A Guide to Caring for your Newborn
Contents
1. You can find this booklet and other related resources at ihc com mombaby in INTERMOUNTAIN HEALTH CARE IHC 2004 INTERMOUNTAIN HEALTH CARE Clinical Education Services The content presented here is for your information only It is not a substitute for professional medical advice and it should not be used to diagnose or treat a health problem or disease Please consult your health care provider if you have any questions or concerns Clinical Education Services 801 442 2963 IHCED WNOO3 4 042. LIVING A N D LEARNING TOGETHER a guide CO caring for your newborn IHC 2004 INTERMOUNTAIN HEALTH CARE Clinical Education Services CARING FOR YOUR NEWBORN WHAT S INSIDE see page 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 a e fa a a doctor and other health care Cram 9 i L e d providers We encourage you to consult with your baby s doctor any time you have questions or concerns about your baby s health Kd B INSURING YOUR NEWBORN Be sure to call your health insurance plan to enroll your newborn within 30 days of birth Otherwise his medical expenses may not be covered 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 The symptoms may indicate an urgent problem Call 911 or take your baby to the nearest hospital emergency room immediately The symptoms may indic
3. and 99 5 F 37 5 C How to take armpit axillary temperatures m Make sure your baby s armpit is dry m Put the tip of the thermometer in your baby s armpit directly against her skin skin should completely surround the tip of the thermometer CALL YOUR BABY S DOCTOR if you notice either of the m Close your baby s armpit by holding her elbow against her following chest B low temperature your m Follow the directions on your thermometer to determine how baby can become long you should hold the thermometer in place before reading it stressed and develop difficulty breathing CHOKING ON MUCUS OR MILK B High temperature E p j If your baby begins to choke on mucus or milk turn him on his side infecti Id b i E OUT with his head slightly lower than his body If necessary gently assist tarti aune him in clearing any visible fluid from his mouth or nose with a cloth or your fingers If this method doesn t work you may need to use a bulb syringe See the instructions on the following page A normal temperature taken in the baby s armpit is between 97 7 F 36 5 C and 99 5 F 37 5 C NE N 18 CARING FOR YOUR NEWBORN COLDS AND OTHER ILLNESSES Babies can get colds just like the rest of us A cold is caused by a virus and usually results in mild symptoms in your baby stuffy or runny nose mild fever mild cough Another common illness in infants is RSV respirat
4. Child safety seat Placement Child safety seat harness straps Car safety belts Special considerations CARING FOR YOUR NEWBORN TODDLERS 20 40 pounds AND at least 1 year old Always read the instructions Follow the car seat manufacturer s guidelines Use child safety seats that have harnesses for children weighing up to 40 pounds Face the child safety seat toward the front of the car for a child who is over 20 pounds AND at least 1 year of age It s best to keep children rear facing up to 30 35 pounds if the child safety seat permits Generally the center back seat is the safest place for a child safety seat Use the harness straps at all times for children up to 40 pounds On the back of the child safety seat adjust the harness straps to the top slots at or above shoulder level On a forward facing convertible the top harness slots must be used Fasten the harness snugly At your child s collarbones you should not be able to pinch up any of the excess harness strap webbing between your fingers If there is a chest retainer clip always use it to hold the shoulder straps in place Position the retainer clip at armpit level see the picture on page 34 With some car models you must use a locking clip with the lap shoulder belt Always read your vehicle and your car seat manufacturer s instruction manual When needed place a locking clip on both lap and shoulder belts 1 to 1 from the latch plate see
5. d BE Concentrated liquid This type of formula is packaged with an add water symbol on the label To use it follow the instructions A Feed your baby gt provided on the label S only breast milk or formula unless NH Powdered formula Powdered formula also has an add water otherwise instructed symbol on the label Always follow the instructions for formula by your doctor preparation and storage provided on the label This is the least expensive type of formula and it can be easily stored and transported 12 CARING FOR YOUR NEWBORN WARMING FORMULA You should never microwave formula The microwave heats formula unevenly causing hot spots that may burn the baby s mouth This may occur even if the bottle feels warm to the touch It is best to warm Cleaning your baby s bottles formula under a warm Wash your bottles with hot soapy water and faucet in a pan of warm rinse well Check bottle nipples for tears or cracks water or in a bottle stickiness or enlargement If any of these occur eat throw the nipple away Rinse bottles before putting them in the dishwasher PACIFIERS How much formula does your baby need If you choose to use a The table below shows the approximate number of pacifier follow these feedings per day and number of ounces per feeding for simple guidelines babies of different ages Remember that every baby is unique If your child s feeding schedule var
6. you ll be given a screening kit and instructions for when to follow up with your doctor Make sure you take your screening kit with you to your follow up appointment v The table below summarizes some of the tests currently required by Utah and Idaho laws As technology and genetic knowledge advance newborn testing may expand Phenylketonuria PKU A hereditary disease in which the body Special diet v v 1 in 10 000 newborns can t break down certain parts of proteins phenylalanine amino acids Can lead to mental retardation Hypothyroidism A hereditary condition in which Thyroid v v 1 in 5 000 newborns the thyroid gland doesn t produce replacement enough of a substance called medicine thyroxine May cause mental retardation and slow growth thyroxine Galactosemia A rare hereditary condition in which Special diet V4 V4 1 in 50 000 newborns the body can t break down galactose a type of sugar which is found mostly in dairy products May lead to mental retardation cataracts and liver damage By Hemoglobinopathies Abnormalities in the hemoglobin of Early education v request including sickle cell red blood cells May lead to anemia and clinical care anemia and bleeding problems 1 in 3 000 newborns Note Idaho also screens for several other disorders caused by the body s chemistry metabolic disorders 25 CARING FOR YOUR NEWBORN IMMUNIZATIONS Immunizations vaccines are an important way to p
7. hot or cold air ducts A baby can receive a burn from a radiator The forced air ducts can dry out your baby s nose and throat increasing her susceptibility to respiratory problems 29 IT S THE LAW Utah law B Everyone in the car must be properly restrained M Children under 5 must be restrained in an approved child safety seat Idaho law M Everyone in the car must be properly restrained B Children under the age of four or 40 pounds must ride in an approved child restraint device Call 801 588 CARS if you have any questions about your child safety seats or for information on having your child safety seats checked at an approved site in your area CARING FOR YOUR NEWBORN CAR SAFETY Despite laws in all 50 states that require the use of child safety seats for young children more children are killed as passengers in car crashes than from any other type of injury Almost half of these deaths can be prevented if children are properly restrained in an appropriate child safety seat An appropriate child safety seat m Is the right size for the child m Fits the vehicle s seat and seat belt systems m Is easy for parents to use properly m Meets all applicable federal safety standards The next few pages summarize child safety seat guidelines for your child beginning with infants like your newborn baby Keep the information for toddlers school age and older children as a refere
8. 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 NEVER leave your baby or toddler unattended in the bath A newborn can drown in just an inch of water fingertips You may also use a soft emery board to file your baby s fingernails os CARING FOR YOUR NEWBORN 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 cor
9. of when a large amount o comfortable milk is returned forcibly Some babies vomit m When formula feeding your baby burp him midway through and occasionally If at the end of the feeding In the beginning this would be after vomiting continues every half ounce Keep the nipple full of formula throughout the consult your feeding to decrease the amount of air your baby swallows baby s doctor m When breastfeeding burp your baby when you switch breasts and after each feeding Breastfed babies take in less air so your breastfed baby may not need to be burped OVER YOUR SHOULDER ACROSS YOUR LAP SITTING ON YOUR LAP Hold your baby against your Lay your baby face down Sit your baby on your lap chest with his head supported across your legs knees Support his chin with one on your shoulder Gently pat making sure the head is hand Lean your baby his back with your hand supported Gently rub or forward and pat his back pat your baby s back 14 CARING FOR YOUR NEWBORN SLEEPING Most but not all newborn babies sleep a lot Some sleep for as many as 18 20 hours a day while others may sleep for only 8 hours a day Some babies are more active and alert while others are more fussy and demanding or more calm and quiet In general as your baby gets older he will require fewer naps Most parents are anxious for their newborn to sleep through the night When this time comes it is a glorious event But be
10. to 2 months INTERACTING newborns can focus best on Interacting with your newborn is one of the most important things ees ene NEE ON EEES you can do It encourages his development and helps him feel loved Pictures such as these are T and secure Interact with your baby by giving him experience with all good to show your baby of his senses Normal newborns can see hear feel smell taste suck swallow follow with their eyes a short distance and distinguish sounds Newborns also show interest in human faces and voices Infant development studies show that newborns can understand and learn There are many ways you can interact with your baby Talk and sing to your baby Give him musical toys brightly colored toys or a mobile for him to follow with his eyes Smile and play with your baby Try to establish eye contact Stroke pat massage and rock him Make bathing changing and feeding times special You can help your baby learn more and you can enjoy her more by under standing her development Your baby is an individual who will learn faster in some areas and slower in others Don t try to push or rush your baby Allow her to develop at her own pace IF YOUR BABY HAS A BROTHER OR SISTER Often older siblings have a hard time with a new baby at home They may experience feelings of jealousy or rivalry about the new baby Some regress to earlier behaviors such as bed w
11. your child from injury visit the National Safe Kids campaign website at www safekids org CARING FOR YOUR NEWBORN O DON T B Don t leave a child alone in the house or car even for a short time M Don t leave a child under the age of 5 alone in the bathtub Children can drown in as little as one inch of water in only one to two minutes If the phone or doorbell rings wrap the child up in a towel and take him with you or better yet let the phone ring B Don t leave the crib side rails down B Don t pick up a child by his arm Instead grasp him at the chest PET SAFETY Pets can be a source of joy or a serious hazard to a new baby Pets may also be a source of potential infection Be sure to watch the pet s reaction to the infant Some animals experience hostility or jealousy and may harm the baby You may have to take steps to protect the baby especially if you have an exotic pet Never leave a new baby alone with any pet 36 Don t smoke around your baby B Don t leave babies or young children alone while they re eating B Don t say Medicine is candy It isn t B Don t leave a mop pail of water where a child could get into it a child could drown B Don t allow plastic bags where your baby could reach them or roll into them B Don t leave an infant alone on a bed or changing table Know your child Being aware of your child s development allows yo
12. ING FOR YOUR NEWBORN SAFETY GUIDELINES As a parent of a newborn you re likely to have many concerns about the safety of your baby This section provides some guidelines on keeping your baby safe WHAT IS THE POISON CONTROL CENTER POISON SAFETY Its never too early to poison proof your home Children under the age The Poison Control Center of 5 are at the greatest risk for accidental poisoning All children are was established to help born with a natural curiosity about the environment around them you if a poisoning occurs They explore this environment by putting everything into their mouths Specially trained staff are E available 24 hours a day to As they begin to crawl walk and climb this curiosity increases and so d MN answer any questions you does the risk for poisoning A have about poisoning Call the Center anytime you Many poisonings occur while a parent is using a product such as a suspect someone may have cleaning solution or paint The child may start to play with the cleaning been poisoned bucket or paint can Don t be taken by surprise Poison Control Center If a poisoning occurs remain calm and follow these instructions 1 800 222 1222 E Swallowed poison Call the Poison Control Center W Poison in the eye Gently rinse the eye with luke warm not hot water for 15 minutes Do not force THE LATEST ON the eyelid open Call the Poison Control Center THE USE OF IPECAC SYRU
13. P The American Academy of M Poison on the skin Remove contaminated Pediatrics no longer recommends clothing and rinse skin with water for keeping a bottle of ipecac syrup on 10 minutes Wash skin gently with soap hand at home In fact they recommend and water and rinse thoroughly Then call that parents throw away existing ipecac the Poison Control Center syrup The first action for a caregiver of kite i T achild who may have ingested a toxic l Ws Years substance is to call the Poison Control E Inhaled poison Immediately move into Sear ust Center The AAP also continues to fresh air Avoid breathing fumes Open PIRE doors and windows wide to allow effective weapon against 665 EXP 04 03 fresh air into the area If the victim poisoning is not breathing start CPR and call the Poison Control Center CARING FOR YOUR NEWBORN SLEEPING AND CRIB SAFETY Most people who care for babies suppose that a baby is always safe while sleeping However some sleep situations can lead to injury or death Young babies have suffocated in soft bedding materials and others have died when they became caught between the mattress and the bed frame Some babies have even been smothered by a parent Because of concerns who rolled over them while sleeping in the same bed These situations about infant suffocation can be prevented on soft bedding products bumper pads are not routinely recommended M DON T pl
14. RELINQUISHMENT ACTS SUMMARY OF WHEN TO SEEK MEDICAL HELP CARING FOR YOUR NEWBORN YOUR BABY S APPEARANCE Every new baby is unique and beautiful Don t be surprised gt however if your baby doesn t look like the babies you see on a 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 y X This section discusses some of what you can expect to see in a normal newborn s appearance and what should cause you concern Skin color in newborns can SKIN vary greatly from a pink Many parents first anxious questions relate to the appearance of their and white or yellowish tone baby s skin Is my baby too red What are those marks on his to the typical redness 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 s
15. REN greater than 80 pounds Always read seat belt instructions Follow the car manufacturer s guidelines The back seats with the lap shoulder belts are the safest places for a child Any child under age 13 should sit in a rear seat Any child 13 years of age or older who must sit in the front seat of a vehicle with a passenger side air bag should be properly restrained and the vehicle seat should be moved back as far as possible Most children will fit in a lap shoulder belt when they are at least 80 pounds and 4 feet 9 inches tall Keep the lap belt snug and low across the hips and do not let it ride up on the abdomen Make sure the shoulder belt crosses the shoulder not the neck or face Do not wear the shoulder belt behind the back or under the arm For better fit the child may slide closer to the buckle toward the center of the vehicle 33 CARING FOR YOUR NEWBORN rear facing infant car seat gt V A mat oat t m ACA cac oT eet Ler Led VT Tet La Et chest harness retainer clip straps fl n LT ul nun With some cars you must use a locking clip with the lap or Shoulder belt When needed place the locking clip on both lap and shoulder belts 1 2 to 1 from the latch plate 34 SECOND HAND SMOKE Cigarette smoke is harmful to your baby More than 50 recently published studies show that exposure to smoke puts your baby at higher risk for the following proble
16. 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 For more information check out these websites When you reach either of the following websites type CARING FOR YOUR NEWBORN 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 necessary According to the American Academy of Pediatrics and the American Medical Association there is not enough medical evidence to support routine circumcision Studies do show some potential medical benefits of circumci sion but there are also potential risks see the table at the bottom of the page Since circumcision is not essential to the child s current well being 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 Potential Benefits Reduced r
17. a Safe Haven without being subjected to prosecution for abandonment Safe Havens include hospitals licensed in the state of Idaho licensed physicians and staff working at their offices and clinics advanced practice nurses physician s assistants and certain emergency medical personnel first responders EMTs and paramedics 37 CARING FOR YOUR NEWBORN NOTES INSURING YOUR NEWBORN Remember to enroll your newborn in your health insurance plan within 30 days of birth to make sure your baby s medical expenses are covered 38 CARING FOR YOUR NEWBORN SUMMARY OF WHEN TO SEEK MEDICAL HELP Get emergency care in the following cases Dusky or blue skin or lips Poisoning or suspected poisoning call Poison Control first 1 800 222 1222 Ej M Excessive sleepiness floppiness or difficulty rousing E E Trouble breathing or chest sinking in with breathing SKIN Jaundice a yellow appearance that does not go away or spreads to cover more of the body A rash that concerns you Mottled and pale skin and a temperature that s higher or lower than normal Cradle cap Severe or persistent diaper rash SIGNS OF INFECTION OR ILLNESS Reddened or firm skin around the umbilical site or skin that has pus or a foul smell Redness swelling tenderness pus or bleeding at the circumcision site Vomiting more than occasionally or vomit that is green or bloody Unstable or abnormal temper
18. ace your baby to sleep on any soft loosely filled surface such as comforters pillows sheepskins or cushions filled with polystyrene beads These surfaces can mold to your baby s face and interfere with breathing DON T allow hanging crib toys mobiles crib gyms within your baby s reach Remove any hanging crib toy when your baby begins to push up on her hands and knees or when she is 5 months old whichever comes first These toys can strangle your baby DON T let your baby sleep on a waterbed Babies can become trapped and suffocate DON T use thin plastic wrapping materials such as cleaning bags or trash bags as mattress covers Do not allow these things near your SLEEPING IN baby The baby may suffocate if these items are near the face THE SAME BED AS YOUR CHILD i DON T allow your baby s head to become covered during sleep If you choose to sleep in the same bed with your infant avoid DON T allow cords from drapes soft sleep surfaces Do not place or window blinds near the crib quilts blankets pillows comforters Do not place any items with or other similar soft material under strings or small parts near the the infant Don t smoke or use p substances such as alcohol or crib These things can strangle drugs that may impair your or choke the baby ability to wake up Also make sure other bed sharers also DON T leave the baby alone on avoid these substanc
19. and thoroughly clean the skin m Fewer than 4 stools in a 24 hour period on the e For girls Wipe the genitals from front to back For the first 4 fourth day of age weeks after birth it s not unusual for girls to have a white W Fouwerd4hsmhsust milky discharge that may or may not be tinged with blood diapers in a 24 hour period on the 4th day For boys Clean under the scrotum Do not push or pull the of age foreskin on an uncircumcised penis M Sudden changes in Watch those pins If you use cloth diapers watch out for open bowel movements in combination with safety pins Always point them outward away from the baby irritability poor eating or other concerns E 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 fourth 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
20. aps in the slots that position them to come up and over the baby s shoulders Fasten the harness snugly At your baby s collarbone you should not be able to pinch up any of the excess harness strap webbing between your fingers Always use the chest retainer clip to hold the shoulder straps in place Position the retainer clip at armpit level see the picture on page 34 When installed properly the child safety seat should move very little when shaken at the anchor points one inch or less side to side and front to back where the seat belt goes through With some car models you must use a locking clip with the lap shoulder belt Always read your vehicle and your child safety seat manufacturer s instruction manual When needed place the locking clip on both lap and shoulder belts 1 2 to 1 from the latch plate see the picture on page 34 If needed to prevent slouching or sliding place rolled diapers or blankets on both sides of the infant s body and between the legs DO NOT put padding behind infants backs or under their bottoms or use car seat inserts that don t come with the car seat In an emergency situation it is suggested that parents remove the entire seat with the child in it by releasing the seat belt because it takes less time Infants should be reclined at an angle of 30 45 degrees to avoid stress to the neck and back and to keep the infant s head from falling forward possibly cutting off the airway 31
21. ate a problem Call your baby s doctor now to determine the best course of action 4 2 O9 CY YOUR BABY S APPEARANCE SRI kw ae eR ee ee a 4 Legs 2 5 Head and face 6 Eyes rrr n 4 BASIC CARE ACTIVITIES Bathing 8 Fingernail care 8 Diapering rns 9 Circumcision and penis care 10 Umbilical cord care 11 Feeding 12 Sleeping 15 Interacting 16 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 NEWBORN SCREENING TESTS Bilirubin screening 24 Hearing screening 24 Screening tests for hereditary diseases 25 IMMUNIZATIONS SAFETY GUIDELINES Poison safety 217 Sleeping and crib safety 28 Car safety 30 Second hand smoke 34 Other safety guidelines 35 SAFE
22. ature A baby s normal temperature armpit is 97 7 F 36 5 C to 99 5 F 37 5 C Thrush white or grayish white slightly elevated patches resembling curds of milk on the tongue roof of the mouth lips or throat Breathing faster than 60 breaths per minute Wheezing or coughing Lethargy or an overall change in activity or temperament Call your baby s doctor if you notice any of the following Excessive irritability has a high pitched cry or is inconsolable Poor eating for example refusal to eat at all or consistently sleeping 5 6 hours between feedings BOWEL MOVEMENTS AND URINATION No bowel movement by 36 hours of age or persistent constipation Fewer than 3 bowel movements in a 24 hour period on the 3rd day of life On the 4th day of age Fewer than 4 wet diapers in a 24 hour period Fewer than 4 bowel movements in a 24 hour period After the 4th day of age Fewer than 6 wet diapers in a 24 hour period Fewer than 4 bowel movements in a 24 hour period No bowel movements within any 24 hour period Sudden changes in bowel movements in combination with irritability poor eating or other concerns Diarrhea or stool that s watery green foul smelling or contains mucus Signs of discomfort with urination or failure to urinate within 6 8 hours after a circumcision It s okay to call your doctor any time you have a concern about your baby s health even for symptoms not listed here 39
23. aypen and leave the room for a while Check on your baby every 10 15 minutes Remember it s okay for babies to cry it s normal and it won t hurt them If possible have friends or family take over if you feel yourself losing it No matter how stressed or frustrated you get never shake a baby or young child y 7 Fatherhood is exciting and rewarding Your baby s emotional and physical well being depends on your involvement Studies prove that men who share in caring for their children have a much stronger and more meaningful bond with them Parenthood isn t always easy Both mothers and fathers get stressed occasionally especially when their babies don t stop crying But remember no matter how stressed or frustrated you get NEVER SHAKE A BABY Follow the tips on the previous page to help you cope with a crying baby And be sure to set aside some time each day for yourself go for a run take a hot shower listen to music or do anything else that will relax you 21 PREVENTING SHAKEN BABY SYNDROME When people shake a baby it s usually because tension and frustration build up when a baby is crying or irritable However shaking a baby can cause Shaken Baby Syndrome which is a serious and sometimes fatal form of child abuse Babies have very weak neck muscles If they re shaken their heads wobble back and forth which may cause the brain to shift inside their skull Thi
24. c pants during the day as often and for as long as possible m Ifa strong ammonia smell is present treat the diapers with a solution of bleach Be sure to rinse thoroughly m Try washing diapers with a different soap and rinse carefully CALL YOUR BABY S DOCTOR If you are using disposable diapers or wipes if you notice any of the following m Try changing to a different brand 7 Ba Vomiting more than occasionally or vomit that is green or bloody CONSTIPATION Your baby might become constipated especially if he s being fed Ec or ele ce formula If your baby is constipated his stool will appear hard and diaper rash formed or pellet like If constipation persists notify your baby s doctor B Constipation that DIARRHEA persists If your baby s stool is watery green foul smelling or contains mucus B Watery green or foul notify your baby s doctor Babies can dehydrate very rapidly smelling stool or stool that contains mucus 17 CARING FOR YOUR NEWBORN FEVER Call your baby s doctor if your baby s temperature is higher or lower than the following normal ranges You only need to take your baby s temperature when you think he is ill Where to take the temperature For children less than 3 months 90 days old take an armpit axillary temperature It s a safe method that is adequate for screening Normal temperature range Armpit axillary temperature from 97 7 F 36 5 C
25. e 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 ta
26. es a couch or a bed 28 CARING FOR YOUR NEWBORN Place the healthy young baby on his back to sleep When babies are able to roll over they can choose TTT Consider using a sleeper or other sleep clothing as i 1 their own sleeping position an alternative to blankets If you re using a blanket put your baby with his feet at the foot of the crib Tuck the blanket around the crib mattress reaching only as far as your baby s chest Dress your baby in the type of clothing or cover with the amount of blankets that you would find If you can put a soda can comfortable for sleeping between the bars of your Keep the room temperature about 70 F baby s crib the bars are too far apart Be sure your baby s crib is safe and in good repair Make sure crib slats are no more than 2 Y s inches apart to prevent the baby s head from getting stuck If you can put a soda can between the bars they are too far apart Make sure the mattress is firm and fits the crib The space between the mattress and the crib should not allow more than 2 finger widths Make sure the railing is at least 26 inches higher than the lowest level of the mattress support so your growing baby can t climb over it easily Make sure the crib has smooth surfaces sturdy hardware and a secure teething rail Place the crib next to an inside wall rather than near an outside wall or window Keep the crib away from radiators and
27. etting They may request a bottle when they notice that the new baby is getting a lot of attention You can help older siblings adjust to your newborn with the following strategies M Even before you bring the new baby home reassure older brothers and sisters that they are just as important to you even though the new baby will take a lot of time and attention Give siblings extra love and try to spend some special time with them Read to them while you feed the baby and help them hold or examine the new baby They might need constant supervision and reminders that the baby is not a doll or a toy M Give siblings a doll to care for Having their own baby to care for may ease their jealousy 16 COMMON PROBLEMS DIAPER RASH Most babies at some time or another will probably get a rash on their bottoms diaper rash To prevent diaper rash keep the diaper area clean and dry by changing the diaper every time it is wet or soiled If your baby has diarrhea or is on antibiotics the Use A amp D possibility of developing a diaper rash is increased Use ointment protective cream such as petroleum jelly A amp D ointment Desitin or zinc Desitin or zinc oxide to help prevent or treat the diaper rash OX Ge EO TCI prevent diaper rash n To treat diaper rash expose your baby s skin rash Oxide Cream to air as often and for as long as possible If you are using cloth diapers m Remove plasti
28. hough Idaho Medicaid still does You should check with your own insurance provider before you make a choice Also talk with hospital or clinic staff if needed for information on costs and financial assistance Potential RISKS B Bleeding infection and improper healing These are risks of any Surgery Cutting the foreskin too short or too long If too little skin is removed the circumcision may have to be repeated If too much skin is removed the penis can take longer to heal or may require reconstructive surgery Irritation and urination problems When the foreskin is removed the tip of the penis may become irritated and cause the opening of the penis to become too small In rare cases this can cause urination problems that may need to be surgically corrected CARING FOR YOUR NEWBORN Care of the circumcised penis If your child did have a circumcision read below to learn what to expect and how to care for your child s penis B For all types of circumcision It s normal for the site to be red and raw and have yellow crusts for about 5 days Keep the penis clean by washing it gently with soap and warm water during your son s bath You don t need to use cotton swabs astringents or any special bath products Observe the site for signs of infection listed under CALL YOUR BABY S DOCTOR to the right The circumcision should heal completely within 7 to 10 days B For a circumcision using a Plastibell clamp The P
29. ies greatly from this talk M Keep the pacifier clean to your doctor B Do not tie a pacifier around your baby s neck Your baby could Approximate number Approximate number of of feedings per day ounces per feeding strangle B If the pacifier becomes 0 1 months on demand 6 8 feedings 2 5 ounces each torn cracked sticky enlarged or shows 1 2 months 5 7 feedings 3 6 ounces each other signs of wear 1 replace it immediately 2 3 months 4 7 feedings 4 7 ounces each B Use only store bought 3 4 months 4 6 feedings 6 8 ounces each pacifiers 13 CARING FOR YOUR NEWBORN Positioning your baby SPITTING UP AND DOMITIRC Your baby should be in a semi sitting position to eat This helps keep air from entering his stomach Never prop a bottle for feeding To Most babi it ft i A a avoid choking and to promote bonding hold your baby while you ue ially at first 3 L HAE feed him Your baby should never be left with a bottle while sleeping There is a difference as this promotes tooth decay between spitting up and vomiting Spitting up is Burping your baby M vel ang When babies eat they may swallow air especially when drinking Eur ciu from a bottle Not all babies have to burp so if your baby doesn t for worry Your baby will burp he probably doesn t need to As your baby gets older you euius nis e Duas LE won t need to burp him as often To help make your baby more hen a lar mount
30. ighters quickly find which rooms are children s bedrooms Keep the following items locked up in child proofed cupboards All household cleaning products All prescription and over the counter medicines All gardening and auto products Keep children away from space heaters Keep all razors and blades away from children Buy only fire resistant nighttime clothing Keep the iron in an out of the way safe place after using it Turn the water heater temperature down from 160 to 120 160 water can cause third degree burns in one second 120 water allows 2 to 3 seconds to respond to hot pain 35 Keep all plants out of reach of children Some plants are poisonous when eaten Teach children to stay away from the garbage cigarettes ash trays matches safety pins and straight pins Keep all plastic bags away from children When using tablecloths try not to have them hang over the edge of the table Remove all heavy objects on the top of tablecloths Turn pot handles toward the center of the stove while cooking so children can t pull pots off the stove and get burned Use a harness or belt in a high chair and stroller Avoid giving toys and foods that may be choking hazards For example children can choke on broken pieces of balloons Small children can also choke on objects such as hot dog pieces peanuts carrots popcorn kernels pennies and marbles For more information on protecting
31. ilk on the tongue roof of the mouth lips or throat These patches cling and will not wipe or rinse off easily If they are wiped off they leave the underlying tissue raw and may make it bleed Other symptoms of thrush may include irritability poor eating and a persistent diaper rash Diaper rash caused by a yeast infection may have red spots along the edges If you think your baby has thrush or a yeast infection contact his doctor If you are breastfeeding and your baby develops thrush you may also have a yeast infection on your breasts which can cause your nipples to crack itch or burn Nipples may also become red swollen and painful For information on treating yeast infections for your baby or yourself refer to IHC s Guide to Breastfeeding booklet If you have a vaginal yeast infection you need to be sure to thoroughly wash your hands so you don t pass it on to your baby Thrush and other yeast infections are treated with medication and or ointment Many times both you and your baby must be treated at the same time CHANGE IN BEHAVIOR IRRITABILITY OR LETHARGY Every baby has his own temperament and personality Some babies are calm and placid while others are fussy Most babies are very sleepy for a couple of days after birth You will quickly discover your baby s unique temperament Changes in your baby s temperament or energy level may signal problems Look to the guidelines at the right to help you decide when to cal
32. isk for bladder infection in the 1st year of 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 the penis 1 out of 1 000 000 circumcised men will develop cancer of the penis This may be slightly more common in males who are not circumcised who do not practice good hygiene Slightly reduced risk of getting sexually transmitted diseases STDs possibly including HIV However behavioral factors are far more important in preventing these diseases than the presence or absence of a foreskin Easier genital hygiene and prevention of infection under the foreskin However boys who are not circum cised can learn how to clean beneath the foreskin 10 parents should determine what is in the best interest of their child Whether or not to have your son circumcised is YOUR choice In addition to weighing potential medical benefits and risks you should also consider any cultural religious or ethnic traditions that may affect your decision To learn more ask your health care providers and visit one of the websites listed to the left Make sure you have the information you need to make an informed choice You may have to pay for your son s circumcision Because routine circumcision is not considered medically necessary your health care insurance may not pay for it In fact as of July 1 2003 Utah Medicaid no longer pays for circumcision alt
33. ke 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 CARING FOR YOUR NEWBORN 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 m 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 fo
34. kin 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 m 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 4 CARING FOR YOUR NEWBORN M 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 m 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
35. l the doctor or get emergency care RAPID OR SLOW BREATHING A newborn s breathing pattern tends to be more rapid and irregular than an adult s breathing However if your baby takes more than 60 breaths per minute call your baby s doctor If your baby s chest sinks in during breathing or if your baby appears to have trouble breathing seek emergency care 23 GET EMERGENCY CARE in the following cases Excessive sleepiness floppiness or difficulty rousing Trouble breathing or chest sinking in with breathing CALL YOUR BABY S DOCTOR if you notice any of the following Thrush white or grayish white slightly elevated patches resembling curds of milk on the tongue roof of the mouth lips or throat An overall change in your baby s activity or temperament Excessive irritability has a high pitched cry or is inconsolable FOLLOW UP AS INSTRUCTED If your doctor instructs you to have a follow up bilirubin test after you take your baby home from the hospital it s very important that you do so If the bilirubin level becomes too high and isn t treated your baby could suffer neurological brain damage CARING FOR YOUR NEWBORN NEWBORN SCREENING TESTS Your baby is screened for several problems before going home including high bilirubin hearing impairment and hereditary diseases BILIRUBIN SCREENING Every newborn is screened fo
36. lastibell is a plastic rim that is placed between the foreskin and the glans of the penis If your baby has a Plastibell don t use any special dressings or ointments on your baby s penis The plastic rim usually drops off in 5 10 days B For a circumcision using a Gomco or Mogen clamp Gomco and Mogen clamps are used to surgically remove the foreskin No special dressing is required However to prevent the diaper from rubbing against or sticking to the sore area you can use a small amount of petroleum jelly on the tip of the penis Care of the uncircumcised penis If you chose not to have your son circumcised read below to learn how to care for your child s penis M Wash the penis gently with soap and warm water during your son s bath You don t need to use cotton swabs astringents or any special bath products B Never forcibly pull back the foreskin to clean beneath it B Over time the foreskin will retract on its own This happens at different times for different children but most boys can retract their fore Skins by the time they re 5 years old After that time you can teach your child to gently pull the foreskin back away from the glans and clean the glans and the inside fold of the foreskin with soap and warm water CALL YOUR BABY S DOCTOR if you notice any of the following M Increased redness swelling and tenderness Development of pus filled blisters Bleeding apply pressu
37. lds 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 nm 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 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 Your newborn baby can focus best at a distance of 8 14
38. ms m Colds coughs and sore throats Bronchitis and pneumonia m Ear infections and reduced hearing E Developing or worsening asthma m Sudden infant death syndrome SIDS also called crib death Here s what you can do to prevent these risks m If you smoke quit m If you quit smoking when you were pregnant don t start again m Don t let others smoke in your home in your car or around your baby For information and resources to help you quit smoking ask your health care provider for a copy of IHC s Journey to Freedom Un viaje a la Libertad This booklet is also available online at ihc com prevention This booklet presents a step by step approach to quitting It also lists IHC state and national resources to help you quit CARING FOR YOUR NEWBORN OTHER SAFETY GUIDELINES As your newborn grows and begins to explore his environment be sure to follow these safety guidelines Put safety covers on all unused electrical sockets Install gates at the top and the bottom of stairs Have the Poison Control Center emergency number on every phone 1 800 222 1222 Have smoke detectors installed on each level of the home Check once a month to see if they are working Replace the batteries yearly use a yearly event such as a holiday or birthday as a reminder Use a bathtub mat Put a tot finder on children s bedroom windows A tot finder is a highly visible decal that can help firef
39. nce as your child grows 30 When you transport your baby in a car you ll need to keep a few important rules in mind M Always place your child in an approved child safety seat Never leave your child unattended in a car not even for a moment Enter and exit the car on the curb side Child safety seat Placement Child safety seat harness straps Car safety belts Special considerations CARING FOR YOUR NEWBORN INFANTS 20 pounds or less AND less than 1 year old Always read the child safety seat instructions Follow the manufacturer s guidelines Infant only child safety seats are designated for infants weighing up to 20 pounds You can use infant only seats with or without the base Most convertible seats can be used for rear facing up to 30 35 pounds Make sure the handle is down on infant only seats when used in the vehicle The back seat especially the center back seat is the safest place for an infant seat Keep your infant rear facing until she is at least one year old AND weighs 20 pounds It is recommended that infants stay rear facing up to 30 35 pounds if the car seat permits NEVER put infants in the front passenger seat of vehicles with air bags Do not wrap the infant in blankets or extra clothing Fasten harness straps on the infant first Cover the infant with a blanket last On the back of the child safety seat place harness str
40. ner to the outer using different parts 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 starts to crack ask your doctor to prescribe a cream that does not contain any fragrances or alcohol CARING FOR YOUR NEWBORN 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 m Be ready Before beginning to diaper have the necessary items within easy reach CALL YOUR BABY S DOCTOR if you notice any of the E Be safe If you use a changing table it should be sturdy and have following 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 B No bowel movement by should never turn your back while changing the baby 36 hours of age m Clean well Gently
41. 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 E 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 mitia 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 W 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 correct
42. ory syncytial virus RSV usually causes mild cold like CALL YOUR BABY S DOCTOR if you notice any of the following symptoms but sometimes it can be more serious Look to the guidelines to the right to help you know when to call the doctor or get emergency care B Fever armpit tempera For mild colds there is usually no special treatment However if the ture over 99 5 F or nose becomes too runny or stuffy it may make it hard for a young baby 37 5 C to nurse or drink from a bottle Since a baby can t blow her nose you E Poo eaeoe may have to clear out mucus by suctioning with a bulb syringe see irritability below Also talk to your doctor about using warm water or saline B Breathing rate faster than 60 breaths per minute nose drops to loosen up dried mucus before suctioning Don t give your baby any medications without checking first with your doctor The best thing you can do for colds and other illnesses is prevent them m Wheezing or coughing Follow these guidelines E Wash your hands Wash your hands with soap and warm water before touching your baby and ask others to do the same E Stay home Keep your baby at home as much as possible Especially avoid taking your baby to crowded locations such as shopping malls GET EMERGENCY CARE restaurants and church in the following cases B Trouble breathing or chest sinking in with breathing E Keep sick people away Keep people who have colds away from
43. ou notice signs of illness such as a fever contact your baby s doctor Is it colic If you ve ruled out other causes of crying your baby may have colic irritable infant syndrome Symptoms of colic include E Crying or fussiness for more than 3 hours per day E Difficulty soothing your baby E Baby is happy much of the day but becomes progressively fussier as the day goes on E Baby draws his knees up to his chest and passes gas flails his arms and frequently arches his back and struggles when held m Baby s belly muscles may feel hard during crying Occasionally colic is caused by sensitivity to food in the nursing mother s diet Cow s milk products such as cheese 1ce cream and butter are common sensitivities Other food items that may cause problems include stimulants caffeine and gas producing foods Your baby s doctor or your lactation consultant may suggest eliminating these food products for a time to see if the symptoms of colic improve Talk with your doctor if you think your baby may have colic The cause of colic is unknown but your parenting style is generally not a factor Nor is feeding style Breastfed babies are as likely to have colic as bottle fed babies 20 CARING FOR YOUR NEWBORN If you ve tried everything Crying isn t harmful to your baby but it can frustrate even the most patient of parents If you ve tried everything put your baby in a safe place like a crib or pl
44. patient it might be a while Every baby is different and there is no set schedule In the beginning parents should adapt their sleeping patterns to the baby s Feeding your baby solid foods will NOT help your baby sleep through the night When your baby is ready he will sleep through the night Put baby to sleep ON HIS BACK The American Academy of Pediatrics recommends that babies should be put on their backs to sleep There is a relationship between Sudden Infant Death Syndrome SIDS or crib death and babies sleeping on their stomachs If your baby has special needs your doctor may recommend other sleeping positions 15 WHEN IS TUMMY TIME OKAY When your baby is awake and is being watched it s good to give him some play time on his tummy Tummy time gives your baby these benefits M Helps him develop his back and neck muscles B Helps prevent flattening of the back of the head that occurs when babies spend a lot of time on their backs B Helps him learn to shift his weight to reach for a toy or look around which helps him roll crawl pull to a stand and walk earlier Try to give your baby some tummy time each day start ing with just a few minutes and building up from there But remember if your baby falls sleep gently place him on his back Other sleeping and crib safety DOs and DON Ts are provided in the Safety section of this booklet CARING FOR YOUR NEWBORN From birth
45. r make her comfortable in every Way Decrease your baby s stimulation Work on creating a more quiet calm structured environment for your baby Avoid sudden noises keep the lights dimmed and limit visitors Hold your baby so he feels secure Try swaddling your baby in a soft warm blanket Try anything that provides a slow gentle motion Motion is generally calming to both you and the baby Try taking your baby for a ride in a stroller or in the car Also try cuddling her in a rocking chair or letting her sit in an infant swing Try singing talking quietly to your baby or playing the radio Some babies are soothed by listening to low toned rhythmic monotonous sounds Sometimes running a vacuum a humidifier or a tape of a heartbeat may help Try nursing longer on one breast to allow your baby to receive richer milk Call a relative or friend They may offer advice or watch the baby for a while Colic can be trying and you need support CARING FOR YOUR NEWBORN CRYING AND COLIC Crying is the only way your baby can tell you what he needs Babies cry for a lot of reasons hunger wet or soiled diapers tiredness uncomfortable temperatures hot or cold ilIness fear or the need for company Some infants cry at certain times of the day or night Feeding and changing may help but sometimes even that doesn t work If your baby cries more often than normal and is inconsolable or if y
46. r high bilirubin hyperbilirubinemia before leaving the hospital High bilirubin causes jaundice described on page 22 If your baby s test result shows that your baby is at risk you ll be instructed to take your baby to your doctor s office or to the hospital or an outpatient lab to repeat the test a day or two after your baby goes home It s very important that you have this follow up test as instructed HEARING SCREENING Good hearing is essential for the normal development of language and listening skills yet 1 in 300 newborns have some sort of hearing problem Too often hearing loss is not detected in until a speech or language delay has already occurred That s why the American a Academy of Pediatrics recommends and f X Utah and Idaho state laws require that all newborns have a hearing screening before they leave the hospital 24 CARING FOR YOUR NEWBORN SCREENING TESTS FOR HEREDITARY DISEASES Most states require that newborns be tested for certain hereditary diseases The problems caused by these disorders can usually be prevented if treatment is started early enough Testing requires taking a few drops of blood from your baby s heel Usually two tests are necessary The first test is done shortly before your baby goes home from the 8 hospital A follow up test may be required sometime between 7 and 28 days of age in Utah and between 5 and 15 days in Idaho If a second test is necessary
47. re and call your baby s doctor right away Signs of discomfort with urination Failure to urinate within 6 to 8 hours of a circumcision UMBILICAL CORD CARE Your baby s umbilical cord doesn t require any special care except for keeping it clean and dry If the cord does become dirty for example if there is a small amount of drainage on or around the cord simply wipe it with a warm wet washcloth cotton ball or Q tip and let it dry Since there are no nerve endings CALL YOUR BABY S DOCTOR in the umbilical cord you don t need to worry about hurting your baby if you notice the following B Reddened or firm skin around the umbilical cord or skin that has pus or a Folding the baby s diaper below the cord will improve air circulation and help keep the cord dry After the cord drops off usually in about 12 14 days after birth you may notice some drainage and slight bleeding This is normal just clean the cord site gently until the drainage stops However if the skin around foul smell the umbilical cord becomes reddened firm and or has pus or a foul smell call the doctor It could be infected CARING FOR YOUR NEWBORN FEEDING Breast milk or formula is the only food your baby will need for the first six months of life Water sugar water juice and electrolyte drinks for example Pedialyte are not needed don t give them unless you are instructed to do so by your doctor Cow s milk or goat s milk sho
48. rotect your baby from life threatening diseases Vaccines are among the safest and most effective medicines Vaccines work best when they are given at certain ages with some vaccines given over a series of properly spaced doses They are started at birth and are required before starting school The following table summarizes the routine early child hood immunization schedule as of 2004 This schedule Is based on recommendations of the American Academy of Pediatrics the American Academy of Family Physicians and the Centers for Disease Control AGE VACCINATIONS IN SERIES Newborn Hepatitis B 1 2 months EB Hepatitis B 2 DTaP 1 Hib 1 Polio 1 Pneumococcal 1 When your baby is E NN vaccinated your health care provider should give g you a Vaccine Information A te DTaP 2 Hib 2 Polio 2 Pneumococcal 2 Statement VIS for each vaccine your baby receives 6 months Hepatitis B 3 DTaP 3 Hib 3 Polio 3 Pneumococcal 3 For more information about FE al vaccines visit the following websites H E HERE E www cdc gov nip 12 18 months DTaP 4 Hib 4 Pneumococcal 4 MMR 1 Varicella 1 E www immunize utah org 2 4 years 4 6 years IE Hepatitis A 1 DTaP 5 Polio 4 MMR 2 Hepatitis A 2 DTaP Diptheria Tetanus and Pertussis Hib Haemophilus influenzae type b MMR Measles Mumps Rubella 26 CAR
49. s is deposited in the skin Yo leaving the hospital ally moves reaks down bilirubin in up of babies reatment Treatment downward ont bilirubin levels are high en r W frequent apy orescent light trea feedings of breast r formula In most case U can be done at home but sometimes ed iS required If your baby s bilirubin level is above normal in the hospital but includes Nu d not high enough to require treatment your doctor may schedule you for a follow up bilirubin test It s very important to have this testing done If high bilirubin levels are not treated some babies may suffer neurological brain damage That s why it s also important to notify your baby s doctor if you notice your baby becoming more yellow or if the jaundice covers more of the body than when you were in the hospital You should also notify your baby s doctor if your baby becomes lethargic is eating poorly has an unstable temperature or has behavior changes these can all be signs b amp T gt of a high bilirubin level Prompt treatment is important to prevent permanent injury in a newborn Frequent feedings of breast milk or formula will also help decrease jaundice 22 CARING FOR YOUR NEWBORN THRUSH AND OTHER YEAST INFECTIONS Thrush is a yeast infection in your baby s mouth It may appear as white or grayish white slightly elevated patches resembling curds of m
50. s shifting may cause brain damage and bleeding in and on the surface of the brain resulting in blindness brain damage or death Never shake a baby or child for any reason B Always provide support for your baby s head when holding playing with or transporting him B Make sure that everyone who cares for your baby knows the dangers of shaking him This includes babysitters child day care personnel and siblings B Learn what you can do if your baby won t stop crying Remember all babies cry a lot during the first few months of their lives For more information on Shaken Baby Syndrome call 1 888 273 0071 or go to www dontshake com CALL YOUR BABY S DOCTOR if you notice any of the following Jaundice a yellow appearance that does not go away or spreads to cover more of the body Breathing rate faster than 60 breaths per minute Lethargy or an overall change in activity or temperament Excessive irritability has a high pitched cry or is inconsolable Poor eating An unstable temperature CARING FOR YOUR NEWBORN JAUNDICE Jaundice is the yellowish coloring of the skin and eyes that is sometimes seen in newborns Jaundice is caused by hyperbilirubinemia a condition in which a substance called bilirubin builds up in the bloodstream and baby is v for high bilirubin before A little Jaundice is in newbo The yellow color of jaundice ead an yE the jaundice gradually di
51. s itself GET EMERGENCY CARE in the following cases B Dusky or blue skin or lips 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 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 CARING FOR YOUR NEWBORN 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 th
52. the picture on page 34 Newer cars and child safety seats may use the latch system Read the car and child safety seat guidelines You may place your child in a booster seat If your child s ears are above the top of the safety seat back OR If your child s shoulders are too broad for the car safety seat OR When the upper weight limit of 4O pounds is reached When available you can use built in seats instead of forward facing convertible seats There are no installation problems with these seats Each device has its own instructions and weight limits for children will vary 32 Child safety seat booster seat Placement Car safety belts Placement Car safety belts E E E CARING FOR YOUR NEWBORN SCHOOL AGED CHILDREN 40 80 pounds School aged children should use booster seats Booster seats help safety belts fit older children properly Always read the instructions Follow the child safety seat manufacturer s guidelines The back seat is the safest place for a child booster seat Always use a location that has a lap shoulder belt Any child under 13 should sit in a rear seat The vehicle s lap shoulder belts do not fit a child without the use of a booster seat The booster seat raises the child up for better fitting in shoulder and lap belts and adds bulk to their small bodies The lap belt must stay low over the hips Do not let the shoulder belt cross the neck or face OLDER CHILD
53. u to keep one step ahead by injury proofing areas before your child can reach them Babies up to 6 months old B Roll over and reach for objects M Are often poisoned or given foods that can be choked on by older siblings trying to be helpful Babies 7 to 12 months old B Learn to crawl pull to stand and walk by holding onto furniture B Can pull pans off a stove or pull on a tablecloth with objects on it In either case a severe injury could occur Toddlers B Like to investigate are very curious M Have the highest accident rate of any age group B May get into danger by climbing on high unlocked cabinets and shelves CARING FOR YOUR NEWBORN SAFE RELINQUISHMENT ACTS UTAH SAFE RELINQUISHMENT OF A NEWBORN CHILD ACT In 2001 the state of Utah passed an act that provides a process for a parent or a parent s designee to safely relinquish care and custody of a newborn child less than 72 hours old to hospital personnel at a hospital with emergency medical services As long as the child has not been neglected or abused the person leaving the child will not be required to provide any information to the hospital However he or she may voluntarily provide information including but not limited to the medical history of the parent s or the child IDAHO SAFE HAVEN ACT Idaho has a similar act called the Safe Haven Act It states that a custodial parent may leave a child less than 30 days old at
54. uld also not be fed to a baby younger than one year of age These milks are high in protein and salt and are harder for babies to digest In addition these milks do not contain many of the important vitamins and minerals your baby needs They are especially low in folic acid and vitamin B42 two nutrients that help prevent anemia and iron deficiency Preparing formula If you feed your baby formula keep in mind that the American Academy of Pediatrics recommends using iron fortified formula Always carefully follow the preparation instructions for the formula you give to your baby For example never try to stretch formula by adding more water The American Academy of mE To reduce waste prepare only the amount of formula your baby Pediatrics recommends bresstrecime ron St edet usually takes in one feeding Throw away any formula left in the bottle the first year of your baby s after each feeding As your baby gets older she will gradually take life Breast milk has special larger amounts of formula properties that help protect your baby from illness See IHC s Guide to Breastfeeding booklet TYPES OF FORMULA Formulas are available in the following forms to learn more M Ready to feed formula This type of formula does not require water to be added It comes in multiple or single serving cans or in ready to use baby bottles It s convenient but it s also the most expensive type of formula available
55. your baby including brothers and sisters Parents or other caregivers who feel ill should wear a mask and refrain from kissing the baby B Dusky or blue skin or lips E Don t smoke Don t smoke or allow others to smoke near your l l M Excessive sleepiness baby Exposure to tobacco smoke can increase the severity of viruses us floppiness or difficulty and infections rousing USING A BULB SYRINGE If repositioning your baby or wiping your baby s mouth or nose doesn t relieve congestion you may need to try using a bulb syringe Here s how B n the mouth Turn your baby on her side with her head slightly lower than her body Press in the bulb before placing it in the baby s mouth As you suction out the mucus or milk be careful not to catch the delicate mucous membranes inside the cheeks or the back of the throat Remove the bulb and squirt the contents into a cloth B In the nose Suction mucus from the nostrils in a similar way inserting only the tip of the bulb syringe Be extremely careful when you do this Suctioning the mouth or nose too vigorously too often or for too long can dry and irritate delicate tissues and cause severe trauma to the mouth or nose 19 WAYS TO COPE WITH CRYING Sometimes babies cry for hours at a time and nothing seems to soothe them Although there are no magical cures some of the following techniques may help Check your baby s basic needs Feed and diaper he
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