Newborn Care

• Appointments and Questions for the Doctor
• Bathing Your Baby
• Calming and Caring for Baby
• Care of the Umbilical Cord and Fingernails
• Clothing
• Discharge Phone Calls
• Immunizations
• Laundry
• Pacifiers
• Sleep and Positioning
• Temperature
• Tummy Time
• When to Call Your Baby's Physician

When Should I Make My Baby’s First Follow-up Appointment?
Your baby should be seen by a health care provider within 1-3 days of discharge from the hospital.

When Do I Call for Advice or Help?
This is a question new parents frequently ask. When your baby is new, the answer is to call whenever you find yourself worried. In time, you learn to trust your feelings and will know when things are not right with your baby. While you’re in the hospital, nursing and physician staff welcomes your questions. When you go home, please call your baby’s physician.

Care of the Umbilical Cord and Fingernails
Umbilical Cord
After delivery, you will see a clamp on your baby’s umbilical cord. This plastic clamp will be removed by your baby’s nurse 24 hours after delivery.

Care of the umbilical cord in the postpartum period includes effective hand washing and keeping the cord dry and exposed to air or loosely covered with clean clothes, with the diaper folded below the umbilicus. If the umbilical cord stump becomes soiled with urine or feces, then cleansing the area with water is adequate.

As the cord dries and begins to fall off, you may note a small amount of dark red blood on the baby’s diaper or shirt. Call your baby’s doctor if the cord continues to bleed, has yellow-green discharge and a foul odor or your baby has a fever or seems sick.

Nail Care
The best time to trim your baby’s nails is when he or she is asleep. Sometimes the nail end detaches without being clipped and can be easily pulled away. An infant sized emery board works well.

Bathing Your Baby
Newborns generally do not become very dirty. Bathing is primarily a time of enjoyment for the family and a time for happy interaction with your baby. The American Academy of Pediatrics recommends only sponge baths until your baby’s umbilical cord falls off.

For cleanliness, we recommend that you wash your baby’s bottom with plain warm water every time you change the diaper. Wash your baby’s face with warm water whenever it’s dirty and shampoo hair two or three times a week. As long as these areas are kept clean, a complete bath can be done as frequently or infrequently as you and your baby wish. If your baby loves the bathing experience, it can be a daily ritual. If your baby is not happy bathing initially, skip it for a few days and try again. A full bath once a week is sufficient for cleanliness.

You may find the following ideas helpful at bath time:

• Use an inexpensive, large plastic tub for bathing your baby alone, or climb into the bathtub and have someone hand the baby to you.
• We do not feel it is necessary to measure the water temperature with a thermometer every time you immerse your baby. Check the water temperature with your hand and wrist. Babies enjoy warm water and it should feel comfortably warm to you. If you are one who loves scalding baths, however, that is too hot for baby.
• Try placing a towel or washcloth in the bottom of the tub to make it softer and less slippery.
• You may want to wash your baby’s face and scalp before you undress him or her for the rest of the bath. Your baby can be held “football fashion” over the tub or sink.
• Wash the face with clear, warm water, cleaning the eyes from the inside corner to the outside. Wash in and behind the ears with the corner of the washcloth (no Q-tips in the ears!).
• Wash the scalp with a mild soap and a small soft brush or your fingertips. Rinse well and dry. Now you’re ready to undress your baby and place him or her in the tub water.
• Until your baby is crawling through mud puddles, there is no need to use soap on your baby’s skin. Clean water and a cloth do an excellent job. After placing your baby in the tub, you may find that covering him or her with another warm cloth or towel is both calming and warming.
• Warming your bath towels in the dryer before wrapping baby after the bath is a nice way to keep him or her warm and comfortable.
• Keep the bath simple and enjoyable. You will come up with your own creative ideas for making this a happy time with your baby.

Clothing
It is not necessary to adjust the temperature of your home when your baby arrives. A helpful guideline in general is to dress your baby in one more layer than you are wearing.  

Laundry
You may use mild soaps, detergents, bleaches, and softeners when washing your baby's clothing. The key is thorough rinsing. You may need to the runt he clothing through an extra rinse cycle. Fabric softeners may reduce the absorbency on home-laundered diapers.  

Immunizations
Immunizations are now available to treat almost any “childhood disease.” The benefits of immunization are much greater than the possible risks of the vaccines for almost all people. Because these vaccines are so effective, it is easy to forget how serious the diseases they prevent are. For instance:

• Diphtheria attacks the throat and nose, interferes with breathing, can damage the heart and kidneys, and is fatal in 10% of cases.
• Tetanus is fatal in 50% of cases.
• Pertussis (whooping cough) causes coughing spasms and gasping for breath. Most cases occur in infants and young children, and 70% of pertussis deaths occur in children under one year of age.
• Polio (IPV) attacks the nervous system, can cause paralysis of legs and other areas of the body, and 10% of cases are fatal.
• Measles can cause hearing loss, convulsions, intellectual disabilities, and death.
• Mumps may cause inflammation of the brain and spinal cord (meningitis) and may cause permanent deafness.
• Rubella (German measles) can cause miscarriage, stillbirth, and multiple birth defects in a baby if the mother has this disease during pregnancy. It can also cause soreness and swelling of the joints (arthritis) that can last a week or two, or in some cases, last for months or years.
• Haemophilus Influenzae Type B (Hib) is the most common cause of bacterial meningitis. In 25% of cases, this type of meningitis can result in permanent brain damage.
• Hepatitis B Vaccine (HB) prevents a disease that affects and often damages the liver and can be fatal.
• Varicella Vaccine (Var) prevents chicken pox. Chicken pox can result in scarring and in encephalitis in some rare cases.
• Pneumococcal Conjugate (PCV) helps prevent pneumococcal infection that can cause pneumonia, meningitis, and even death.

Discuss with your baby’s physician the availability of new vaccines.

Massachusetts State Law requires that every child be immunized before entering school and daycare centers. Your baby may receive the first of three hepatitis B shots while in the hospital. The remaining immunizations are available at your baby’s well-baby checkups, at the local health department, or at a community clinic.

The possible risks or side effects of each immunization will be explained to you at the time your baby receives each vaccine. Risks vary, but can include such symptoms as soreness at the injection site, fever, and fussiness.

Keep an accurate record of all the vaccines your baby has received. This record will be necessary if you place your baby in daycare and when your child begins school and even college. This is also a good time to get your own immunizations up to date. As an adult, you will need to have a tetanus-diphtheria booster (Td) every 10 years.

Tummy Time
When awake and under adult supervision, place your baby on his or her tummy to avoid the development of a flat spot on the back of the head. This positioning also facilitates good neck muscle rotation and tone and stimulates the development of prone motor skills. Toys and other stimulating objects can be placed in the infant’s field of view to encourage turning his or her head from side to side. You can begin this activity right after birth. Check with your provider.  

Pacifiers
Pacifiers are only used upon a parents’ request. Each time your baby signals that he or she is hungry, we will encourage you to feed your baby rather than delay a feeding by using a pacifier. When feeding goes well, you are less likely to have problems with engorgement or to have a baby with poor weight gain and jaundice. Some babies still want to suck even following a good feeding. Using a clean pacifier could be an option once feeding is going well and the baby is gaining weight.  

Calming and Caring for Baby
Babies cry for good reasons. Crying is your baby’s way of letting you know he or she has reached their limit. Unfortunately, we don’t always understand this form of communication. Common things to check are: hunger, gas, too hot/too cold, and simply needing attention.

Ways to comfort your baby:

• Nurse or bottle-feed to see if your baby is hungry.
• Try burping or patting baby’s bottom. Leg and abdominal exercises, applying a tepid hot water bottle, or heating pad on very low heat can also help with gas.
• Removing clothes and extra blankets if you think your baby may be too hot.
• Changing baby’s diapers can help if you think your baby is too cold. Other warming techniques include putting baby in a warm bath, putting baby in a snuggli, warming baby’s blanket(s) in the dryer and then swaddling baby, cuddling baby, increasing room temperature, and adding clothes.
• If your baby has been startled, try swaddling, cuddling, holding baby’s extremities, carrying baby in a sling or snuggli, putting baby in a hammock, walking baby, taking baby for a car ride, rocking baby in the cradle, rocking baby standing up (back and forth or up and down), putting baby in a swing chair. If baby is still crying, try walking outside, turning on the bath water, giving baby a bath, massaging baby, turning on/off music, dancing with baby, showering with baby.

Also, just because something didn’t work last time or half an hour ago doesn’t mean it won’t work now. After a while, both you and baby will develop favorite calming methods. At times, you may need to take care of yourself to take care of the baby. If the baby is still crying after trying everything, you could make the baby as happy and safe as possible, and give yourself ten minutes alone in the shower or with your favorite music. Every member of the family needs to help you. Take turns trying to comfort baby. Sometimes, a new person doing the same thing can help calm baby.

Remember, your baby has come a long way from the warm and completely comforting womb. Touching, talking, holding, rocking, cuddling, and stroking are forms of communication. They tell your baby that you care.

Sleep and Positioning
The SAFE TO SLEEP campaign was developed by multiple professional organizations including the NIH (National Institutes of Health) and AAP (American Academy of Pediatrics). During your stay at Newton-Wellesley Hospital, our maternity team will also be sharing and reinforcing this information.

AAP: Safe Sleep Environment for Your Infant
The American Academy of Pediatrics recommendation for safe sleep

• Infants are placed on their backs to sleep for every sleep time. This includes naptime and at night.
• Infants sleep on a firm sleep surface without any additional objects in the crib.
• Infants sleep in the same room as the parent but not the same bed.

Initial Sleeping Habits
Very few babies sleep through the night during their first months of life. Try not to make sleeping through the night your number one objective. Also, don’t compare your baby’s sleep habits to your neighbor’s baby.

With few exceptions, babies need to be fed several times at night to get adequate calories for growth. Recognize night feedings as normal behavior for infants. Gradually, night sleep lengthens as your baby matures.

Helping Your Baby to Sleep:

• Position your baby on his or her back rather than the side or tummy. Sleeping on the back is associated with a greatly decreased incidence of SIDS (Sudden Infant Death Syndrome).
• Do not use pillows, soft comforters, plastic waterproofing materials, or lambskin in the baby’s bed.
• Being snuggly wrapped in a receiving blanket helps some newborns settle into sleep. Avoid over bundling in many blankets.
• The motion of rocking, walking, swinging, or car rides may help your baby relax for sleeping.
• Try music, singing, or a gentle massage for a soothing sleep ritual.
• Continue making your usual family sounds when you bring your baby home. Babies have the ability to close out sounds and learn to sleep through most noises.
• Babies sleep from 10 to 20 hours in 24 hours, with an average of 14 hours. As long as your baby is feeding well and is healthy, trust your baby to know how much sleep he or she needs.

Taking Your Baby’s Temperature - Is There a Fever?
Many pediatricians will ask you for a rectal temperature reading if you think your baby is sick. Do not use ear thermometers in infants under six months of age. They are not accurate.

How to Take a Rectal Temperature:

• Use a digital thermometer and lubricate lightly with Vaseline, A& D Ointment, or KY Jelly before inserting into rectum.
• Position your baby on her or his back and hold the baby’s ankles in one hand, the thermometer in the other.
• Gently insert the bulb of the thermometer into the rectum about one-half inch, or until the bulb can no longer be seen.
• Always hold both the baby and the thermometer.

When to Call Your Baby's Physician

• Rectal temperature of 100.4ºF or higher.
• Any yellow or yellow-green discharge from the eye.
• Concerns about the circumcision, including bright red bleeding (more than a spot), swelling, foul discharge, or inability to urinate.
• Concerns about the umbilical cord, including bright red bleeding (more than a spot) or a foul odor.
• If your infant’s behavior changes and he/she is very lethargic or listless.
• Call your baby’s physician if your newborn infant feeds fewer than seven or eight times in 24 hours, does not have a bowel movement in 24 hours, or has fewer wet diapers than he is days old. (For instance, we expect that a three-day-old infant will have three wet diapers.) By the time your milk is in, we expect six to eight wet diapers in 24 hours.
• Your baby’s physician is a wonderful resource for your questions and concerns.

Discharge Phone Calls
Following discharge from the hospital, you may receive a phone call from one of our nursing staff. The purpose of this call is to find out how you are doing, how your stay was, and to ask if there is anything we can do to improve our services. If you are having difficulties of any kind the staff will refer you to the appropriate resource. The hospital will also seek your comments through a mailed survey, which we hope you will take a few minutes to complete and return. Our goal is to provide excellent care. To do so we need your honest evaluation of our services.