Keeping Your Newborn Safe and Healthy

ExitCare ImageThis guide is intended to help you care for your newborn. It addresses important issues that may come up in the first days or weeks of your newborn's life. It does not address every issue that may arise, so it is important for you to rely on your own common sense and judgment when caring for your newborn. If you have any questions, ask your caregiver.

FEEDING

Signs that your newborn may be hungry include:

  • Increased alertness or activity.

  • Stretching.

  • Movement of the head from side to side.

  • Movement of the head and opening of the mouth when the mouth or cheek is stroked (rooting).

  • Increased vocalizations such as sucking sounds, smacking lips, cooing, sighing, or squeaking.

  • Hand-to-mouth movements.

  • Increased sucking of fingers or hands.

  • Fussing.

  • Intermittent crying.

Signs of extreme hunger will require calming and consoling before you try to feed your newborn. Signs of extreme hunger may include:

  • Restlessness.

  • A loud, strong cry.

  • Screaming.

Signs that your newborn is full and satisfied include:

  • A gradual decrease in the number of sucks or complete cessation of sucking.

  • Falling asleep.

  • Extension or relaxation of his or her body.

  • Retention of a small amount of milk in his or her mouth.

  • Letting go of your breast by himself or herself.

It is common for newborns to spit up a small amount after a feeding. Call your caregiver if you notice that your newborn has projectile vomiting, has dark green bile or blood in his or her vomit, or consistently spits up his or her entire meal.

Breastfeeding

  • Breastfeeding is the preferred method of feeding for all babies and breast milk promotes the best growth, development, and prevention of illness. Caregivers recommend exclusive breastfeeding (no formula, water, or solids) until at least 6 months of age.

  • Breastfeeding is inexpensive. Breast milk is always available and at the correct temperature. Breast milk provides the best nutrition for your newborn.

  • A healthy, full-term newborn may breastfeed as often as every hour or space his or her feedings to every 3 hours. Breastfeeding frequency will vary from newborn to newborn. Frequent feedings will help you make more milk, as well as help prevent problems with your breasts such as sore nipples or extremely full breasts (engorgement).

  • Breastfeed when your newborn shows signs of hunger or when you feel the need to reduce the fullness of your breasts.

  • Newborns should be fed no less than every 2–3 hours during the day and every 4–5 hours during the night. You should breastfeed a minimum of 8 feedings in a 24 hour period.

  • Awaken your newborn to breastfeed if it has been 3–4 hours since the last feeding.

  • Newborns often swallow air during feeding. This can make newborns fussy. Burping your newborn between breasts can help with this.

  • Vitamin D supplements are recommended for babies who get only breast milk.

  • Avoid using a pacifier during your baby's first 4–6 weeks.

  • Avoid supplemental feedings of water, formula, or juice in place of breastfeeding. Breast milk is all the food your newborn needs. It is not necessary for your newborn to have water or formula. Your breasts will make more milk if supplemental feedings are avoided during the early weeks.

  • Contact your newborn's caregiver if your newborn has feeding difficulties. Feeding difficulties include not completing a feeding, spitting up a feeding, being disinterested in a feeding, or refusing 2 or more feedings.

  • Contact your newborn's caregiver if your newborn cries frequently after a feeding.

Formula Feeding

  • Iron-fortified infant formula is recommended.

  • Formula can be purchased as a powder, a liquid concentrate, or a ready-to-feed liquid. Powdered formula is the cheapest way to buy formula. Powdered and liquid concentrate should be kept refrigerated after mixing. Once your newborn drinks from the bottle and finishes the feeding, throw away any remaining formula.

  • Refrigerated formula may be warmed by placing the bottle in a container of warm water. Never heat your newborn's bottle in the microwave. Formula heated in a microwave can burn your newborn's mouth.

  • Clean tap water or bottled water may be used to prepare the powdered or concentrated liquid formula. Always use cold water from the faucet for your newborn's formula. This reduces the amount of lead which could come from the water pipes if hot water were used.

  • Well water should be boiled and cooled before it is mixed with formula.

  • Bottles and nipples should be washed in hot, soapy water or cleaned in a dishwasher.

  • Bottles and formula do not need sterilization if the water supply is safe.

  • Newborns should be fed no less than every 2–3 hours during the day and every 4–5 hours during the night. There should be a minimum of 8 feedings in a 24 hour period.

  • Awaken your newborn for a feeding if it has been 3–4 hours since the last feeding.

  • Newborns often swallow air during feeding. This can make newborns fussy. Burp your newborn after every ounce (30 mL) of formula.

  • Vitamin D supplements are recommended for babies who drink less than 17 ounces (500 mL) of formula each day.

  • Water, juice, or solid foods should not be added to your newborn's diet until directed by his or her caregiver.

  • Contact your newborn's caregiver if your newborn has feeding difficulties. Feeding difficulties include not completing a feeding, spitting up a feeding, being disinterested in a feeding, or refusing 2 or more feedings.

  • Contact your newborn's caregiver if your newborn cries frequently after a feeding.

BONDING

Bonding is the development of a strong attachment between you and your newborn. It helps your newborn learn to trust you and makes him or her feel safe, secure, and loved. Some behaviors that increase the development of bonding include:

  • Holding and cuddling your newborn. This can be skin-to-skin contact.

  • Looking directly into your newborn's eyes when talking to him or her. Your newborn can see best when objects are 8–12 inches (20–31 cm) away from his or her face.

  • Talking or singing to him or her often.

  • Touching or caressing your newborn frequently. This includes stroking his or her face.

  • Rocking movements.

CRYING

  • Your newborns may cry when he or she is wet, hungry, or uncomfortable. This may seem a lot at first, but as you get to know your newborn, you will get to know what many of his or her cries mean.

  • Your newborn can often be comforted by being wrapped snugly in a blanket, held, and rocked.

  • Contact your newborn's caregiver if:

  • Your newborn is frequently fussy or irritable.

  • It takes a long time to comfort your newborn.

  • There is a change in your newborn's cry, such as a high-pitched or shrill cry.

  • Your newborn is crying constantly.

SLEEPING HABITS

Your newborn can sleep for up to 16–17 hours each day. All newborns develop different patterns of sleeping, and these patterns change over time. Learn to take advantage of your newborn's sleep cycle to get needed rest for yourself.

  • Always use a firm sleep surface.

  • Car seats and other sitting devices are not recommended for routine sleep.

  • The safest way for your newborn to sleep is on his or her back in a crib or bassinet.

  • A newborn is safest when he or she is sleeping in his or her own sleep space. A bassinet or crib placed beside the parent bed allows easy access to your newborn at night.

  • Keep soft objects or loose bedding, such as pillows, bumper pads, blankets, or stuffed animals out of the crib or bassinet. Objects in a crib or bassinet can make it difficult for your newborn to breathe.

  • Dress your newborn as you would dress yourself for the temperature indoors or outdoors. You may add a thin layer, such as a T-shirt or onesie when dressing your newborn.

  • Never allow your newborn to share a bed with adults or older children.

  • Never use water beds, couches, or bean bags as a sleeping place for your newborn. These furniture pieces can block your newborn's breathing passages, causing him or her to suffocate.

  • When your newborn is awake, you can place him or her on his or her abdomen, as long as an adult is present. "Tummy time" helps to prevent flattening of your newborn's head.

ELIMINATION

  • After the first week, it is normal for your newborn to have 6 or more wet diapers in 24 hours once your breast milk has come in or if he or she is formula fed.

  • Your newborn's first bowel movements (stool) will be sticky, greenish-black and tar-like (meconium). This is normal.

    If you are breastfeeding your newborn, you should expect 3–5 stools each day for the first 5–7 days. The stool should be seedy, soft or mushy, and yellow-brown in color. Your newborn may continue to have several bowel movements each day while breastfeeding.

  • If you are formula feeding your newborn, you should expect the stools to be firmer and grayish-yellow in color. It is normal for your newborn to have 1 or more stools each day or he or she may even miss a day or two.

  • Your newborn's stools will change as he or she begins to eat.

  • A newborn often grunts, strains, or develops a red face when passing stool, but if the consistency is soft, he or she is not constipated.

  • It is normal for your newborn to pass gas loudly and frequently during the first month.

  • During the first 5 days, your newborn should wet at least 3–5 diapers in 24 hours. The urine should be clear and pale yellow.

  • Contact your newborn's caregiver if your newborn has:

  • A decrease in the number of wet diapers.

  • Putty white or blood red stools.

  • Difficulty or discomfort passing stools.

  • Hard stools.

  • Frequent loose or liquid stools.

  • A dry mouth, lips, or tongue.

UMBILICAL CORD CARE

  • Your newborn's umbilical cord was clamped and cut shortly after he or she was born. The cord clamp can be removed when the cord has dried.

  • The remaining cord should fall off and heal within 1–3 weeks.

  • The umbilical cord and area around the bottom of the cord do not need specific care, but should be kept clean and dry.

  • If the area at the bottom of the umbilical cord becomes dirty, it can be cleaned with plain water and air dried.

  • Folding down the front part of the diaper away from the umbilical cord can help the cord dry and fall off more quickly.

  • You may notice a foul odor before the umbilical cord falls off. Call your caregiver if the umbilical cord has not fallen off by the time your newborn is 2 months old or if there is:

  • Redness or swelling around the umbilical area.

  • Drainage from the umbilical area.

  • Pain when touching his or her abdomen.

BATHING AND SKIN CARE

  • Your newborn only needs 2–3 baths each week.

  • Do not leave your newborn unattended in the tub.

  • Use plain water and perfume-free products made especially for babies.

  • Clean your newborn's scalp with shampoo every 1–2 days. Gently scrub the scalp all over, using a washcloth or a soft-bristled brush. This gentle scrubbing can prevent the development of thick, dry, scaly skin on the scalp (cradle cap).

  • You may choose to use petroleum jelly or barrier creams or ointments on the diaper area to prevent diaper rashes.

  • Do not use diaper wipes on any other area of your newborn's body. Diaper wipes can be irritating to his or her skin.

  • You may use any perfume-free lotion on your newborn's skin, but powder is not recommended as the newborn could inhale it into his or her lungs.

  • Your newborn should not be left in the sunlight. You can protect him or her from brief sun exposure by covering him or her with clothing, hats, light blankets, or umbrellas.

  • Skin rashes are common in the newborn. Most will fade or go away within the first 4 months. Contact your newborn's caregiver if:

  • Your newborn has an unusual, persistent rash.

  • Your newborn's rash occurs with a fever and he or she is not eating well or is sleepy or irritable.

  • Contact your newborn's caregiver if your newborn's skin or whites of the eyes look more yellow.

CIRCUMCISION CARE

  • It is normal for the tip of the circumcised penis to be bright red and remain swollen for up to 1 week after the procedure.

  • It is normal to see a few drops of blood in the diaper following the circumcision.

  • Follow the circumcision care instructions provided by your newborn's caregiver.

  • Use pain relief treatments as directed by your newborn's caregiver.

  • Use petroleum jelly on the tip of the penis for the first few days after the circumcision to assist in healing.

  • Do not wipe the tip of the penis in the first few days unless soiled by stool.

  • Around the 6th day after the circumcision, the tip of the penis should be healed and should have changed from bright red to pink.

  • Contact your newborn's caregiver if you observe more than a few drops of blood on the diaper, if your newborn is not passing urine, or if you have any questions about the appearance of the circumcision site.

CARE OF THE UNCIRCUMCISED PENIS

  • Do not pull back the foreskin. The foreskin is usually attached to the end of the penis, and pulling it back may cause pain, bleeding, or injury.

  • Clean the outside of the penis each day with water and mild soap made for babies.

VAGINAL DISCHARGE

  • A small amount of whitish or bloody discharge from your newborn's vagina is normal during the first 2 weeks.

  • Wipe your newborn from front to back with each diaper change and soiling.

BREAST ENLARGEMENT

  • Lumps or firm nodules under your newborn's nipples can be normal. This can occur in both boys and girls. These changes should go away over time.

  • Contact your newborn's caregiver if you see any redness or feel warmth around your newborn's nipples.

PREVENTING ILLNESS

  • Always practice good hand washing, especially:

  • Before touching your newborn.

  • Before and after diaper changes.

  • Before breastfeeding or pumping breast milk.

  • Family members and visitors should wash their hands before touching your newborn.

  • If possible, keep anyone with a cough, fever, or any other symptoms of illness away from your newborn.

  • If you are sick, wear a mask when you hold your newborn to prevent him or her from getting sick.

  • Contact your newborn's caregiver if your newborn's soft spots on his or her head (fontanels) are either sunken or bulging.

FEVER

  • Your newborn may have a fever if he or she skips more than one feeding, feels hot, or is irritable or sleepy.

  • If you think your newborn has a fever, take his or her temperature.

  • Do not take your newborn's temperature right after a bath or when he or she has been tightly bundled for a period of time. This can affect the accuracy of the temperature.

  • Use a digital thermometer.

  • A rectal temperature will give the most accurate reading.

  • Ear thermometers are not reliable for babies younger than 6 months of age.

  • When reporting a temperature to your newborn's caregiver, always tell the caregiver how the temperature was taken.

  • Contact your newborn's caregiver if your newborn has:

  • Drainage from his or her eyes, ears, or nose.

  • White patches in your newborn's mouth which cannot be wiped away.

  • Seek immediate medical care if your newborn has a temperature of 100.4° F (38° C) or higher.

NASAL CONGESTION

  • Your newborn may appear to be stuffy and congested, especially after a feeding. This may happen even though he or she does not have a fever or illness.

  • Use a bulb syringe to clear secretions.

  • Contact your newborn's caregiver if your newborn has a change in his or her breathing pattern. Breathing pattern changes include breathing faster or slower, or having noisy breathing.

  • Seek immediate medical care if your newborn becomes pale or dusky blue.

SNEEZING, HICCUPING, AND YAWNING

  • Sneezing, hiccuping, and yawning are all common during the first weeks.

  • If hiccups are bothersome, an additional feeding may be helpful.

CAR SEAT SAFETY

  • Secure your newborn in a rear-facing car seat.

  • The car seat should be strapped into the middle of your vehicle's rear seat.

  • A rear-facing car seat should be used until the age of 2 years or until reaching the upper weight and height limit of the car seat.

SECONDHAND SMOKE EXPOSURE

  • If someone who has been smoking handles your newborn, or if anyone smokes in a home or vehicle in which your newborn spends time, your newborn is being exposed to secondhand smoke. This exposure makes him or her more likely to develop:

  • Colds.

  • Ear infections.

  • Asthma.

  • Gastroesophageal reflux.

  • Secondhand smoke also increases your newborn's risk of sudden infant death syndrome (SIDS).

  • Smokers should change their clothes and wash their hands and face before handling your newborn.

  • No one should ever smoke in your home or car, whether your newborn is present or not.

PREVENTING BURNS

  • The thermostat on your water heater should not be set higher than 120° F (49° C).

  •  Do not hold your newborn if you are cooking or carrying a hot liquid.

PREVENTING FALLS

  • Do not leave your newborn unattended on an elevated surface. Elevated surfaces include changing tables, beds, sofas, and chairs.

  • Do not leave your newborn unbelted in an infant carrier. He or she can fall out and be injured.

PREVENTING CHOKING

  • To decrease the risk of choking, keep small objects away from your newborn.

  • D o not give your newborn solid foods until he or she is able to swallow them.

  • Take a certified first aid training course to learn the steps to relieve choking in a newborn.

  • Seek immediate medical care if you think your newborn is choking and your newborn cannot breathe, cannot make noises, or begins to turn a bluish color.

PREVENTING SHAKEN BABY SYNDROME

  • Shaken baby syndrome is a term used to describe the injuries that result from a baby or young child being shaken.

  • Shaking a newborn can cause permanent brain damage or death.

  • Shaken baby syndrome is commonly the result of frustration at having to respond to a crying baby. If you find yourself frustrated or overwhelmed when caring for your newborn, call family members or your caregiver for help.

  • Shaken baby syndrome can also occur when a baby is tossed into the air, played with too roughly, or hit on the back too hard. It is recommended that a newborn be awakened from sleep either by tickling a foot or blowing on a cheek rather than with a gentle shake.

  • Remind all family and friends to hold and handle your newborn with care. Supporting your newborn's head and neck is extremely important.

HOME SAFETY

Make sure that your home provides a safe environment for your newborn.

  • Assemble a first aid kit.

  • Post emergency phone numbers in a visible location.

  • The crib should meet safety standards with slats no more than 2⅜ inches (6 cm) apart. Do not use a hand-me-down or antique crib.

  • The changing table should have a safety strap and 2 inch (5 cm) guardrail on all 4 sides.

  • Equip your home with smoke and carbon monoxide detectors and change batteries regularly.

  • Equip your home with a fire extinguisher.

  • Remove or seal lead paint on any surfaces in your home. Remove peeling paint from walls and chewable surfaces.

  • Store chemicals, cleaning products, medicines, vitamins, matches, lighters, sharps, and other hazards either out of reach or behind locked or latched cabinet doors and drawers.

  • Use safety gates at the top and bottom of stairs.

  • Pad sharp furniture edges.

  • Cover electrical outlets with safety plugs or outlet covers.

  • Keep televisions on low, sturdy furniture. Mount flat screen televisions on the wall.

  • Put nonslip pads under rugs.

  • Use window guards and safety netting on windows, decks, and landings.

  • Cut looped window blind cords or use safety tassels and inner cord stops.

  • Supervise all pets around your newborn.

  • Use a fireplace grill in front of a fireplace when a fire is burning.

  • Store guns unloaded and in a locked, secure location. Store the ammunition in a separate locked, secure location. Use additional gun safety devices.

  • Remove toxic plants from the house and yard.

  • Fence in all swimming pools and small ponds on your property. Consider using a wave alarm.

WELL-CHILD CARE CHECK-UPS

  • A well-child care check-up is a visit with your child's caregiver to make sure your child is developing normally. It is very important to keep these scheduled appointments.

  • During a well-child visit, your child may receive routine vaccinations. It is important to keep a record of your child's vaccinations.

  • Your newborn's first well-child visit should be scheduled within the first few days after he or she leaves the hospital. Your newborn's caregiver will continue to schedule recommended visits as your child grows. Well-child visits provide information to help you care for your growing child.