Journey through Parenthood Part Two

A partner for lifelong health Contents

23 Seeing your physician 23-24 Postpartum care for mom 25 If you have the “baby blues” Helpful information for siblings 26 Caring for your baby Jaundice 27 Signs your baby could be ill 27-30 30 Oral health for your child 31 Bathing your baby Umbilical cord care 32 Circumcision care Shaken Baby Syndrome “The Period of Purple Crying” 33 Safety in your home 34 Safe sleep environment 35 Reducing the risk of Sudden Death Syndrome 36 & 37 Valuable community resources 38 & 39 Your notes

22 | LMH Health Family Birthing Center Journey through Parenthood: Part Two

Activity and exercise For the first several weeks after a vaginal delivery, you should not do much more than you did in the hospital. Gradually increase your activity as you feel able. Allow family and friends to help you with meals, laundry, other household chores and care of older children. Climbing stairs, vacuuming, heavy lifting or vigorous exercise should be resumed gradually and upon the advice of your physician. It is recommended that you not drive while taking narcotic medication. Caring for mom after discharge Most activities and mild exercise may be resumed gradually, as long as comfort and rest are considered Follow-up appointment first. Your physician will want to see you in his or her If you had a Cesarean birth, you will be recovering office at around two and six weeks after delivery. from major abdominal surgery, as well as from Your physician will instruct you before you leave the childbirth. During the first week at home, slowly hospital when to return to the office for your follow- progress toward normal activities. Pay attention to up visits. Be sure to call ahead for an appointment. comfort and avoid overtiring. You can safely resume Don’t hesitate to call before this appointment if you driving a car when you can comfortably press on the have any questions or concerns. brake, usually around two weeks postpartum. Postpartum warning signs and Muscle soreness symptoms It’s normal for your muscles to be sore after delivery. Notify your doctor if you experience ANY of these This can be attributed to the hard work of labor and symptoms after birth. delivery. The discomfort should disappear during the ⚫ Heavy bleeding (one pad per hour) first few days following birth. Resting, warm showers ⚫ Passage of large clots (greater than a half-dollar in and pain medication your doctor prescribes will help size) ease this discomfort. ⚫ Temperature higher than 101 degrees Fahrenheit Vaginal bleeding ⚫ Sore, painful, reddened or hot area on your Vaginal bleeding after delivery is much like a regular breast(s) or in your armpit (you may or may not menstrual period and should slow down in three to have fever or flu-like symptoms) four days. You may notice a light increase in bleeding ⚫ Pain or burning while you urinate when you get home because you have increased ⚫ Signs of infection such as redness, swelling, pain, your activity and possibly again at the 10th to 14th drainage or foul-smelling discharge from your day when the scar on the inside of the uterus where vagina, episiotomy or abdominal incision the placenta was attached falls off. You will have a vaginal discharge which may last up to six weeks Swollen, red, painful area on your leg(s) (especially ⚫ after delivery and will become lighter and clearer your calf) that is hot to the touch each day. If your flow becomes heavy or you have a ⚫ Having difficulty coping, you are crying foul-smelling discharge, you may have an infection uncontrollably or you aren’t able to sleep and need to notify your physician. You can expect a ⚫ Signs of preeclampsia such as stomach pain, menstrual period five to 12 weeks after delivery unless headache, nausea, vomiting, seeing spots, you are breastfeeding. Breastfeeding may suppress swelling in your hands and face, weight gain of periods, but not for everyone. Breastfeeding does not more than 5 pounds in a week. prevent pregnancy.

Journey Through Parenthood | Part Two | 23 Bowel movements when moist. Avoid using breast pads with plastic Try to maintain normal bowel habits after delivery backing. Wear a supportive bra that does not contain to avoid constipation and painful hemorrhoids. Most an underwire. Notify your physician if you have any women can expect not to have a bowel movement of these symptoms: cracked or bleeding nipples, an after delivery until they are at home. Extra fluids and area on the breast that is red, hard and tender to a good high fiber diet may help. This would include touch, and/or your temperature is above 101 degrees /bran cereals, multi-grain breads and fresh fruits Fahrenheit. These may be signs that you have a and vegetables. Ensuring daily exercise such as breast infection. walking also will help maintain normal bowel function. Caring for your incision Your physician may recommend that you continue taking an over-the-counter stool softener after you after a cesarean section leave the hospital. The abdominal incision is usually closed with small skin staples that are removed a few days after Hemorrhoids surgery and steri-strips applied. Keep your incision Your doctor may recommend a stool softener to clean and dry. There is no need to wear a dressing avoid straining when you have a bowel movement. over your incision. Your steri-strips may become Warm soaks, topical ointments and oral pain loose as you shower. They can be removed by pulling medications can help with the discomfort of swollen the strip toward the incision. Your incision may be hemorrhoids. Talk to your physician about other washed gently with soap and water in the shower or recommendations if you have painful hemorrhoids. bath. The incision may feel firm or numb as it heals. If your incision opens up, becomes tender and red, or Family planning begins to drain, or if you have a temperature above Discuss your post-delivery contraception with your 101, call your physician. These may indicate you have physician. Refrain from sexual intercourse, use of an infection. tampons and douches until your physician tells you they are safe. Caring for your stitches after a Nutrition vaginal delivery Just as you needed a nutritious diet during your Your stitches should dissolve within two weeks. pregnancy, you will need a nutritious diet after your They do not have to be removed. Discomfort should baby is born. Your body is healing and needs extra improve daily and may be soothed by soaking in a attention at this time. The best advice is to select clean, shallow tub of warm water. This will promote foods from each of the four food groups each day. healing and cleanliness. After your bath, apply one to two Tucks Pads to your perineum and change them If you would like to lose weight, cut down on foods as needed. Use sanitary pads instead of tampons, and high in sugar and fat and on alcoholic beverages. change them every two to three hours. After you use Remember, if you are breastfeeding, you will need to the bathroom, use the peri-bottle you received in the drink 8 to 10 eight ounce glasses of fluid a day and hospital to clean yourself. Do this by pouring warm increase your caloric intake by 300 to 500 calories water over your perineum from the front toward your per day if no weight change is desired. Avoid foods rectum. Also, your physician may have given you a that contain caffeine because they will rob your body prescription for pain medicine. Take it as needed. of fluid. You should continue taking prenatal vitamins Call your physician if you have increasing discomfort, until your current supply is gone. foul-smelling discharge or a temperature above 101 Breastfeeding moms degrees Fahrenheit. These may be signs of infection. If you are breastfeeding, it is important to keep Home medications your nipples clean and dry. Do not use soap on your Before you leave the hospital, your physician will nipples because it tends to dry them out and cause provide prescriptions for any medications to take cracking. You can expect some nipple soreness in at home. Be sure to read and follow all instructions the beginning. To help ease the soreness, let your provided by your nurse and pharmacist. Take nipples air dry after breastfeeding and use lanolin as medications only as directed to avoid food or directed by your physician. Change your breast pads medication interactions.

24 | LMH Health Family Birthing Center Postpartum adjustment Where to find help The arrival of a new baby is unlike any other If you are feeling one or more of these warning experience in your life up to now. No one can prepare signs, seek help from your doctor, therapist or a you for the many emotions you may feel as you non-judgmental listener who you trust. Postpartum undergo birth and the transition to parenthood. depression is the number one complication of The most significant changes will be in your priorities childbirth for women and is a treatable condition. and demands on your time. Everything is so new This says nothing about your capability or strength as and unfamiliar that it is difficult to know what is a parent. You are not to blame, you are not alone, and “normal.” If you had a trouble-free pregnancy and with help you will get better. Please turn to the back an easy delivery, you may expect the adjustment of this booklet to find resources available. to parenthood to be made with ease and minimal interruption to your routine. For some that happens, If you’re a support person for others it does not. After delivery, your support to mom and baby is important. You can help by diapering, burping, Most new parents experience an array of thoughts and comforting baby. Spend time with and feelings. These can range from an incredible baby by rocking, holding, massaging and talking to “high” right after the birth to sadness and, your baby. This is your opportunity for you and baby sometimes, resentment and anger at the changes to get to know each other. After several weeks, you to their life that parenthood brings. will begin to recognize the cues for when your baby The baby blues is hungry, wet, or sleepy. Almost all women experience fluctuations in their Siblings: Making the transition emotions after birth, which often is referred to as Preparing your child/children for the arrival of a new the “baby blues.” You may find yourself feeling very baby brother or sister may help minimize feelings of emotional and tearful. This is natural, and it is not jealousy or resentment. How you prepare will depend permanent. Many of the these feelings could be upon the age, temperament and understanding of an related to the tremendous fatigue experienced by older sibling. Consider these tips: new , hormonal changes after pregnancy, ⚫ If you have to move your older child to a different and the changes that becoming a parent means to room, try to do it several months before you are your life. The feelings likely will pass more quickly due. if you get lots of rest, eat nutritiously, get help with If possible, arrange for your child to go with you chores and baby care, and have someone to care ⚫ to a prenatal visit to hear the baby’s heartbeat and for you. With time, the emotional fluctuations you meet your doctor. experience will subside. ⚫ Consider taking your child on the Tike Hike offered If they do not, you need to get assistance. Emotional by LMH Health. warning signs: ⚫ Make frequent phone calls or video-chat with your ⚫ Excessive worry or anxiety, irritability or short child during your hospital stay. temper ⚫ Arrange for your child to visit you and the new ⚫ Sleep problems that increase (too little or too baby during your hospital stay. much) ⚫ Have someone other than you carry the baby ⚫ Changes in appetite (eating too little or too much) inside when you arrive home from the hospital. ⚫ Over concern or no concern about your baby ⚫ Have baby bring a gift home to big brother/sister ⚫ Loss of focus and concentration from the hospital. ⚫ Becoming withdrawn (avoiding people/pushing ⚫ Arrange for alone time with your older child. This family or friends away) may include taking 10 or 15 minutes to read a book ⚫ Suicidal thoughts to them, look through photo albums for pictures of their infancy or do a puzzle. ⚫ Allow your older child to help you with the baby (such as getting a diaper for you or helping with bathing).

Journey Through Parenthood | Part Two | 25 Caring for your baby released during the normal breakdown of red blood cells. Although the liver in the newborn is fully Safe sleep for your baby developed, it is not fully efficient. Extra bilirubin is The American Academy of recommends transferred to the blood and stored in the skin until that normal, healthy be positioned on their the liver breaks it down. There are some babies who backs to sleep. Some babies may have medical are more likely to get jaundice. These babies include: indications which require different sleep positions. ⚫ Premature babies Always check with your baby’s doctor to determine Babies with bruising to their head or body during the best sleep position for your baby. During your ⚫ birth hospital stay, you will watch a video, “Safe Sleep for Babies,” which will provide you with important ⚫ Babies whose blood was very different than their information on safe sleep practices for your baby. ’s blood Babies with liver or other health problems Your nurse will give you a survey to fill out on ⚫ completion of the video. Use this opportunity to ⚫ Babies who are not getting enough fluids ask any questions you have. ⚫ Breastfeeding babies Crying and your baby Signs of jaundice Crying is a normal part of your baby’s development. ⚫ Your baby’s skin and the whites of his/her eyes All babies cry, but the amount of crying varies may turn yellow. Your baby also may have between one infant and another. As you get to know yellowing of the mucous membranes (areas of the your baby, you will start to recognize what many of mouth such as the tongue and gums). your baby’s cries mean. Your baby may cry because ⚫ Your baby’s urine or bowel movements may be he/she is wet, hungry or uncomfortable. Your baby dark yellow. may cry, and you are unsure of why your baby is ⚫ Your baby may be tired or very fussy. crying. Sometimes you may be able to soothe your baby by using various techniques such as carrying, Testing for jaundice comforting, rocking, walking or talking; however, these Bilirubin levels are checked by using a non-invasive techniques may not always work. There are a few key skin test. The nurse will perform this test when your points to remember when it comes to your baby and baby is over 24 hours old unless your baby is showing crying. signs of jaundice sooner. If your baby’s results are ⚫ Around two weeks of age, babies may start to cry high, a blood test will be performed by a small prick in more each week. your baby’s heel. ⚫ By around two months of age, babies typically cry Treating jaundice more than any other time. The treatment is based on the underlying cause and ⚫ After two months, babies typically begin to cry less severity of jaundice. Phototherapy, also referred to each week. as “bililites,” is a common treatment. The baby’s skin ⚫ For most babies, increased crying occurs late is exposed to special fluorescent lights that help afternoon or evening. lower the buildup of bilirubin. The baby’s eyes are covered while under these lights. In more severe cases During your hospital stay you will watch the video, of jaundice, exchange blood transfusions may be “The Period of Purple Crying,” which will provide you required. with information on normal , what you can expect when your baby cries, why this crying Signs of illness and your baby can be frustrating to you, and how to keep your baby A common question from all parents — new and safe. Your nurse will give you a survey to fill out on experienced — is: “How do I know if my baby is sick?” completion of the video. Use this opportunity to ask Here are symptoms of illness. If they occur, notify your any questions you have. There is also an app you can baby’s physician for assistance. use when you go home. ⚫ Difficulty breathing Jaundice ⚫ Eating poorly or several refused feedings in a row Jaundice, which is a yellowing of your baby’s skin ⚫ Redness, drainage or foul odor from the umbilical and whites of his or her eyes, is caused by too much cord bilirubin in the blood. Bilirubin is a yellow substance ⚫ Forceful vomiting after feeding

26 | LMH Health Family Birthing Center ⚫ Fewer than six wet diapers (by the third to fourth 7. Practice rooming-in – allow mothers and infants day after birth) to remain together 24 hours a day. ⚫ Hard, difficult to pass stools or no stool for 48 hours 8. Encourage breastfeeding on demand. ⚫ Diarrhea (frequent or successive bowel movements 9. Give no pacifiers or artificial nipples to with excess fluid) or frequent stools with mucus or breastfeeding infants. foul odor 10. Foster the establishment of breastfeeding Increasing yellow discoloration of the skin or whites ⚫ support groups and refer mothers to them on of eyes discharge from the hospital or birth center. ⚫ Any unusual rash The 10 Steps to Successful Breastfeeding form Excessive crying, increased fussiness, or inability to ⚫ the basis of the Baby-Friendly Hospital Initiative, a console your baby worldwide breastfeeding quality improvement project Taking your baby’s temperature created by the World Health Organization and the It is not necessary to take your baby’s temperature United Nations Children’s Fund. regularly; however, if you suspect your baby is sick, it Baby-Friendly hospitals and birth centers also uphold is one of the most important and frequent questions the International Code of marketing of your healthcare provider will ask when you call for Substitutes by offering parents support, education assistance. Your baby’s temperature can be taken and educational materials that promote the use of under the armpit. A digital thermometer is given to you milk rather than other infant food or drinks, during your hospital stay. and by refusing to accept or distribute free or Please ask your healthcare team to teach you how subsidized supplies of breastmilk substitutes, nipples to use the thermometer before you go home. If you and other feeding devices. have a thermometer at home that you will use, it is Breastfeeding your baby important to follow the manufacturer’s instructions for The American Academy of Pediatrics recommends that thermometer. that infants be breastfed exclusively for the first six Breastfeeding months of life and that breastfeeding continue for The Cindy Murray Family Birthing Center supports the at least 12 months. Breast milk provides the best “Ten Steps to Successful Breastfeeding,” published nutrients and infection-fighting antibodies for your in a joint statement called “Protecting, Promoting baby. Breastfeeding is a learned behavior for both and Supporting Breastfeeding: The Special Role of mom and baby; however, lactation is automatic. Maternity Services.” Some general information and guidelines below can help establish a successful and lasting breastfeeding 1. Have a written breastfeeding policy that is experience. routinely communicated to all health care staff. Expect your baby to breastfeed 8-12 times (every one 2. Train all health care staff in the skills necessary to to three hours) in 24 hours for the first few months of implement this policy. life. Your baby needs to breastfeed frequently due to 3. Inform all pregnant women about the benefits and the small size of your baby’s stomach. By one week management of breastfeeding. of age, your baby will need a weight check. Until your 4. Help mothers initiate breastfeeding within one baby is steadily gaining weight, your baby may need hour of birth. to be awakened to feed. It is normal for newborns to feed more frequently late evening and during the 5. Show mothers how to breastfeed and how to night. maintain lactation even if they are separated from their infants. 6. Give infants no food or drink other than breast- milk, unless medically indicated.

Cradle Cross Cradle Side Lying Football/Clutch

Journey Through Parenthood | Part Two | 27 ⚫ Support your breast by using the C-hold or the L-hold. ⚫ Place your hand around the base of your baby’s neck with your finger and thumb by the ears. ⚫ Use your forearm to bring your baby’s body close to you and ensure that your baby’s chin is touching the breast first. ⚫ Be sure to bring the baby up to your breast, not your breast to your baby. ⚫ Bring baby toward the breast when your baby begins to open his/her mouth. ⚫ Aim your nipple toward the roof of the mouth What to expect when latching your baby. The length of time it takes your baby to feed will vary If your baby is getting enough with breastfeeding, from one feeding to the next. Do not limit time at your baby should have wet diapers and bowel breast. movements. This is what you can expect: Common infant feeding cues Bowel Movements Early Days 1 - 3: Days 4 - 6: After day 4: ⚫ Smacking or licking lips Getting lighter Opening and closing mouth At least 3 or 4 ⚫ Dark green, in color, yellow bowel ⚫ Sucking on lips, tongue, fingers, toes, toys, or almost black, becoming movements in clothing sticky. more and more 24 hours. Active yellow. ⚫ Rooting around on chest of whoever is holding Wet Diapers them Days 1 - 3: After day 4: ⚫ Trying to position for nursing, either by lying back or pulling on your clothes Few, but increasing 6 to 8 wet diapers somewhat each day. in 24 hours. ⚫ Fidgeting or squirming ⚫ Fussing or breathing fast When to call for advice or help ⚫ If you do not have breast changes in weight or size Late and/or changes in milk volume and composition by ⚫ Moving head frantically from side to side day 3-5 ⚫ Crying ⚫ If your nipples are painful, cracked, or bleeding Some questions to ask yourself when your baby ⚫ If your baby has only rapid, nibbling, shallow type breastfeeds: of sucking ⚫ Does the feel comfortable? ⚫ If your baby falls asleep on the breast without drinking and does not wake up ⚫ Does your baby demonstrate long bursts of sucking with swallows and short pauses? ⚫ If your baby still has dark green, almost black bowel movements after 5 days of age ⚫ Do you hear your baby swallow? ⚫ If your baby is having infrequent wet diapers after To ensure that breastfeeding gets off to the best start 3 days of age possible, it is important that you put your baby skin- to-skin and initiate breastfeeding within the first hour after delivery. Physical contact and nourishment are both important for your infant. Some key points to practice when latching your baby are: ⚫ Get in a comfortable position.

28 | LMH Health Family Birthing Center Who you can call ⚫ Your baby’s doctor ⚫ LMH Health Infant Nutrition Center: 785-505-6398 ⚫ Lawrence-Douglas County Health Department: 785-856-5350 Sore nipples It is normal to experience some soreness of the nipples during the first three to six days postpartum. This should subside as the nipples develop more elasticity and typically resolves after one week. Tender, cracked and bleeding nipples frequently occur due to the infant being latched improperly at the ⚫ Request assistance from a lactation nurse to assess breast. and assist you with infant latch. Indications of a good latch Engorgement ⚫ Nipple is elongated, but the same shape when It is common for women to experience a feeling of infant comes off the breast fullness in the breast between days three and five. ⚫ Pain that lasts for 20-30 seconds after the initial This is normal as colostrum changes to mature milk. latch, but subsides as the feeding progresses This fullness usually diminishes over several days, ⚫ Swallows are noted approximately every four to six but it may last up to two weeks. Avoid formula sucks supplements (unless medically indicated). Pacifiers and other artificial nipples decrease feeding Indications of an incorrect latch frequency and can cause latch issues. ⚫ Nipple is peaked, wedge-shaped, or has a white crease when infant comes off the breast To prevent engorgement ⚫ Prolonged nipple pain lasting throughout the Breastfeed or remove milk frequently (at least 8-12 feeding times in 24 hours). If your baby is not latching, you will need to use a or hand express to remove No swallows are noted, or infant is “nibbling” at the ⚫ your milk. Avoid alternate feeding methods, which breast can lead to decreased milk removal from breast. Because you should expect some nipple soreness in Pacifiers and other artificial nipples decrease feeding the first week, here are some recommendations that frequency and can cause latch issues. will help decrease the soreness you experience during this period. To treat engorgement (if your breasts ⚫ Always try to express colostrum/breastmilk prior are severely swollen, hard, painful to latching your baby. and warm to touch) ⚫ Do not limit the length of feeding as long as your ⚫ Hand express breast milk to soften your areola baby is swallowing at the breast. before latching your baby. (If you are unable ⚫ Only remove your baby if swallows are not noted. to express milk, you may need to use cold ⚫ Be sure that you break suction when removing compresses or cabbage leaves for 10 to 15 minutes your baby from the breast by placing a clean finger before breastfeeding.) in the corner of your baby’s mouth (between the ⚫ Gently massage before and during breastfeeding. jaws) and taking the baby away when you feel the ⚫ Apply cold compresses or cabbage leaves to your suction break. breasts after nursing for 10 to 15 minutes until ⚫ Modified lanolin, gel pads (Soothies), and breast discomfort and swelling is resolved. shells can be used as comfort measures and you ⚫ Notify your physician if you experience a fever may ask your nurse for these items if needed. of 101 degrees Fahrenheit and/or sore, painful, ⚫ Always inform your nurse or physician if you notice reddened or hot area on the breast(s) or in the any trauma to your nipples (cracks, bleeding, or armpit (may be accompanied by fever and flu-like blisters). symptoms).

Journey Through Parenthood | Part Two | 29 Breastmilk collection Using stored milk ⚫ Wash hands with soap and water. Breastmilk should be room temperature when ⚫ Wash all parts that touch your breasts or you feed your baby. Never microwave breastmilk. breastmilk with hot soapy water. Rinse well and air Microwaving can cause severe burns to baby’s mouth dry on a towel. from hot spots that develop during microwaving. ⚫ Always read the instruction manual that Here are some general guidelines for thawing frozen accompanies your breast pump before using it. breastmilk or warming refrigerated breastmilk. To thaw breastmilk, you can place the frozen breastmilk Pumping should not hurt, and your nipple should ⚫ in the refrigerator overnight. You can keep thawed fit comfortably into the barrel of the breastshield. breastmilk in the refrigerator for 24 hours. You can If you have questions about the fit, consult a also thaw frozen breastmilk prior to feeding by lactation consultant or your healthcare provider. placing the sealed container of breastmilk in a cup of ⚫ If you are returning to work, begin to pump warm water for 10 to 20 minutes (to bring it to body and store breastmilk at least two weeks before temperature). Do not let the water level reach the cap returning to work. of the container. Always check the temperature of the Breastmilk storage breastmilk by dripping a small amount onto the inside ⚫ Avoid adding freshly pumped breastmilk to of your wrist. refrigerated (cooled) breastmilk. Oral health – birth to age 6 ⚫ Cool the breastmilk in the refrigerator after pumping, and then you can add to the already Tips for healthy, cavity-free teeth refrigerated breastmilk. ⚫ As a parent, practice daily oral hygiene, including ⚫ You may add refrigerated milk to already frozen brushing and flossing. You are a role model breastmilk. Be sure the quantity you are adding is for your child. less than what is frozen. ⚫ Do not put pacifiers or spoons in your mouth ⚫ Freeze breastmilk in small amounts (2-4 ounces). before giving it to your child. Decay-causing Small amounts of breastmilk thaw more quickly, bacteria from your mouth can be passed to your and you will waste less. When freezing breastmilk, child. These bacteria can hide in the furrows of the be sure to leave room at the top of the storage tongue until the teeth erupt. container so it does not overflow (during freezing/ ⚫ Childproof your home to prevent dental injuries – thawing). cover outlets and sharp corners on furniture. ⚫ Write the date and time on the container and be ⚫ Before your baby has teeth, wipe your baby’s gums sure the container is sealed tightly before storing. after each feeding. Use clean, damp gauze or a washcloth. Breastmilk Storage Guidelines ⚫ Begin brushing when your child’s first tooth erupts. (For Healthy Full-term Infants) Clean your child’s teeth with a soft toothbrush two times a day, after breakfast and before bedtime. Location Temperature Duration ⚫ Use fluoridated toothpaste. If your child is Room (<25˚ C/77˚ F) Up to 4 hours younger than 3 years, use a smear. If your child Temperature is older than 3, use a pea-sized amount. Cooler with Schedule your child’s first dental visit by age 1 Frozen (15˚ C /59˚ C) Up to 24 hours ⚫ and visit the dentist regularly. Ice Packs Never put your child to bed with a bottle Refrigerator (4˚ C/40˚ F) Up to 4 days ⚫ or training cup. Freezer (-18˚ C/0˚ F) Up to 12 months ⚫ Once your child is eating solid foods, offer milk Store in at mealtime and water between meals. Thawed Breast- Use within 24 refrigerator milk hours ⚫ If your child uses a pacifier, do NOT dip it in sugar, after thawing honey or other foods. *Guidelines referenced from the Centers for Disease Long-term sucking habits can cause problems with Control and Prevention. ⚫ tooth alignment and proper growth of the jaws. Wean a child from pacifier habit by age 2. Thumb habits should end by age 4.

30 | LMH Health Family Birthing Center Eruption and shedding of Personal care for your baby primary (baby) teeth Bathing your baby Your baby only needs to have a bath two to three times per week, but you may choose to bathe them more often. Your baby should only be given sponge baths until the umbilical cord falls off and is healed, and if you have a circumcised boy, the circumcision is healed. Here are some recommendations to make bath time go more smoothly and help you as a new parent to feel less stressed. ⚫ Avoid feeding your baby before you bathe them. ⚫ Gather supplies before beginning (bath towel, washcloths, baby soap, baby shampoo, clean warm water, diaper and clean clothes) and make sure all Dietary choices are within reach. ⚫ Beverages: Water between meals, milk at mealtime. ⚫ Choose a place in your home you will be ⚫ Only 4 ounces of juice a day, at a meal — if any. comfortable bathing your baby in a room that is ⚫ Limit soda, energy drinks, Gatorade, Kool-Aid not too cold. and sweet tea. ⚫ Lay your baby on a towel (leave your baby’s ⚫ Snack Foods: Recommend fresh fruit, fresh clothes on until you are ready to begin cleaning vegetables and cheese for between-meal snacks. this area). Use a clean, wet washcloth to wipe your ⚫ Limit consumption of cookies, candy, gummy baby’s eyes. Always wipe from the inner to the bears, goldfish crackers, chips and Cheetos outer portion of the eye. Use a different corner of between meals. the washcloth for each eye. Wipe off your baby’s face with a clean, wet If your child does drink sugary beverages or eats ⚫ washcloth (do not use soap). Never insert a sugary/starchy snacks occasionally, have your child swab in your baby’s nose or ear to clean. rinse with water, drink water or brush his/her teeth to prevent tooth decay. ⚫ Undress your baby (leave your baby’s diaper on until you are ready to clean this area). Wash the — Information provided by Lawrence Pediatric rest of your baby’s body using soap and water Dentistry, 346 Maine Street, Lawrence, KS 66044; and pay close attention to get between folds. 785-842-9223. Try to keep the cord area dry. Gently cleanse the Vitamin D supplementation area with a clean, damp cloth if it is soiled. ⚫ Remove diaper and clean the genitals. Remember in newborns to always wipe front to back. Vitamin D is a substance that helps our bodies Place a clean diaper on. Be sure to fold the diaper function. Vitamin D also is important for healthy bone ⚫ down below the cord to prevent rubbing and allow development and prevention of rickets, a softening to air dry. of the bones in growing children. The American Wrap your baby in a clean dry towel and hold your Academy of Pediatrics (AAP) recommends that all ⚫ baby in a “football” hold. infants up to 12 months of age have a daily minimum of 400 international units (IU) of vitamin D beginning ⚫ Pour some clean water on your baby’s head. soon after birth. Talk with your child’s doctor or other Place a small amount of shampoo on the scalp. trusted healthcare provider such as your pharmacist Gently massage over the entire scalp. Rinse or lactation specialist to learn more. thoroughly with clean water and gently towel dry. ⚫ Lotion is not necessary for your baby’s skin. Avoid using powders, because your baby could inhale them. ⚫ Dress and swaddle your baby.

Journey Through Parenthood | Part Two | 31 Umbilical cord care Your baby’s umbilical cord will fall off two to three weeks after birth. There is no special care required for the umbilical cord other than keeping it clean and dry. As your baby’s umbilical cord heals, it will look like a scab. Do not try to remove the umbilical cord by picking or pulling at it. Allow the umbilical cord to fall off naturally. After the cord falls off, you may notice some slightly blood-tinged discharge which is normal. If you notice oozing that persists for more than a couple of days and has a foul odor, redness in the surrounding skin, or fever, you should report this to your baby’s physician immediately. Circumcision care If considering circumcision, it is important to discuss all potential risks and benefits of the procedure with Causes of Shaken Baby Syndrome your baby’s doctor, so you can make an informed Your baby’s head is supported by weak neck muscles, decision. and the brain is small in comparison to the size of There are different techniques (Plastibell, Gomco, the head. When a baby is vigorously shaken, his/ Mogan) used by physicians when doing a her head moves back and forth (similar to whiplash) circumcision. Dependent upon the technique your which can cause bleeding and increased pressure in baby’s physician uses, after care of the circumcision his/her head. Shaking your baby can cause blindness, will vary. deafness, learning disabilities, paralysis and death. ⚫ Plastibell – Plastic ring device is used. There will be a plastic ring attached to the penis, and will usually Symptoms fall off within the first week after the procedure. ⚫ Swollen soft spots on the head Larger than normal head size ⚫ Gomco or Mogan – No device attached to the ⚫ penis. Using petroleum jelly on the penis or diaper ⚫ Bleeding in the eyes for the first few days or as instructed by your ⚫ Excessive sleepiness or fussiness baby’s physician can assist in healing and prevents ⚫ Seizures the diaper from sticking. ⚫ Projectile vomiting You may see drops of blood in the first days after the ⚫ Unresponsiveness circumcision. Urine is sterile; so, unless the head of the penis is soiled with stool, you should not wipe the What to expect head of the penis. To clean the area if it is soiled, use Babies spend a lot of time crying. This is how your warm water and a washcloth and wipe gently. Change baby communicates. Your baby will cry when he/she the diaper at least every four hours to keep it from is hungry, cold, in pain, and for many other reasons. sticking to the penis and inspect the circumcision. Babies are often shaken simply, because they won’t If you have any concerns about the appearance of the stop crying. While most people understand they circumcision, or see more than a few drops of blood, should not hit a baby, many people do not realize the you should notify your baby’s physician. potential injury which may be caused by shaking a baby. You will be given a video called “The Period of Shaken Baby Syndrome Purple Crying” to watch before you are discharged NEVER, NEVER, EVER SHAKE YOUR BABY from the hospital. It is recommended that you have all Shaken Baby Syndrome is a term used to describe individuals who will be caring for your baby watch this traumatic injuries which an infant suffers when shaken video as well. There is also an app you can use when vigorously. you go home.

32 | LMH Health Family Birthing Center Prevention Second-hand smoke ⚫ Always support your baby’s head and neck. Your baby is being exposed to second-hand smoke if ⚫ Never toss or shake a baby (even if you are just you or someone you know smokes where your baby playing). spends time or handles your baby after smoking. ⚫ Educate family and other caregivers on the Babies exposed to second-hand smoke are more importance of never shaking your baby. at risk of developing coughs/colds, asthma and ear infections, and they are at greater risk for SIDS Immunizations (Sudden Infant Death Syndrome). Anyone who Immunizations (also referred to as shots or handles your baby after smoking should change their vaccinations) are one way to protect your baby clothes and wash their face and hands. If you smoke against a variety of diseases. Your baby’s healthcare and you are interested in information on smoking provider will discuss the routine immunizations that cessation, please speak with your healthcare provider your baby should receive and the recommended or your local health department. schedule of these immunizations. Choking Health and safety You should keep all objects smaller than the size of for your family at home your baby’s fist away from them. If you have older children, it is important that you discuss this with Smoke and carbon monoxide them. If your child is choking, you should not put your detectors fingers in their mouth unless you can see the object It is recommended that you have smoke and carbon and remove it. It is recommended that all caregivers monoxide detectors on each floor of your home be trained in infant and child CPR (cardiopulmonary and near sleeping areas. It is important to check resuscitation). them often to ensure that they are working properly. Batteries should be changed once a year or as needed Falls Babies rely on us to keep them safe. To avoid injury (when you hear them making a chirping noise). to your baby, it is important that you never leave your Water temperature and burns baby alone on any high surfaces such as a changing Check your hot water heater settings. The thermostat table, your bed, or sofa. should be set no higher than 120 degrees Fahrenheit. For more information about how to keep your When giving your baby a bath, fill the tub up then baby safe, visit safekids.org or call your local health check the temperature of the water with your skin department to locate a SAFE KIDS coalition in your first. Never fill the tub up with your baby in the tub. area. You should never hold your infant while you are carrying hot liquid or while you are cooking.

Journey Through Parenthood | Part Two | 33 What Does A Safe Sleep Environment Look Like? The image below shows a safe infant sleep environment.

Use a firm and flat sleep Baby should not sleep in Baby’s sleep area is in surface, such as a mattress an adult bed, on a couch, Do not smoke or let the same room, next to in a safety-approved crib*, or on a chair alone, with anyone else smoke where parents sleep. covered by a fitted sheet. you, or with anyone else. around your baby.

Do not put pillows, blankets, sheepskins, Dress your baby in sleep Always place your baby on or crib bumpers anywhere in your clothing, such as a wearable his or her back to sleep, for baby ’s sleep area. blanket. Do not use a loose naps and at night. blanket, and do not overbundle. Keep soft objects, toys, and loose bedding out of your baby’s sleep area. Make sure nothing covers the baby’s head.

* A crib, bassinet, portable crib, or play yard that follows the safety standards of the Consumer Product Safety Commission (CPSC) is recommended. For information on crib safety, contact the CPSC at 1-800-638-2772 or http://www.cpsc.gov.

34 | LMH Health Family Birthing Center Safe Sleep For Your Baby Reduce the Risk of Sudden Infant Death Syndrome (SIDS) and Other Sleep-Related Causes of Infant Death

Always place baby on his or her back to sleep, for naps and at night, to reduce the risk of SIDS. Use a firm and flat sleep surface, such as a mattress in a safety-approved crib*, covered by a fitted sheet with no other bedding or soft items in the sleep area. Share your room with baby. Keep baby in your room close to your bed, but on a separate surface designed for infants, ideally for baby’s first year, but at least for the first 6 months. Do not put soft objects, toys, crib bumpers, or loose bedding under baby, over baby, or anywhere in baby’s sleep area. Breastfeed your baby to reduce the risk of SIDS. Breastfeeding has many health benefits To reduce the risk of SIDS, women should: for mother and baby. If you fall asleep while Get regular prenatal care feeding or comforting baby in an adult bed, during pregnancy. place him or her back in a separate sleep area as soon as you wake up. Avoid smoking, drinking alcohol, and using marijuana or illegal drugs during pregnancy or after Follow guidance from your health care the baby is born. provider on your baby’s vaccines and regular health checkups. Do not smoke during pregnancy, and do not smoke or allow smoking around your Avoid products that go against safe baby or in your baby’s environment. sleep recommendations, especially those that claim to prevent or reduce Think about giving your baby a pacifier for the risk for SIDS. naps and nighttime sleep to reduce the risk of SIDS. Wait until breastfeeding is Do not use heart or breathing monitors well established (often by 3 to 4 weeks) in the home to reduce the risk of SIDS. before offering a pacifier. Give your baby plenty of tummy time Do not let your baby get too hot when he or she is awake and someone during sleep. is watching.

For more information about the Safe to Sleep® campaign, contact us: Phone: 1-800-505-CRIB (2742) | Fax: 1-866-760-5947 * A crib, bassinet, portable crib, or play yard that follows the safety Email: [email protected] standards of the Consumer Product Safety Commission (CPSC) is Website: http://safetosleep.nichd.nih.gov recommended. For information on crib safety, contact the CPSC at Mail: 31 Center Drive, 31/2A32, Bethesda, MD 20892-2425 1-800-638-2772 or http://www.cpsc.gov. Federal Relay Service: Dial 7-1-1

Safe to Sleep® is a registered trademark of the U.S. Department of Health and Human Services. NIH Pub. No. 18-HD-5759 | January 2019

Journey Through Parenthood | Part Two | 35 Additional resources for you and your family

Classes LMH Health Breastfeeding and LMH Health Therapy LMH Health Connect Care New Parent Support Group and Wellness 785-505-5800 ⚫ Bring your baby and your LMH Health Therapy and Wellness lmh.org/wellness/events concerns, meet other moms has physical therapists who ⚫ Childbirth classes and have your baby’s weight specialize in pre- and post-partum ⚫ Mother and baby care classes checked. Free. No RSVP needed. physical therapy as well as pelvic ⚫ Boot Camp for New Dads ⚫ The support group meets 10 a.m. floor physical therapy. If you have ⚫ Car seat safety inspections to 11:30 a.m. Mondays on the any issues with pain, diastasis and education lower level of the hospital. recti (abdominal wall separation), Infant/child safety ⚫ For more information, call leakage of urine or bowel, or and CPR classes ⚫ 785-505-5800. other musculoskeletal concerns ⚫ Breastfeeding classes please contact your physician for ⚫ Tike Hike (for siblings/parents) Breastfeeding Coalition of a referral. For more information, Douglas County call 785-505-2712 or visit Breastfeeding ⚫ This group continually www.lmh.org/therapy. LMH Health Infant updates the list of Nutrition Center/The Perfect Fit resources on its website: 785-505-6398 breastfeedingcoalitiondgco. ⚫ Breastfeeding wordpress.com. ⚫ Consultations ⚫ Bra Fittings ⚫ Breastfeeding supplies

36 | LMH Health Family Birthing Center Parenting Daycare referrals ⚫ Build your Village, LMH Health’s ⚫ Lawrence-Douglas County and advice Perinatal Mood Support Group, Health Department parenting ⚫ Child Care Aware is a peer support group for program: Healthy Families of Eastern Kansas (but not limited to) women ldchealth.org, 785-856-5335 877-678-2548 or experiencing symptoms of ⚫ Parents as Teachers in Lawrence: 785-357-5171 perinatal mood disorders, usd497.org/parentsasteachers east.ks.childcareaware.org including postpartum depression East Heights Community Developmental screenings and anxiety. Free. No RSVP Connections Center Tiny-k Early Development needed. The support group 1430 Haskell Avenue ⚫ 785-330-2323 meets 10 a.m. to 11:30 a.m. Lawrence KS, 66044 usd497.org/tiny-k Thursdays on the lower level 785-832-5680 or 785-330-1651 of the hospital. For more Lawrence-Douglas County In Eudora: ⚫ information, call 785-505-5800 ⚫ Health Department eudoraschools.org, then click or visit buildyourvillagekansas. 785-843-0721 on Early Childhood Programs wordpress.com or facebook. ldchealth.org com/buildyourvillagekansas. 913-669-8818 In Baldwin City: Other resources ⚫ Bert Nash Community Mental ⚫ Dads of Douglas County Baldwin STAR ⚫ Health Center facebook.com/dadsof usd348.com 200 Maine Street douglascounty Lawrence, KS 66044 785-594-7050 Healthy Dads Program 785-843-9192 Bert Nash Community Mental ⚫ ⚫ (Lawrence-Douglas County Health Services ⚫ The Pregnancy and Postpartum Health Department) bertnash.org Resource Center 785-856-5338 or 785-843-9192 913-677-1300 785-393-3802 Catholic Charities of Northeast ⚫ Postpartum Support ⚫ Lawrence Babywearing Kansas, 785-856-2694 ⚫ International Find meeting times on 800-944-4773 ⚫ Christian Psychological Services, Facebook or email ⚫ Your family physician also can 785-843-2429 lawrencebabywearing@gmail. be a resource for you if you have ⚫ Insight Women’s Center Earn com. postpartum depression. Please While You Learn program ⚫ Native Health Services and be sure to seek help. 785-842-6499 Information at ⚫ Parent Information Line Haskell Health Center (Headquarters Counseling 2415 Massachusetts Street Center), 785-841-2345 Lawrence, Kansas 66046 785-843-3750 or 785-832-4840 ⚫ Success by 6 – Parenting & Support ⚫ Willow Domestic Violence 785-842-8719, Center 785-843-3333 or [email protected] 800-770-3030 willowdvcenter.org ⚫ Women, Infants and Children Food and Nutrition (WIC) Lawrence-Douglas County Health Department 785-856-5350

Journey Through Parenthood | Part Two | 37 Notes

38 | LMH Health Family Birthing Center Notes

Journey Through Parenthood | Part Two | 39 ©2021 The Lawrence Memorial Hospital DBA LMH Health. All rights reserved. LMH Health provides care that is sensitive to cultural, racial, religious and other differences and does not discriminate on the basis of race, religion, age, ethnicity, culture, language, socio-economic status, sex, sexual orientation, gender identity or expression, national origin, physical or mental disability, or source of payment, nor in relation to employment practices. 2021