Newborn Care


In the Hospital
Immediately after delivery, your baby will be placed under a radiant warmer, dried, and have his/her mouth and nose suctioned.  Antibacterial ointment will be placed in both eyes, and a vitamin K injection given into the thigh.

It is common for newborns to have mild breathing difficulties right after delivery.  While in the uterus, the baby’s lung sacs are filled with fluid.  As labor progresses, more of the fluid is absorbed out of the lung sacs.  If your child has some difficulty breathing right after delivery, he/she will be observed in an Observation Unit.  In most cases, the breathing difficulty resolves within in a couple of hours as more fluid is being absorbed out of the lung sacs.  And more often than not, the babies are fine afterwards.

Triple dye or another antibacterial agent may be applied to your child’s umbilical cord to prevent colonization of bacteria on the cord.

If your child has no problems, he/she may start breastfeeding or bottle feeding within couple hours of delivery.

Usually, full-term, uncomplicated newborns are discharged around 48 hours of life.  This may be prolonged if the mother is recovering from caesarian section. The State Newborn Screens (heel-stick blood test) are drawn before the discharge of the baby.  Currently, Illinois screens for congenital adrenal hyperplasia, hypothyroidism, sickle cell disease and other hemoglobin disorders, and metabolic disorders, such as, phenylketonuria (PKU), galactosemia, biotinidase deficiency, etc.

Please obtain a car seat before bringing the newborn home.  Many hospitals will not discharge the newborn unless the car seat is brought to the nursery.  Infant car seats are supposed to face towards the rear of the car.  The ideal place to place the seat is in the middle of the back seat.

Feeding
Formula Feeding– Cow milk based formulas are usually the first type of formula introduced.  There are also soy based formulas and some pre-digested formulas for babies with special needs.  Feedings during the first month of life usually are around 2-3 oz every 2-3 hours. Expect 2-3 overnight feedings as well.  Just remember “2-3.”

Breastfeeeding–American Academy of Pediatrics (AAP) is trying to encourage breast feeding because it:

  1. Promotes mother-baby bonding.
  2. Confers immunological protection, promoting fewer infections.
  3. Contains easily digestible fat content and special polyunsaturated fatty acids to promote central nervous system development.
  4. Naturally calming.
  5. Fewer digestive problems and has a laxative effect.
  6. Fewer allergies, eczema, and asthma development.
  7. Has a lower incidence of SIDS (Sudden Infant Death Syndrome).

Breast milk is considered superior to formula among pediatricians.  Initially the breast milk will be a clear to honey colored, thick substance called colostrum.  Breast milk then will turn to mature milk within the first week of breastfeeding.

Breastfeeding should be done initially every 2-3 hours when Mom is awake.  The constant nipple stimulation will help promote more milk production, especially when there’s little milk production in the beginning.  Breastfeeding may take about 10-30 minutes.  Eventually with good milk production, the frequency of breastfeeding will pan out to be every 3-4 hours by the end of the first month of life.  During the first month of life, do not let your newborn go beyond 4 hours without feeding.

There is a lack of Vitamin D in breast milk, and the AAP recommends giving vitamin D supplements to the breast fed infant to prevent rickets, starting within the first 2 weeks of life.

If you are pumping the breast milk, here are some tips on storing it:

  1. Store in sealed bottle in the amount of baby’s feeding.
  2. Fresh breast milk is good at room temperature for up to 8 hours.
  3. Breast milk in the refrigerator can be stored up to 1 week.
  4. Breast milk in a conventional freezer can be stored up to 3 months.
  5. Breast milk in a deep freezer can be stored up to 6 months.
  6. Do no re-refrigerate or re-freeze thawed breast milk.
  7. Use thawed breast milk for feeding within 1 hour of thawing at room temperature.
  8. Thawed breast milk placed in refrigerator is good for 24 hrs.

Physiological Reflux
It is normal to have some spitting up after feeding. The most common causes of large amount of spitting up are overfeeding and swallowing large amount of air while feeding.  Remember to “burp” your child after feeding to remove some of the swallowed air in the stomach.  Depending on how much air your child swallows, burping may be done during and after feedings.  Here are some other tips to help with reflux:

  1. Consider smaller amount of feeds, but more frequently.
  2. Double burp your child—burping your child in middle and after feeds, or during the switching of breast while breastfeeding.
  3. Hold your child upright for 5-10 minutes after feeding.
  4. Have your child lie in 30 degree incline (head up) after feeding to help prevent further spitting up.

If your child is happy and not fussy, and is gaining weight well, beyond the initial weight loss after birth, then no further management is required beyond the above tips.  If your child becomes fussy with spitting up and arches his back (signs of acid reflux and heartburn) or has poor weight gain, then further intervention may be required:

  1. Thickening the formula may help with spitting up.  Some anti-reflux formulas have added rice starch to thicken the formula.  Also you may try adding 1 teaspoon of baby rice cereal to every ounce of formula to help decrease spitting up.  Be sure to use a nipple with a larger hole to accommodate a thicker formula to pass through.
  2. Some medication can help to decrease acid production in the stomach, to relieve the heartburn.  Other medications can help by increasing the rate of stomach emptying into the small intestine, thus alleviating some reflux.

Some More Tips
Keep the newborn warm.  Over clothing or excessive ambient warmth is a risk factor for SIDS.  The rule-of-thumb is to give the baby one extra layer of garment for every amount of garment you are wearing, which makes you comfortably warm.

Sterilize bottles, nipples, and pacifiers each night.

Expect at the very least 6 diaper changes per 24 hour period.  Infant’s stools look like a mushy collection of yellow seeds.  Also, if fed formula, the stools may turn green due to the iron content of the formula.

Skin Care
Give the baby a full-body washing 2-3 times per week.  Daily washings are not necessary in the newborn, especially since they sleep during most of the day and are not playing out in the dirt.  Infant skin is thinner than adults.  This makes the infant’s skin more prone to dryness, which can lead to irritation and rash formation.  The baby’s natural oils will help keep his/her skin soft.  Apply light skin lotion right after the washing to help seal in the moisture.  It’s okay to apply lotion to the face, but do not use thick emollients on the face.  Thick emollients (eg, petroleum jelly) can plug pores causing rash outbreaks.  Our goal is to keep the baby’s skin smooth, soft, and hydrated.  Consider washing folded areas (armpits, groin, and neck) everyday because these areas are more prone to trap dirt and fungus.

Expect some skin peeling in the first 3 weeks of life.  This does not necessarily mean your newborn’s skin is dry.  Older skin peels off as newer softer skin comes in.  This is considered normal.

Do not use the baby baths (baby bath tubs filled with water) until 1 week AFTER the cord falls off, which is the approximate time needed for the umbilical stump to heal after the cord falls off.  Until then, just cloth wash him/her.

Umbilical Cord
Do not wipe off the Triple dye or antibiotic ointment, if placed.  Keep the diaper edge below the umbilical cord so that the cord stays out of the wet diaper.  This will help the cord dry up faster.  The cord usually falls off by the 2nd week of life.  Some people say to clean the umbilical stump daily with rubbing alcohol and a soft cotton cloth; however some studies have shown that this “cleaning” may cause irritation and delay the healing of the umbilical stump after the cord falls off.  No uniform consensus has been made, so the decision will be up to the caretaker.

Preventing SIDS
It is recommended to have the baby sleep on his/her back.  Studies have shown this has decreased the incident of sudden infant death syndrome (SIDS).

Exposure to cigarette smoke and having too much clothing, causing excessive heat retention, are also risk factors for SIDS.  Remember, have your baby wear one extra layer or garment for every amount of garment you are wearing which makes you feel comfortably warm.

American Academy of Pediatrics does not recommend co-sleeping on the same bed as the infant, as this increases risk of SIDS.  It is recommended to have your infant sleep in the same bedroom, but in a separate crib, until 6 months of age.

Safety Precautions
Avoid having string loops (e.g., curtain cord) hanging near, in, or on the crib/bassinette.  A baby’s head can get caught in the loop, resulting in an accidental hanging.  Also avoid having small objects or toys made up of small, breakable parts around the baby.  It is not recommended to have jewelry on the baby, including ear rings, because of the risk of the baby pulling the jewelry off and placing it in his/her mouth.  Remember, infants place EVERYTHING in their mouths, and we want to be cautious on preventing choking incidences.

Illnesses
For any newborn, a rectal temperature of 100.4 F or greater is a medical emergency.  A newborn’s immune system is immature, so in theory, it takes a good amount of infection just to elicit a small fever.  Do not give any fever reducing medicine, because this can mask symptoms.  Bring your newborn to the emergency room if he/she has a fever.

Newborns do not breathe through their mouths.  So if they have a cold and the nose is stuffy, the newborn may not breathe well.  Decongestants and cough suppressants are not indicated for this age.  If your newborn has a stuffy, running nose, then humidify the room with a cool mist humidifier, and use normal saline nose drops and bulb suction as needed.  Sneezing is good, because it helps clear debris in the nose.  The more your baby sneezes, the less you have to suction his/her nose.

Oral thrush is a fungal infection.  It presents with white curdy substance in the mouth, which cannot be wiped away.  It can be anywhere in the mouth but usually builds up on the tongue and inner cheeks.  Anti-fungal solution can be prescribed by your healthcare professional to treat this.

Diaper rash are common among infants.  It usually develops from persistence skin contact with moisture, either from urine or feces, resulting from mild skin irritation to skin maceration.  Zinc oxide ointment is beneficial in promoting skin healing.  However if the rash is not getting better with zinc oxide ointment or is beefy red with smaller little rashes around a larger confluent rash, then the rash is most likely a fungal rash, and an anti-fungal ointment is needed.  Over-the-counter anti-fungal clotrimazole 1% cream/ointment can be used —apply 3 times per day for about 10-14 days.  Do not use topical steroids for diaper rashes, unless directed by healthcare professional.  Also do not use talcum powder, which is a strong respiratory irritant, because the powder can be inhaled by the baby.  Corn starch increases the risk of fungal infections in the diaper area.

Jaundice
Jaundice is a very common issue in the newborn during the first 2 weeks of life.  Jaundice is the yellowish discoloration of the eyes and skin due to increase blood levels of bilirubin— which is the breakdown product of red blood cells.  Jaundice usually starts appearing in the face and then goes downward towards the feet as the blood level of bilirubin increases.  If your child’s bilirubin levels are high, as determined by healthcare professional, then phototherapy (exposure to blue or white lights at a special wavelength) will be used to help lower the bilirubin levels.

While at home, to prevent a rapid rise in bilirubin level, you may try placing the baby near the window or in a well sunlit room, but not in direct sunlight to avoid sunburn.  The more surface area (less clothing) the baby’s exposure has to the light, the more effective in preventing a rapid rise in bilirubin level.  However, remember to keep ambient temperature warm enough for the infant when exposing the newborn.  Maintain adequate amount of feedings—a dehydrated baby will have a more concentrated bilirubin level.  If the jaundice progresses despite these two tips and spreads down to the chest or hands, then have the newborn evaluated by a healthcare professional.

Sleep
The American Academy of Pediatrics recommends having your child sleep on his/her back, which decreases the incidence of SIDS.  Alternate each day on which side the head is placed in the crib/ bassinet.  That way, the baby will look out from the crib in different directions on separate days, thus decreasing the chance of asymmetrical head shape.  The baby’s mattress should be firm and no pillows are needed.  Initially your newborn will sleep about 18-20 hours per day.

Calming a Fussy Newborn
Crying is a way that your baby communicates.  If he/she is fussing, then ask yourself:

  1. Is it time for the next feeding?
  2. Is my baby too warm?  Too cold?
  3. Does my baby’s diaper need to be changed.
  4. Is my baby tired and wishes to sleep?  Is he/she being overstimulated?  Your baby may be just tired and wishes to be laid down to sleep.
  5. Are there any signs of illness, e.g., running nose, coughing, vomiting, diarrhea, etc.?

If your baby’s needs are met by the above questions and is still fussing, then:

  1. Try swaddling your baby.
  2. Try pushing his/her knees towards the chest, or move the legs in a bicycle fashion.  This will help the baby release some abdominal gas.
  3. Try burping your child.
  4. Try using a pacifier.  Non-nutrient sucking is soothing to young infants.
  5. Try softly talking or sing to your baby.
  6. Try rocking your baby.
  7. Try some “white noise,” e.g., vacuum cleaner, static on radio, running water, hair dryer, etc.
  8. Check your baby’s temperature.
  9. Check for any hernias (abnormal bulges).  Most hernias are at the umbilicus or in the groin area.  If there is a bulge, try pushing it down.  If you are able to push the hernia down and your baby calms, then notify your healthcare professional the next day.  If the bulge is hard feeling and it doesn’t go down, then bring your child to the emergency room.
  10. Check for any hair or string tightly wrapped around any toes or fingers.  If so, and the hair or string is cutting deep into the baby’s skin, then bring the baby to his/her healthcare professional.

 

Well Child Visits
Well baby/child healthcare visits are usually scheduled:

2-3 days after discharge from the nursery;
2 weeks of age;
1 month old;
2 months old;
4 months old;
6 months old;
9 months old,
12 months old;
15 months old;
18 months old;
24 months old;
and then yearly.

Hepatitis B vaccine is recommended (not required, unless the mother is high risk for hepatitis B infection) before nursery discharge.  Most other vaccinations usually start at 2 months of age.

Looking for the right pediatrician? Schedule a free interview with Dr. Kevin Lue!

1-2-3 Pediatrics
3925 75th Street, Suite 105; Aurora, IL 60504
(630) 978-7337