: The sclera (whites of the eyes) mayhave a bluish tint in the normal newbornbecause the membranes surrounding theeyeball are still very thin. If the baby isjaundiced, the sclera may appear yellow. NEWBORNTear ducts: The tear ducts in a newbornare small and do not function at birth. Tearsare usually not produced with crying untilthe baby is 1 to 3 months old. Cross-eye: Many newborns appear tohave cross-eye because the upper eyelids ofthe newborn often show folds. This—incombination with the wide, flat bridge ofthe nose—can create an illusion of the babyhaving cross-eye. The illusion can be testedby looking at the reflection in the baby’spupils to see if both eyes are focused onthe same object. This condition tends todisappear with further development of thefacial structures. Uncoordinated eye movements:Uncoordinated eye movements are commonin newborns. At times, it might seem thatthe eyes are operating independently. Thisis normal. Coordination of eye movementsgradually occurs as the nerves and musclesof the eye develop. Fairly good eyecoordination is usually apparent by thethird or fourth month. In newborns, randomand jerky movements are also normal.Your newborn baby can focus best at a distanceof 8-14 inches—about the distance from hereyes to yours as you nurse or feed her.Babies also notice movement, light,patterns, and shapes. And as the firstweeks go by, their ability to seeand to focus improves.7
CARINGFORYOURNEWBORNBASIC CARE ACTIVITIESYour newborn will depend on you for every aspect of her care. Thissection provides guidelines for some basic care activities.BATHINGFor the first year of life, your baby will only need to be bathed every2-3 days. Sponge baths are a good way to help you and your babybecome accustomed to the new routine. Limit bathing to spongebaths—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 basicguidelines to follow. As you become more comfortable with your baby,you can adapt these guidelines to fit your baby’s needs:NEVER leave your baby (or in just an inch of water. When washing the genitals,always wipe girls from frontdraft-free environment.toddler) unattended in thebath. A newborn can drownBathe your baby in a warm,to back. When bathing a boy, Have bath supplies readynever forcefully push back thebefore beginning the bath.foreskin on an uncircumcisedpenis.Keep the water temperaturecomfor tably warm, not hot. Before placing your baby inTo avoid heat loss, wash thebaby’s hair last.the water, always test theFINGERNAIL CAREtemperature of the water withBabies will scratch them- after a bath, cover her headyour elbow.selves if their nails are toolong. It may be easier toTo help keep your baby warmwith a dr y towel. Wash the baby’s face first, clip your baby’s nailsusing plain water and a wash-when he is asleep, or withcloth. Wash your baby’s eyesoils, or creams on your baby.from the inner corner to theIf the skin becomes too dr youter, using different par ts ofor star ts to crack, ask yourthe washcloth for each eye.doctor to prescribe a creamsomeone else’s help.Use clippers designedespecially for babies, andbe careful not to cut thefinger tips. You may alsouse a soft emer y board tofile your baby’s fingernails.Do not routinely use lotions,that does not contain any Use a mild non-deodorant soapand a soft washcloth to washthe rest of the baby’s body,working downward toward thebaby’s feet. Pay special attention to folds and creases.8fragrances or alcohol.
CARINGFORYOURNEWBORNDIAPERINGYou should change your baby’s diaper frequently, as soon as it’s wetor soiled. Initially, you may feel clumsy diapering—but as with anynew skill, you’ll get better with practice. Here are some tips:URYOBe safe. If you use a changing table, it should be sturdy and havea safety strap. Also be sure it has plenty of room to contain all theitems you need to change your baby. Even with a safety strap, youshould never turn your back while changing the baby. DOCTO RBe ready. Before beginning to diaper, have the necessary itemswithin easy reach. B A B Y'S CALLClean well. Gently and thoroughly clean the skin.CALL YOUR BABY’S DOCTORif you notice any of thefollowing: No bowel movement by36 hours of age Fewer than 4 stools ina 24-hour period on thefour th day of age For girls: Wipe the genitals from front to back. For the first 4weeks after birth, it’s not unusual for girls to have a white,milky discharge that may or may not be tinged with blood. Fewer than 4 wetdiapers in a 24-hourperiod on the 4th day For boys: Clean under the scrotum. Do not push or pull theforeskin on an uncircumcised penis. of age Sudden changes inWatch those pins. If you use cloth diapers, watch out for openbowel movements insafety pins. Always point them outward, away from the baby.combination withSkip the powder. Baby powder may smell good, but it canor other concernsirritate your baby’s lungs. If can also irritate the broken skin ofa diaper rash. See page 17 for tips for preventing and treatingdiaper rash.NORMAL BOWEL MOVEMENTSA baby’s first bowel movements consist of a sticky black or greenishbrown material called meconium. By the four th day of age, bowelmovements should become the characteristic yellowish color producedby a milk diet.Color, consistency, and number of bowel movements will var y betweenbabies. A breastfed baby tends to have loose, seedy yellow or mustardcolored movements that do not have a strong smell. Milk formulaproduces pasty and formed bowel movements, which are light yellowto brown, with a strong sour-milk odor.Some variations in color and texture can be normal if the infant seemshealthy. You will soon be able to judge if a bowel movement seemsunusual. Apparent straining during bowel movements is common.9irritability, poor eating,
NEORYOURNEWBORNMaking a decisionATINFORCIRCUMCISION AND PENIS CAREA circumcision is a procedure that removes a fold of skin, called theforeskin, from the head, or glans, of a baby boy’s penis. Circumcisionis no longer performed routinely. It’s your choice whether to have yourbaby boy circumcised. The following information and resources can helpyou decide.IOFORMCARINGFORMCircumcision is no longer considered medically necessar y. AccordingFor more information,check out these websites:When you reach either ofthe following websites, type“circumcision” in theSearch box in the upperright corner of the screen.www.ihc.comThis site providesinformation produced byIHC, as well as healthto the American Academy of Pediatrics and the American MedicalAssociation, there is not enough medical evidence to support routinecircumcision. Studies do show some potential medical benefits of circumcision, but there are also potential risks (see the table at the bottom of thepage). Since circumcision is not essential to the child’s current well-being,parents should determine what is in the best interest of their child.Whether or not to have your son circumcised is YOUR choice. In additionto weighing potential medical benefits and risks, you should also considerany cultural, religious, or ethnic traditions that may affect your decision.To learn more, ask your health care providers—and visit one of thewebsites listed to the left. Make sure you have the information you needto make an informed choice.information from othertrusted sources.www.medem.comThis site includes awardwinning clinical content fromAmerica’s leading medicalsocieties.PotentialYou may have to pay for your son’s circumcision. Because routinecircumcision is not considered medically necessary, your health careinsurance may not pay for it. In fact, as of July 1, 2003, Utah Medicaidno longer pays for circumcision (although Idaho Medicaid still does).You should check with your own insurance provider before you make achoice. Also, talk with hospital or clinic staff, if needed, for informationon costs and financial assistance.Benefits Reduced risk for bladder infection in the 1st yearof life. The risk is 1 in 1,000 for circumcised boys,and 1 in 100 for boys who are not circumcised. Slightly reduced risk of developing cancer of thepenis. 1 out of 1,000,000 circumcised men willdevelop cancer of the penis. This may be slightlymore common in males who are not circumcisedwho do not practice good hygiene. Slightly reduced risk of getting sexually transmitteddiseases (STDs), possibly including HIV. However,behavioral fac
CARING FOR YOUR NEWBORN 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 .
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