Caring for your newborn

Crying

This is a way that the baby tells you he/she needs feeding, is urinating, having a bowel movement, passing gas, bored, tired, lonely, or just needs to be held. (You will learn to identify different cries). Most babies have a fussy time, frequently in the late afternoon or evening.

• Crying babies can be frustrating. If you find yourself becoming overly stressed and losing control, try some of these strategies:
• Remember, it is all right to allow your infant to cry for a short time while you take a timeout.
• Lay your baby down in the crib, step out of the room, and take some deep breaths before returning.
• If possible, let dad or grandma rock the baby while you take a hot shower.
• Allow yourself enough time to calm down before meeting your baby's needs.
• Do not ever shake your baby! This can cause permanent brain damage or death.
• If you find yourself losing control or feeling anxious all the time, GET HELP. Call your doctor or refer to the Community Resource List at the back of this section for assistance.
• Babies respond to being held, stroked, and spoken to softly. They especially like being held on your left side near your heartbeat. Many like to be wrapped snugly in a warm blanket.

Here are ways to soothe a fussy baby:

• Rock him/her.
• Sing to him/her.
• Place him/her in a baby carrier close to your chest.
• Take him/her for a ride in a car or stroller.
• Put the baby tummy down across your lap and massage his/her back.

About the body

Eyes

Newborns sometimes have swelling around the eyes that will disappear a few days after birth. Your newborn's visibility only extends 8-12 inches until the eye muscles mature.

Head

Often the baby's head is too big to fit through the birth canal, so it takes on a melon shape. It should return to its normal shape within a few days after birth. Soft spots (fontanelles) on the top of the head can be touched gently, but it's important that the baby doesn't get hit on the head or shaken. Soft spots should close completely by the age of 2.

Hiccups

These usually happen after a feeding, sometimes to help bring up air bubbles. You don't need to do anything about them, although sometimes feeding the baby for a few minutes may help.

Rashes (other than diaper rash)

Many infants experience rashes - red, yellow, or white raised areas - that soon disappear without medical intervention. Little whiteheads (milia) that appear on the nose will also disappear.

Skin

Newborns typically have downy fuzz on their bodies that will wear off and disappear, usually after the baby's first bath. Babies also often have cracking skin around the wrists and ankles. This will resolve itself without treatment.

Sneezing

This does not mean your baby has a cold. It just means the baby is clearing his/her nose.

Bathing your baby

Until the umbilical cord falls off, sponge bathe the baby only 2-3 times per week. On the days that the baby does not get a bath, wash your baby's face, neck, behind the ears, buttocks, and genital area. Use warm water and mild soap on the face and body. Once the cord falls off, tub baths may be given 2-3 times per week. When the infant becomes more active, you may bathe the baby more often.

The baby should never be left alone during the bath. Bath water temperature should be 100 degrees Fahrenheit/38 degrees Celsius. You may want to check the water temperature with a bath thermometer before placing the baby in the water. Keep the room draft free and warm during the bath. Wash the eyes from the inner corner of the eye outward only. Do not insert anything into the baby's ears or nose.

You do not need to use powders, lotions, or baby oils on your baby's skin.

Botulism Alert

Don't feed your baby honey during his/her first year. Honey can cause infant botulism, a very serious disease that affects the baby's nerves and muscles.
A baby who has this disease may be weak, constipated, and eat poorly. In extreme cases, the baby may not be able to move, may stop breathing, and could die.

• No honey during your baby's first year.
• Do not add honey to your baby's food, water, or formula.
• Do not dip your baby's pacifier in honey.
• Do not give your baby honey as if it were medicine (breastfeeding mothers may eat honey).

Honey can cause this disease because it often contains bacteria, which can grow in your baby's intestine and create a strong poison.

It is also possible that raw fruits and vegetables contain botulism spores.
To be safe, follow the advice of the American Academy of Pediatrics: Feed only breast milk (or formula) through the first year.

Call your doctor if:

• Your baby is too weak to cry or suck as usual.
• Your baby does not want to eat or can't swallow.
• Your baby has weak arms and legs.
• Your baby has a wobbly head because the neck is weak.
• Your baby does not move his/her bowels and has weak muscles.

Bowel movements

At first, your baby's bowel movements (stools) will be dark greenish black and sticky (called meconium). They will change to a green, then yellow stool after several days.

Breastfed babies may have 6-10 loose, runny, yellow stools each day. Bottle-fed babies may have 1-4 pasty, yellow stools each day. An older baby may not have as many stools per day.

Diarrhea stools are green, watery, foul smelling, and frequent (12 or more each day).

Constipation refers to hard, dry stools passed with extreme difficulty.

All babies may grunt and appear to strain during a bowel movement.

Baby's cord

• Wash your hands before handling the cord.
• Keep the umbilical stump exposed to air or loosely covered with clean clothes.
• Keep the diaper folded down and away from the umbilical stump to prevent soiling from urine or stool.
• Do not pull on the cord stump (even if it is hanging by a small piece of skin) allow it to fall off by itself.
• If the cord stump becomes soiled with urine or stool, cleanse the area with water.

After bathing your baby or cleansing with water, dry thoroughly with clean absorbent cloth or gauze to remove excess moisture. Use a clean cloth or gauze each time.

Use a clean, dry Q-tip to remove any moisture between the base of the cord stump and the abdominal skin. A moist, mucky appearance is normal. The cord stump will change from yellowish green to brown to black as it dries out.

The cord will drop off in about 2 weeks.

Signs of infection

Redness at the base of the stump or on the abdomen, swelling and drainage are not normal; notify your healthcare professional.

Diaper rash

Urine, stool, and soap residue can cause skin breakdown and diaper rash. Cleanse your baby's bottom with warm water and dry with each diaper change, and change the diaper before and after each feeding. Expose your baby's bottom to air 2-4 times a day for 30-60 minutes to dry up any irritations that may occur. If more severe rash occurs, call your pediatrician.

Jaundice

Jaundice is a common and usually harmless condition in newborn infants. The word jaundice comes from a French word meaning "yellow." It describes the yellowish appearance of the whites of the eyes and the skin of many newborn babies. Don't be alarmed if your baby has jaundice.

Physiologic or "normal" jaundice usually appears on the second or third day of life in healthy babies born after a full-term pregnancy. It often disappears within a week. Doctors estimate that as many as two-thirds of full-term babies get physiologic jaundice.

Premature babies are even more likely to get jaundice. It may appear later and last longer in these infants, becoming most noticeable between the fourth and seventh days of life.

In most instances, the jaundice is so mild it can be ignored, and it will disappear without treatment. However, if the condition is more severe or if the jaundice is present at birth or appears during the first 24 hours of life, treatment probably will be necessary.

Call your pediatrician if your baby has jaundice which deepens (skin and whites of the eyes become more yellow).

Major causes

In most babies, jaundice occurs because the liver and other organs are not yet fully mature. This is particularly true in very small or premature babies.

One function of the liver is to rid the blood of a yellowish substance called bilirubin (pronounced "Billy Ruben"). During life, new red blood cells are being created and old ones are being destroyed. As the old cells are broken down, an ingredient in the cells - hemoglobin - is changed into bilirubin and removed by the liver. Until a baby's liver begins to function fully, bilirubin tends to build up in the baby's bloodstream, causing the skin and the whites of the eyes to become yellow. This condition is known as physiologic jaundice.

Potentially more serious kinds of jaundice may occur when the baby's blood type is different from the mother's blood type. One of these conditions is called ABO incompatibility. If a baby has this condition, jaundice usually appears within the first two days after birth.

A more severe form of jaundice can occur when the mother has Rh-negative blood and the baby has Rh-positive blood. In babies who have this condition, jaundice is seen the first day of life.

Treatment

Physiologic "normal" jaundice goes away without treatment. When a baby's jaundice does require treatment, phototherapy is usually used. Phototherapy simply means treatment using light. Light - either sunlight or artificial light - speeds up the removal of bilirubin from the body.

In phototherapy, the baby's skin is exposed to special, high-intensity lights, often called "bililights." All the baby's clothes are removed and the eyes are covered to protect them from the light. While undergoing phototherapy, the baby is kept warm in an isolette or uses a "biliblanket," which allows the baby to stay with mom. The doctor determines the best phototherapy method.

Phototherapy continues until the amount of bilirubin in the baby's blood falls to and remains at a safe level. The level is checked regularly by testing a small blood sample taken from the baby's heel.

Some babies need to stay in the hospital for a day or two after the phototherapy is complete to ensure that the bilirubin level doesn't rise again.

If your baby has jaundice, you may want more information about its cause and treatment. Your baby's doctor can answer your questions about your own infant's condition.

Remember:

• Jaundice in newborns is very common.
• In the majority of instances, the condition is normal, harmless, and temporary.
• When treatment is needed, the methods are safe and effective.

Penis

Circumcised

A little oozing of blood can be expected at first. To avoid
irritation of the penis by the diaper, apply Vaseline^® on a piece of gauze
to the circumcised area with each diaper change. Continue until the
circumcision looks like it is healed. If your baby has a plastic bell, the ring
will fall off. No Vaseline^® or gauze needs to be used with a plastic bell. Clean the circumcised penis with warm water and squeeze out the washcloth so the water runs over the circumcision. This will clean the area without irritating
the incision line.

Uncircumcised

Wash and rinse your baby's penis every day. Do not push back the foreskin. Pushing back the skin may cause pain and bleeding. The natural separation of the foreskin from the glans may take many years. For more information about care of your baby's uncircumcised penis, talk with your baby's doctor.

Sleep

Place your baby on his/her back to sleep, unless your doctor says otherwise. All babies are different in their need for sleep. Some are only awake for short periods between feedings, and others are awake for more than 12 hours out of the 24. Most babies wake up every 2-3 hours, or more often. There may
be one long sleep period - 4-5 hours - at some time of the day or night.

Some sleep hints:

• Sleep when the baby sleeps so you are not exhausted.
• Help the baby get used to the dark-light cycle by keeping the room bright during the day.
• Gently rouse the baby every 2-3 hours during the day and offer a feeding.
• Sleep with your baby if you are comfortable with this.

Sudden infant death syndrome

These simple infant care practices may help reduce the risk of SIDS for
some babies. At the present time, however, there is no known way to prevent a SIDS death.

• Always place your baby on his or her back to sleep, for naps and at night. The back sleep position is the safest, and every sleep time counts.
• Place your baby on a firm sleep surface, such as on a safety-approved crib mattress, covered by a fitted sheet. Never place your baby to sleep on pillows, quilts, sheepskins, or other soft surfaces.
• If you use a blanket, place the baby with feet at the end of the crib. The blanket should reach no higher than the baby's chest. Tuck the ends of the blanket under the crib mattress to ensure safety.Keep soft objects, toys, and loose bedding out of your baby's sleep area. Don't use pillows, blankets, quilts, sheepskins, and pillow-like crib bumpers in your baby's sleep area, and keep any other items away from your baby's face.
• Do not allow smoking around your baby. Don't smoke before or after the birth of your baby, and don't let others smoke around your baby.
• Keep your baby's sleep area close to, but separate from, where you and others sleep. Your baby should not sleep in a bed or on a couch or armchair with adults or other children, but he or she can sleep in the same room as you. If you bring the baby into bed with you to breastfeed, put him or her back in a separate sleep area, such as a bassinet, crib, cradle, or a bedside cosleeper (infant bed that attaches to an adult bed) when finished.
• Always place your baby on his or her Back to Sleep.Think about using a clean, dry pacifier when placing the infant down to sleep, but don't force the baby to take it. (If you are breastfeeding your baby, wait until your child is 1 month old or is used to breastfeeding before using a pacifier.)
• Do not let your baby overheat during sleep. Dress your baby in light sleep clothing, and keep the room at a temperature that is comfortable for an adult.
• Avoid products that claim to reduce the risk of SIDS because most have not been tested for effectiveness or safety.
• Do not use home monitors to reduce the risk of SIDS. If you have questions about using monitors for other conditions talk to your health care provider.
• Your baby needs Tummy Time! Place babies on their stomachs when they are awake and someone is watching. Tummy time helps your baby's head and neck muscles get stronger and helps to prevent flat spots on the head.
• Reduce the chance that flat spots will develop on your baby's head: provide "Tummy Time" when your baby is awake and someone is watching; change the direction that your baby lies in the crib from one week to the next; and avoid too much time in car seats, carriers, and bouncers.

For more information on SIDS, call (800) 369-SIDS (within California).

Temperature

Taking your baby's temperature

The following instructions include taking your baby's temperature using both the the rectal and axillary (armpit) methods. Talk with your physician about which method they prefer you to use.

To take a rectal temperature

• Clean the thermometer by wiping it with alcohol, then rinsing.
• Position lubricated probe cover on thermometer for easier insertion.
• Hold thermometer and open end of probe cover between thumb and forefinger. Peel back tip of probe cover.
• Place baby on back or side.
• Press the ON/OFF button to turn on unit until display shows 188.8 degrees Fahrenheit and beeper sounds. Display will then read L(OF) with a flashing F.
• Grasp thermometer approximately ³/₈ inch (1 centimeter) from the end of the sensor, hold the baby's feet with your other hand, and insert probe approximately ³/₈ inch into the baby's rectum.
• Wait for a series of beeps to sound.

To take an Axillary (armpit) temperature

• Place the tip of a digital thermometer in your baby's armpit holding the thermometer in line with the baby's body.
• Hold his or her arm tightly against their chest for about 1 minute, until you hear the "beep".
• Check the digital reading. Write down the time you took the temperature and the temperature reading if you will be calling your pediatrician.
• Normal axillary temperature is 97.7 to 99.3 degrees F.
• If your baby's axillary temperature is less than 97.7 or greater than 99.3, retake the temperature rectally before calling your pediatrician. Normal rectal temperature range is 98 to 100 degrees F.

Car safety

Car safety for your baby

Car seats

By law, regardless of age or weight, children are required to be
in a federally approved child safety restraint, belt-positioning booster seat,
or seat belt when being transported in a motor vehicle unless they are:

• 6 years of age or older;
• weigh at least 60 pounds

All children must ride in the back seat of automobiles.

In California, traffic crashes are the leading cause of death for children
ages 4-16. More than 47 percent of fatally injured children, ages 4-7, were
completely unrestrained.

Air bags

Air bags can cause serious injury or death to infants or children
if these steps are not followed:

• Infants less than 1 year old must ride in the back seat of a vehicle in a rear-facing car seat.
• Infants in rear-facing child safety seats must never ride in the front seat of a vehicle with a passenger-front air bag.
• For babies with health concerns, an adult should ride with the baby in the back seat.
• Refer to your vehicle's owner's manual for more information about air bags and child safety seat use.