All about your newborn

1 When to call your baby’s health care provider Call 911 for immediate assistance Call your baby’s health care provider if your baby refuses to eat for more than six hours or if he or she has any of the following symptoms: if your baby: • Temperature less than 97 or more than 100.4 degrees Fahrenheit • Has difficulty breathing • Persistent (not just spitting up), projectile vomiting, or starts wheezing green vomit, swollen tummy • Has blue or pale skin • Fewer than four wet in 24 hours color or blue lips • No stool for 48 hours in full-term newborns; no stool for 24 hours if born before 37 weeks gestation • Blood in stools or black stools after fifth day of life • Frequent bowel movements with excess fluid, mucous or foul odor () • Lethargy (unusual sleepiness, floppy arms or legs or less activity) • Irritability, inconsolable crying, apparent pain • Swollen, red, draining or foul-smelling umbilical cord • (yellow skin, yellow eyes) • Persistent coughing, runny eyes or runny nose • Signs of ear infection: , irritability, pulling at ears • White patches in mouth (thrush) Congratulations • rash that looks very red, raw or has white patches • Swollen or red eyes, excessive tearing, discharge on the arrival of your new baby! • Any injury or fall The day you take your newborn home is exciting – and probably a little scary. You’ll have many questions during the days and months ahead. This booklet contains Bottom line: Call your baby’s health care provider any time you feel a lot of information, but it is not meant as a substitute for professional medical care. something is not right with your baby. You know your baby better If you have questions or concerns, please talk with your health care provider. than anyone else does. Trust your instinct.

Table of contents Warning signs...... 3 Before you go home...... 4 Newborn vaccinations...... 5 Crying and fussiness...... 6 Newborn feeding...... 9 Bathing...... 10 Your baby’s body...... 15 Car travel...... 18 Preventing falls and burns...... 18 Preventing suffocation...... 19 Smoking...... 19 ...... 19 Vaccination schedule...... 19

2 3 Newborn vaccinations Things you’ll need and medications The following supplies will help make While in the hospital, your baby will your baby’s homecoming comfortable receive some essential medications and and safe: vaccinations. These are given routinely, • Appropriate car seat but it is a good idea to make sure your (see page 18) baby receives the following care. • Blankets (for crib and ) • Crib, bassinet or cradle that meets Hepatitis B vaccination safety standards Hepatitis B can cause serious liver • Diapers (disposable or cloth) and damage. Your baby will receive the first diaper wraps or plastic pants if cloth of three hepatitis B vaccinations while diapers are used in the hospital. Clothing: Vitamin K injections • T-shirts or onesies State law requires that all newborns receive a dose of vitamin K, which is • Sleepers essential to blood clotting. Some babies • Booties and socks do not have enough vitamin K and, as a • Receiving blankets result, could develop abnormal bleeding if they do not receive the vitamin at birth. Bathing supplies: • Soft washcloths, towels, Erythromycin eye ointment hooded towels To avoid the possibility of serious • Mild, nonperfumed soap or eye infection from multiple types of commercial baby wash bacteria, erythromycin ointment is • Baby hairbrush placed in your newborn’s eyes within • Small plastic tub or clean sink a few hours of birth. • Bathtub thermometer Protect the family Before you go home, we’ll check your baby’s health. Medicine cabinet supplies: are at a greater risk of •  thermometer Newborn screenings identify conditions hospitalization and death from pertussis Hearing screening • Diaper rash ointment that can affect a child’s long-term (whooping cough) and influenza than The state requires that all newborns be health. Before you go home, we will older children or adults. The DTaP vaccine • Bulb syringe to suction the nose given a hearing screening soon after test your baby for some serious but protects against diphtheria, tetanus and or mouth birth. Your baby will be given up to treatable conditions, as well as jaundice pertussis. Families should make sure that two screens before receiving a “pass” Recommended (but not necessary): (yellowing of the skin), hearing loss everyone involved in is fully or “refer” result. At some hospitals, and congenital heart . vaccinated against both pertussis and flu. • Changing table your baby may go home before the • Baby intercom second screening is done. In this case, an appointment will be made for you to return for the second screening. If your baby does not pass the screen twice, you will be referred to a diagnostic audiology clinic for further evaluation.

4 5 • Gas (needs to burp) Colic • Colic Colic is the name for intense, inconsolable • A need to suck on something crying in an otherwise healthy, well- (Try your clean finger or his or fed baby. Colic affects 10 to 15 percent her thumb.) of all babies. The bouts of crying may • Being too hot or too cold last hours or longer. If colic develops, it If none of these is the problem, try generally does so during the second or rocking, holding your baby skin-to-skin, third week of life, and babies usually singing or playing soothing music, or outgrow it by 3 months of age. This fussy taking your baby for a walk or a ride crying is harmless for your baby, but in the car. can be very frustrating for caregivers. It is normal to feel frustrated if you The cause of colic is unknown. It is not cannot calm your baby. Once you usually caused by or have checked the obvious reasons for excessive gas. A “colicky” baby can discomfort, it’s OK to put your baby in sometimes be soothed by motion (such the crib and let him or her cry while you as riding in an infant swing or in a soft leave the room for a few minutes. This is front pack or going for a ride in a car or especially important if you are exhausted a stroller), warmth, being held securely, or frustrated. A baby must never be being massaged or having a warm bath. shaken. Serious brain injury or death may If the baby has been fed and changed result. If you need a longer break, ask and you have tried to console the baby someone to watch the baby or take turns using the methods listed above, you may Getting to know your baby being “on duty” with your spouse or partner. If you become concerned about (continued) Bonding with your newborn how often your baby cries, contact your Babies are born with their own unique Babies are born with many involuntary child’s health care provider. bodies and very quickly begin to show reflexes. When the palms of their hands are their own personalities. You and your touched, they grasp firmly. When they are baby can begin bonding as soon as you startled, they stretch out all their limbs, then both are ready. Holding your baby skin-to- curl up. When their lower lips are rubbed, skin after birth will benefit both you and they turn their heads and open their your baby. Touch, hold and cuddle your mouths. This is called rooting. They also baby skin-to-skin as often as you can. have a strong desire to suck, whether they are hungry or not. Most of these reflexes Normal newborn behavior disappear a few months after birth. Babies make lots of sounds. Sneezing, Crying and fussiness coughing, passing gas, hiccuping and occasionally spitting up are all normal Crying is the only way a newborn can behaviors. Newborns often breathe loudly communicate. Most newborns cry two or and alternate rapid and slow breathing. three hours a day, but some cry more. It is never a mistake to pick up your baby and Babies startle easily. Sudden loud noises, comfort him or her. When your baby cries, such as the telephone or a siren, may check for these possible causes of distress: make them cry. Before you gently pick up your baby, make your presence known by • Hunger talking softly and touching your baby. • Dirty diapers • Diaper rash

6 7 place the baby in the crib and allow him or her to cry for 15 minutes. If the crying persists after 15 minutes, pick up the baby and try the consoling methods again. It may take several 15-minute sessions before the baby falls asleep. Notify your baby’s health care provider if: • The cry seems to become a more painful one • The crying lasts more than three hours • The colic begins after your baby is 1 month old • Diarrhea, vomiting or occurs • The baby is inconsolable • You or the baby’s caretaker is Reducing the risk of SIDS exhausted or frustrated Always place your baby on his or her Sleeping back to sleep, not on the stomach or Always lay your baby on his or her back to side. The “back to sleep” practice has sleep, not on the stomach or side. helped reduce the incidence of sudden infant death syndrome (SIDS). The This “back to sleep” practice has been American Academy of also associated with lower rates of sudden recommends the following: infant death syndrome (SIDS). • Use a firm sleep surface with no soft For the first few weeks, your newborn materials or objects, such as pillows, may seem to sleep constantly, waking only quilts, comforters or sheepskins, when he or she is hungry. As weeks pass, placed under the sleeping newborn. your baby will gradually spend more time Keep soft objects and loose bedding awake. Newborns have no regular pattern out of the crib. to their sleeping periods, but they become more predictable as they get older. • Avoid exposing the baby to smoke. Caring for your baby This happens naturally – you needn’t force • Provide a sleeping space that is your baby to adjust to a regular schedule, separate from but close to the Holding, carrying and positioning although you can help by establishing a . When the baby sleeps in the Newborns are relaxed and content when braced against your shoulder with your bedtime routine. same room as the mother, the risk they feel secure in their surroundings. hand supporting his or her head. This gives of SIDs is reduced. A crib, bassinet or Feed your baby, sing a lullaby and read Sudden noises, movements or the you one hand free to manage doors, cradle that meets safety standards the same story to settle him or her for sensation of not being held securely can hold onto handrails and so on. is recommended. sleep. By keeping night feedings quiet easily startle or upset babies. and low-lit, you can help your baby learn • Do not let the newborn become Feeding the difference between night and day. To avoid startling your baby, talk for a too warm. second or two before picking him or her Feeding time is an important time for you and your baby. It is one of your newborn’s • E ncourage tummy time only when up. To support your newborn’s weak neck most pleasant experiences. It gives you the baby is awake and continuously and heavy head, place the palm of your an opportunity to bond with each other. observed by an adult. hand under the baby’s neck and back. Cradle the head with your fingers. Support Newborns typically eat eight to 12 times the baby’s body on your lower arm, which per day. Feed your baby any time he or should be braced securely against your she shows signs of hunger. body. Or, you can carry your baby securely (continued)

8 9 Bathing often have questions and concerns about breastfeeding. To help Bath time gives you another opportunity mothers provide the best nutrition for to hold, cuddle and get to know your their newborns, Providence Health & newborn. A few words of caution: Services offers a variety of breastfeeding • NEVER leave your baby unattended (lactation) services. in or near the bath, not even for a few seconds. Bottle-feeding • Gather all necessary items before If you are bottle-feeding, talk to your starting the bath so you won’t have baby’s health care provider about to carry your wet baby around looking formula and proper feeding instructions. for things. Weight loss Newborns do not need to be bathed Newborns often lose 7 to 10 percent every day. A bath every two or three days of their during the first few is fine. When preparing to bathe your days of life. With frequent feedings, they baby, make sure the room and the water usually regain the weight by the time are warm. You may bathe your baby by they are 2 weeks old. using a small plastic tub or the sink lined with a sponge or towel. The warm water should be deep enough to cover the newborn’s shoulders. After feeding, always burp your baby Test the water temperature with your to help remove swallowed air. Hold elbow before putting your baby in the the baby upright over your shoulder or water. Gently wash your baby’s face face down over your lap. Pat or rub his without soap, and then use a soapy or her back gently. Don’t be alarmed if washcloth on his or her body. Wash the the baby spits up a small amount while diaper area last, and then rinse your baby burping, and don’t worry if he or she with clean water. doesn’t burp every time. To wash your baby’s hair, apply a small Preventing drowning Use a soft cloth to clean around the cord amount of gentle soap and warm during the baby’s bath and as needed Spitting up and vomiting A newborn can drown in less than an water. Tip your baby’s head back to avoid during diaper changes. No special care Spitting up is very common for inch of water in just a few minutes. Never getting soap in the face or eyes. Gently is necessary. If the area around the cord newborns. It is not a cause for concern leave your baby alone in a tub of any size. pour clean water over the hair. You can becomes red, if pus develops or if you unless your baby frequently spits up a If you must leave to get something, take wash the hair either at bath time notice a strong, foul odor, call the baby’s large amount. Projectile vomiting or the baby with you. Leaving your baby or when the baby is clothed. health care provider. When the cord green or yellow vomit is not normal. alone in the bath while you answer Wrap your baby in a falls off, you may see a small amount of Call your baby’s health care provider if the phone is not worth the risk. warm towel and dry. blood or discharge from the navel. you are concerned. To avoid skin Care of the navel This is no cause for alarm. Occasionally babies will gag and appear irritation, be sure to be choking on mucus or other fluid. to dry in the folds The stump of the umbilical cord (continued) If this happens, use a bulb syringe to and creases of attached to your baby’s navel should suction your baby’s mouth. To use, place the skin. fall off in one to three weeks. Fold the the tip of the bulb syringe inside the front of the diaper below the navel so baby’s cheek on the side and toward the it won’t cause irritation. back of the mouth. Suction the baby’s nose only when mucus is visible, or you may cause swelling inside the nostril.

10 11 than a week. At home, gently clean the To prevent diaper rash, change diapers penis with plain water until it is healed. frequently – whenever they are wet or It generally takes seven to 10 days for soiled, or every one to two hours during the penis to heal fully after . the day. Clean the diaper area with Problems after a circumcision are rare. disposable wipes or with water and However, call your newborn’s health care mild soap. (Soap can irritate, so don’t provider if: use it every time.) Wipe your baby girl from front to back to prevent infection. • Your baby does not urinate within 24 hours after the circumcision At the first sign of redness, apply a • There is persistent bleeding thick coating of commercially available • Redness around the tip of the penis diaper ointment. Sometimes babies can worsens after three to five days develop a yeast infection in the diaper area. A yeast infection can appear as an Diapers inflamed red rash or as a white cheesy film. It can usually be treated with an Your newborn will use about 70 diapers over-the-counter antifungal cream. per week. If you use cloth diapers, Consult with your child’s health care you’ll also need diaper wraps or plastic provider or pharmacist. pants. Whenever possible, air-dry the baby without a diaper on. Powder is not (continued) recommended because it may irritate Care of the penis your baby’s lungs. It is best not to use , powders, will give you care instructions for the lotions or pre-moistened towelettes PlastiBell, which usually drops off five to on newborn boys as they can irritate eight days after the circumcision. Your the penis. If your little boy has not nurse will give you written information been circumcised, his penis requires no for home. special care. Simply wash the penis with If Surgicel is applied to the site to control soap and warm water. Do not attempt bleeding, do not forcibly remove this to retract the foreskin; it will retract special dressing. The Surgicel will fall naturally in a few years. off on its own. If it is forcibly removed, If your baby has been circumcised, the bleeding may start again. tip of the penis may seem inflamed, Note: Do not use petroleum jelly with yellowish or swollen. For the first PlastiBell or Surgicel. 24 hours after the procedure, the penis should be covered with a gauze When the swelling goes down (about 24 dressing with petroleum jelly to prevent hours after circumcision), push the skin the gauze from sticking. Change on the penis gently toward the baby’s the gauze dressing with each diaper body and clean the area where the skin change. After the first 24 hours, you can meets the head of the penis with warm use petroleum jelly alone to prevent the water. This prevents adhesions from diaper from sticking to the penis. forming. It is important to continue this for seven to 14 days or until the newborn If the PlastiBell circumcision method is is seen by his health care provider. used, a plastic ring will be left on the tip of the penis instead of a gauze and It is normal to have a little yellow petroleum jelly dressing. Your nurse discharge or coating around the head of the penis. This should not last longer 12 13 If breathing becomes labored or if the The newborn’s head baby turns blue or drools, keep the baby Your baby’s head may be odd-shaped upright and call the health care provider because of the birth process. The head or 911 immediately. will regain its rounded, smooth look within a few weeks. Babies are born with Ear infections two soft spots on their heads, one on top Newborns’ ears are highly susceptible and one at the back. These soft spots are to infections caused by bacteria or areas where the bones of the skull have viruses. Symptoms include slight fever, not yet grown together. They will close irritability, crying and loss of appetite. by the time your infant is 12 to 18 months Call the baby’s health care provider old. It is not dangerous to gently touch immediately if you think your child has the soft spots or to gently shampoo and an ear infection. brush your baby’s hair. Fever The back of your baby’s head may gradually become flattened due to Take your baby’s temperature under sleeping on his or her back. This is his or her arm unless the health care normal, and most baby’s heads will return provider instructs you differently. to a more rounded shape once the baby In a newborn, a temperature less than is old enough to change positions while 97 degrees Fahrenheit or more than sleeping. If you are concerned, please talk 100.4 degrees Fahrenheit is cause for with your baby’s health care provider. concern. With lower , watch for signs of ear infections or other serious Eyes, nose and ears illnesses. Call the baby’s health care Newborns often have eye drainage Skin care Don’t overdress your baby. Layer the provider immediately and follow his clothing so you can add or remove during the first few weeks. Wipe it away The skin of newborns will often peel, or her directions. layers as room or outdoor temperatures with a moist, clean washcloth. Always especially on the hands and feet. Most change. Babies lose a lot of body heat wipe eyes from the inside corner out, infants do not need special skin care from their heads. Keeping a hat on the using a clean area of the washcloth each other than on the diaper area. Your baby’s body baby in cold weather will help maintain time. If the drainage is unusually thick or the baby’s body temperature. Sensory stimulation if the eyelids are swollen or red, call the Nail care baby’s health care provider. Keep your baby’s fingernails and toenails Babies need lots of opportunities to see, Colds and coughs Gently clean the nose and outer ears short to prevent scratching. File nails hear and learn. A crib with open slats will with a damp, clean cloth or a cotton with a soft emery board or cover your Mild cold symptoms include runny nose, let your baby look around the room. Give swab. Never insert cotton swabs or any baby’s hands. Be careful: The nails are sneezing and congestion. Stuffy noses him or her plenty of things to look at, other object inside the nose or ears. very soft, and it may be difficult to make it hard for newborns to breathe such as pictures, mobiles, stuffed animals and eat. To help your baby breathe, put and nonbreakable mirrors. Your baby will distinguish the nail from the tip of the Crossed or puffy eyes finger or toe. It may be easier to file a few drops of saline in his or her nose, also enjoy gazing at the faces of family the nails when your baby is sleeping. wait a minute, place the bulb syringe members. The birth process and the medication gently at the entrance of the nostril used in your newborn’s eyes to fight What your newborn hears is equally and suction out the saline. You can also infection may cause the eyelids to look Swaddling and dressing important. Sing, read and talk often use a cool water vaporizer in the baby’s puffy. This should improve within a few Wrapping your newborn securely can to your baby. music and introduce room. If you use a cool water vaporizer, days. Your baby may look cross-eyed make him or her feel safe and relaxed. other soothing sounds. be sure to keep your baby warm. Call the because of undeveloped muscles. As the A wrapped baby is also easier to lift health care provider if fever, coughing or Give your baby tactile stimulation by muscles strengthen, the eyes will begin and carry. To swaddle, wrap your baby breathing difficulties develop. cuddling, rubbing and exercising his or to look normal. snugly in a soft blanket with the edge her body. tucked under smoothly. (continued)

14 15 Flaky scalp () Bowel movements • Vernix: a white, creamy substance that causing the yellowing of the skin. In protects the skin before birth and some newborns, bilirubin can increase Scaly flakes, called cradle cap, may Your newborn will pass a dark, sticky remains in the creases of the skin even to high levels, causing brain damage. develop on your baby’s scalp. Remove the substance called meconium for the after bathing Early detection and management of flakes by gently scrubbing the scalp with first few days. Gradually the stools will jaundice can prevent brain damage. a mild shampoo and soft brush every few become yellow with a green or brown • Newborn rash: small yellowish spots Routine checks by your child’s health care days. Repeat until the flaking disappears. tinge. Breastfed babies usually have surrounded by red blotches, most provider between day 2 to day 5 will loose, seedy stools (up to 10 per day). commonly on the face, trunk and limbs; help determine the need for testing or Infected mouth (thrush) Bottle-fed babies usually have fewer appears and disappears over various treatment. If your baby’s skin becomes stools with a more pasty appearance. parts of the body over several days If your baby has white, cottage cheese- more yellow at any time, call your child’s like patches in his or her mouth, it is As your baby gets older, bowel Skin problems that may require more health care provider right away. probably a yeast infection called thrush. movements will become less frequent (as attention include: This can be painful, so call your baby’s seldom as every few days). This is normal • Heat rash: tiny red bumps around the Body hair (lanugo) health care provider as soon as possible. as long as the stool is soft and the baby shoulders and neck that occur during Your baby may be born with fine, downy If you are breastfeeding, you may need is not straining too hard. It’s common for hot weather or when babies get too hair covering his or her back, shoulders, treatment as well. infants to grunt and turn red when they warm. Keep your baby warm and dry, forehead, ears and face. This condition is are having a bowel movement. but don’t overdress. more common in premature babies. The Genitals Constipation is uncommon with breast- • Any other skin condition not listed lanugo will disappear within a few weeks. The mother’s hormones can cause fed babies but more common with bottle- above that concerns you. Call your conditions in the baby that are normal fed babies. Signs of constipation include baby’s health care provider. Blue feet and hands and will go away without treatment. hard, pebbly stools and abdominal pain. Newborns commonly have blue feet and Babies of both sexes are sometimes born Diarrhea consists of frequent, watery Yellow skin hands because of immature circulation. with swollen nipples, which may ooze stools often accompanied by a foul odor. Jaundice develops as the baby’s body This is a normal condition as long as the small amounts of white liquid. Their If your baby has diarrhea or constipation, breaks down extra red blood cells. The rest of your baby is warm. genitalia are often swollen as well. You let your child’s health care provider know. result of that breakdown is bilirubin. may see a red-orange (“brick dust”) spot Bilirubin can build up in the baby’s blood, on a wet diaper. If your baby is a boy, Skin problems he may have a swollen scrotum. It will Skin abnormalities occur commonly return to normal in a few days. in newborns. Most should cause no Baby girls might have a white coating on concern, require no special treatment and their genitals. This is normal and does disappear by themselves. They include: not need to be washed off. They may • Milia: small white spots on the face due also have a clear mucous-like discharge, to blocked sweat and oil glands again a result of the mother’s hormones. When you bathe your baby and change • Slightly transparent skin with purplish her diapers, gently clean the vaginal area blotches (most common in newborns by spreading the labia and wiping from with fair skin) front to back. • Mongolian spots: a greenish-blue coloring on the lower back (present at If any of these conditions continue or if birth and most common in infants with you are concerned, talk with your baby’s dark skin) health care provider. • Baby acne: a red, pimply rash • Stork bites: visible blood vessels close to the skin on the eyelids, forehead or back of the neck

16 17 Preventing suffocation A baby must never be shaken. Serious brain injury or death may result. If you or Never put your baby on a waterbed, anyone who spends time with your baby beanbag chair, pillow or anything soft is easily angered or frustrated, seek help. enough to cover the baby’s face and block air to his or her nose and mouth. Keep pillows, quilted bedding, bumpers Caring for your child and stuffed animals out of the crib. Vaccination schedule Smoking Vaccines prevent serious by Always keep your baby in a smoke-free helping children build defenses. Most environment. Environmental smoke can babies and children have only mild lead to ear infections, colds, respiratory reactions to vaccines, which can include disease, and an increased risk of asthma slight fever and soreness. and SIDS. If adults in your home smoke, Your child’s health care provider will insist that they smoke outdoors. make recommendations according to what he or she thinks is best for your Child care and shaken child. You may also want to check with baby syndrome your health insurance company to see Be very selective about the people who what it covers. care for your baby. People who are careless, easily angered or frustrated in other situations may behave the same way with a crying baby.

Keeping your baby safe Car travel on a changing table, bed, sofa or chair. When you need to step away – even for When traveling, always put your baby in a a second – put your baby in a safe place, rear-facing, approved car seat. Follow the such as a crib or . manufacturer’s instructions completely when you install it. Make sure your child is Preventing burns Providence - a leader in children’s health care strapped securely into the car seat before placing blankets on your baby. Never Never carry your baby and hot liquids As your baby continues to grow, Providence is right by your side, offering hold your baby in your arms in a moving or hot food at the same time. Prevent health care services especially for children. Providence Health & Services car, even if you are only going a short burns from scalding tap water by distance. For further information, view reducing the temperature of the hot is a leader in children’s health care. The compassionate physicians and the Resource Center water heater. If your baby gets burned, staff, who are experts in children’s health, provide everything from website at Childsafetyseat.org. immediately put the burned area in routine primary care to emergency and critical care. cold water. Keep it there until he or Preventing falls she stops crying. Cover the burn loosely with a bandage or clean cloth, and call Babies wiggle, move and push against the baby’s health care provider. things with their feet soon after they are born. These simple movements can cause a fall. Never leave your baby alone 18 19 OUR MISSION As people of Providence, we reveal God’s love for all, especially the poor and vulnerable, through our compassionate service.

OUR CORE VALUES Respect, Compassion, Justice, Excellence, Stewardship

Providence Health & Services, a not-for-profit health system, is an equal opportunity organization in the provision of health care services and employment opportunities. PH16-20638 3/16