Keeping Your Newborn Safe and Healthy

ExitCare ImageThis guide can be used to help you care for your newborn. It does not cover every issue that may come up with your newborn. If you have questions, ask your doctor.

FEEDING

Signs of hunger:

  • More alert or active than normal.

  • Stretching.

  • Moving the head from side to side.

  • Moving the head and opening the mouth when the mouth is touched.

  • Making sucking sounds, smacking lips, cooing, sighing, or squeaking.

  • Moving the hands to the mouth.

  • Sucking fingers or hands.

  • Fussing.

  • Crying here and there.

Signs of extreme hunger:

  • Unable to rest.

  • Loud, strong cries.

  • Screaming.

Signs your newborn is full or satisfied:

  • Not needing to suck as much or stopping sucking completely.

  • Falling asleep.

  • Stretching out or relaxing his or her body.

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

  • Letting go of your breast.

It is common for newborns to spit up a little after a feeding. Call your doctor if your newborn:

  • Throws up with force.

  • Throws up dark green fluid (bile).

  • Throws up blood.

  • Spits up his or her entire meal often.

Breastfeeding

  • Breastfeeding is the preferred way of feeding for babies. Doctors recommend only breastfeeding (no formula, water, or food) until your baby is at least 6 months old.

  • Breast milk is free, is always warm, and gives your newborn the best nutrition.

  • A healthy, full-term newborn may breastfeed every hour or every 3 hours. This differs from newborn to newborn. Feeding often will help you make more milk. It will also stop breast problems, such as sore nipples or really full breasts (engorgement).

  • Breastfeed when your newborn shows signs of hunger and when your breasts are full.

  • Breastfeed your newborn no less than every 2–3 hours during the day. Breastfeed every 4–5 hours during the night. Breastfeed at least 8 times in a 24 hour period.

  • Wake your newborn if it has been 3–4 hours since you last fed him or her.

  • Burp your newborn when you switch breasts.

  • Give your newborn vitamin D drops (supplements).

  • Avoid giving a pacifier to your newborn in the first 4–6 weeks of life.

  • Avoid giving water, formula, or juice in place of breastfeeding. Your newborn only needs breast milk. Your breasts will make more milk if you only give your breast milk to your newborn.

  • Call your newborn's doctor if your newborn has trouble feeding. This includes not finishing a feeding, spitting up a feeding, not being interested in feeding, or refusing 2 or more feedings.

  • Call your newborn's doctor if your newborn cries often after a feeding.

Formula Feeding

  • Give formula with added iron (iron-fortified).

  • Formula can be powder, liquid that you add water to, or ready-to-feed liquid. Powder formula is the cheapest. Refrigerate formula after you mix it with water. Never heat up a bottle in the microwave.

  • Boil well water and cool it down before you mix it with formula.

  • Wash bottles and nipples in hot, soapy water or clean them in the dishwasher.

  • Bottles and formula do not need to be boiled (sterilized) if the water supply is safe.

  • Newborns should be fed no less than every 2–3 hours during the day. Feed him or her every 4–5 hours during the night. There should be at least 8 feedings in a 24 hour period.

  • Wake your newborn if it has been 3–4 hours since you last fed him or her.

  • Burp your newborn after every ounce (30 mL) of formula.

  • Give your newborn vitamin D drops if he or she drinks less than 17 ounces (500 mL) of formula each day.

  • Do not add water, juice, or solid foods to your newborn's diet until his or her doctor approves.

  • Call your newborn's doctor if your newborn has trouble feeding. This includes not finishing a feeding, spitting up a feeding, not being interested in feeding, or refusing two or more feedings.

  • Call your newborn's doctor if your newborn cries often after a feeding.

BONDING

Increase the attachment between you and your newborn by:

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

  • Looking right 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 massaging your newborn often. This includes stroking his or her face.

  • Rocking your newborn.

CRYING

  • Your newborn may cry when he or she is:

  • Wet.

  • Hungry.

  • Uncomfortable.

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

  • Call your newborn's doctor if:

  • Your newborn is often fussy or irritable.

  • It takes a long time to comfort your newborn.

  • Your newborn's cry changes, such as a high-pitched or shrill cry.

  • Your newborn cries constantly.

SLEEPING HABITS

Your newborn can sleep for up to 16–17 hours each day. All newborns develop different patterns of sleeping. These patterns change over time.

  • Always place your newborn to sleep on a firm surface.

  • Avoid using car seats and other sitting devices for routine sleep.

  • Place your newborn to sleep on his or her back.

  • Keep soft objects or loose bedding out of the crib or bassinet. This includes pillows, bumper pads, blankets, or stuffed animals.

  • Dress your newborn as you would dress yourself for the temperature inside or outside.

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

  • Never put your newborn to sleep on water beds, couches, or bean bags.

  • When your newborn is awake, place him or her on his or her belly (abdomen) if an adult is near. This is called tummy time.

WET AND DIRTY DIAPERS

  • 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.

  • If your newborn is formula fed.

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

  • Expect 3–5 poops each day for the first 5–7 days if you are breastfeeding.

  • Expect poop to be firmer and grayish-yellow in color if you are formula feeding. Your newborn may have 1 or more dirty diapers a day or may miss a day or two.

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

  • A newborn often grunts, strains, or gets a red face when pooping. If the poop is soft, he or she is not having trouble pooping (constipated).

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

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

  • Call your newborn's doctor if your newborn has:

  • Less wet diapers than normal.

  • Off-white or blood-red poops.

  • Trouble or discomfort going poop.

  • Hard poop.

  • Loose or liquid poop often.

  • A dry mouth, lips, or tongue.

UMBILICAL CORD CARE

  • A clamp was put on your newborn's umbilical cord after he or she was born. The clamp can be taken off when the cord has dried.

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

  • Keep the cord area clean and dry.

  • If the area becomes dirty, clean it with plain water and let it air dry.

  • Fold down the front of the diaper to let the cord dry. It will fall off more quickly.

  • The cord area may smell right before it falls off. Call the doctor if the cord has not fallen off in 2 months or there is:

  • Redness or puffiness (swelling) around the cord area.

  • Fluid leaking from the cord area.

  • Pain when touching his or her belly.

BATHING AND SKIN CARE

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

  • Do not leave your newborn alone in water.

  • Use plain water and products made just for babies.

  • Shampoo your newborn's head every 1–2 days. Gently scrub the scalp with a washcloth or soft brush.

  • Use petroleum jelly, creams, or ointments on your newborn's diaper area. This can stop diaper rashes from happening.

  • Do not use diaper wipes on any area of your newborn's body.

  • Use perfume-free lotion on your newborn's skin. Avoid powder because your newborn may breathe it into his or her lungs.

  • Do not leave your newborn in the sun. Cover your newborn with clothing, hats, light blankets, or umbrellas if in the sun.

  • Rashes are common in newborns. Most will fade or go away in 4 months. Call your newborn's doctor if:

  • Your newborn has a strange or lasting rash.

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

CIRCUMCISION CARE

  • The tip of the penis may stay red and puffy for up to 1 week after the procedure.

  • You may see a few drops of blood in the diaper after the procedure.

  • Follow your newborn's doctor's instructions about caring for the penis area.

  • Use pain relief treatments as told by your newborn's doctor.

  • Use petroleum jelly on the tip of the penis for the first 3 days after the procedure.

  • Do not wipe the tip of the penis in the first 3 days unless it is dirty with poop.

  • Around the 6th day after the procedure, the area should be healed and pink, not red.

  • Call your newborn's doctor if:

  • You see more than a few drops of blood on the diaper.

  • Your newborn is not peeing.

  • You have any questions about how the area should look.

CARE OF A PENIS THAT WAS NOT CIRCUMCISED

  • Do not pull back the loose fold of skin that covers the tip of the penis (foreskin).

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

VAGINAL DISCHARGE

  • Whitish or bloody fluid may come from your newborn's vagina during the first 2 weeks.

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

BREAST ENLARGEMENT

  • Your newborn may have lumps or firm bumps under the nipples. This should go away with time.

  • Call your newborn's doctor if you see redness or feel warmth around your newborn's nipples.

PREVENTING SICKNESS

  • Always practice good hand washing, especially:

  • Before touching your newborn.

  • Before and after diaper changes.

  • Before breastfeeding or pumping breast milk.

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

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

  • If you are sick, wear a mask when you hold your newborn.

  • Call your newborn's doctor if your newborn's soft spots on his or her head are sunken or bulging.

FEVER

  • Your newborn may have a fever if he or she:

  • Skips more than 1 feeding.

  • Feels hot.

  • Is irritable or sleepy.

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

  • Do not take a temperature right after a bath.

  • Do not take a temperature after he or she has been tightly bundled for a period of time.

  • Use a digital thermometer that displays the temperature on a screen.

  • A temperature taken from the butt (rectum) will be the most correct.

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

  • Always tell the doctor how the temperature was taken.

  • Call your newborn's doctor if your newborn has:

  • Fluid coming from his or her eyes, ears, or nose.

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

  • Get help right away if your newborn has a temperature of 100.4° F (38° C) or higher.

STUFFY NOSE

  • Your newborn may sound stuffy or plugged up, especially after feeding. This may happen even without a fever or sickness.

  • Use a bulb syringe to clear your newborn's nose or mouth.

  • Call your newborn's doctor if his or her breathing changes. This includes breathing faster or slower, or having noisy breathing.

  • Get help right away if your newborn gets pale or dusky blue.

SNEEZING, HICCUPPING, AND YAWNING

  • Sneezing, hiccupping, and yawning are common in the first weeks.

  • If hiccups bother your newborn, try giving him or her another feeding.

CAR SEAT SAFETY

  • Secure your newborn in a car seat that faces the back of the vehicle.

  • Strap the car seat in the middle of your vehicle's backseat.

  • Use a car seat that faces the back until the age of 2 years. Or, use that car seat until he or she reaches the upper weight and height limit of the car seat.

SMOKING AROUND A NEWBORN

  • Secondhand smoke is the smoke blown out by smokers and the smoke given off by a burning cigarette, cigar, or pipe.

  • Your newborn is exposed to secondhand smoke if:

  • Someone who has been smoking handles your newborn.

  • Your newborn spends time in a home or vehicle in which someone smokes.

  • Being around secondhand smoke makes your newborn more likely to get:

  • Colds.

  • Ear infections.

  • A disease that makes it hard to breathe (asthma).

  • A disease where acid from the stomach goes into the food pipe (gastroesophageal reflux disease, GERD).

  • Secondhand smoke puts your newborn at risk for sudden infant death syndrome (SIDS).

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

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

PREVENTING BURNS

  • Your water heater should not be set higher than 120° F (49° C).

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

PREVENTING FALLS

  • Do not leave your newborn alone on high surfaces. This includes changing tables, beds, sofas, and chairs.

  • Do not leave your newborn unbelted in an infant carrier.

PREVENTING CHOKING

  • Keep small objects away from your newborn.

  • Do not give your newborn solid foods until his or her doctor approves.

  • Take a certified first aid training course on choking.

  • Get help right away if your think your newborn is choking. Get help right away if:

  • Your newborn cannot breathe.

  • Your newborn cannot make noises.

  • Your newborn starts to turn a bluish color.

PREVENTING SHAKEN BABY SYNDROME

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

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

  • Shaken baby syndrome is often the result of frustration caused by a crying baby. If you find yourself frustrated or overwhelmed when caring for your newborn, call family or your doctor for help.

  • Shaken baby syndrome can also occur when a baby is:

  • Tossed into the air.

  • Played with too roughly.

  • Hit on the back too hard.

  • Wake your newborn from sleep either by tickling a foot or blowing on a cheek. Avoid waking your newborn with a gentle shake.

  • Tell all family and friends to handle your newborn with care. Support the newborn's head and neck.

HOME SAFETY

Your home should be a safe place for your newborn.

  • Put together a first aid kit.

  • Hang emergency phone numbers in a place you can see.

  • Use a crib that meets safety standards. The bars should be no more than 2⅜ inches (6 cm) apart. Do not use a hand-me-down or very old crib.

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

  • Put smoke and carbon monoxide detectors in your home. Change batteries often.

  • Place a fire extinguisher in your home.

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

  • Store and lock up chemicals, cleaning products, medicines, vitamins, matches, lighters, sharps, and other hazards. Keep them out of reach.

  • 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 cords that hang from blinds or use safety tassels and inner cord stops.

  • Watch all pets around your newborn.

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

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

  • Remove deadly (toxic) plants from the house and yard. Ask your doctor what plants are deadly.

  • Put a fence around all swimming pools and small ponds on your property. Think about getting a wave alarm.

WELL-CHILD CARE CHECK-UPS

  • A well-child care check-up is a doctor visit to make sure your child is developing normally. Keep these scheduled visits.

  • During a well-child visit, your child may receive routine shots (vaccinations). Keep a record of your child's shots.

  • Your newborn's first well-child visit should be scheduled within the first few days after he or she leaves the hospital. Well-child visits give you information to help you care for your growing child.