Well Child Care, Newborn

NORMAL NEWBORN BEHAVIOR AND CARE

  • The baby should move both arms and legs equally and need support for the head.

  • The newborn baby will sleep most of the time, waking to feed or for diaper changes.

  • The baby can indicate needs by crying.

  • The newborn baby startles to loud noises or sudden movement.

  • Newborn babies frequently sneeze and hiccup. Sneezing does not mean the baby has a cold.

  • Many babies develop a yellow color to the skin (jaundice) in the first week of life. As long as this condition is mild, it does not require any treatment, but it should be checked by your caregiver.

  • Always wash your hands or use sanitizer before handling your baby.

  • The skin may appear dry, flaky, or peeling. Small red blotches on the face and chest are common.

  • A white or blood-tinged discharge from the female baby's vagina is common. If the newborn boy is not circumcised, do not try to pull the foreskin back. If the baby boy has been circumcised, keep the foreskin pulled back, and clean the tip of the penis. Apply petroleum jelly to the tip of the penis until bleeding and oozing has stopped. A yellow crusting of the circumcised penis is normal in the first week.

  • To prevent diaper rash, change diapers frequently when they become wet or soiled. Over-the-counter diaper creams and ointments may be used if the diaper area becomes mildly irritated. Avoid diaper wipes that contain alcohol or irritating substances.

  • Babies should get a brief sponge bath until the cord falls off. When the cord comes off and the skin has sealed over the navel, the baby can be placed in a bathtub. Be careful, babies are very slippery when wet. Babies do not need a bath every day, but if they seem to enjoy bathing, this is fine. You can apply a mild lubricating lotion or cream after bathing. Never leave your baby alone near water.

  • Clean the outer ear with a washcloth or cotton swab, but never insert cotton swabs into the baby's ear canal. Ear wax will loosen and drain from the ear over time. If cotton swabs are inserted into the ear canal, the wax can become packed in, dry out, and be hard to remove.

  • Clean the baby's scalp with shampoo every 1 to 2 days. Gently scrub the scalp all over, using a washcloth or a soft-bristled brush. A new soft-bristled toothbrush can be used. This gentle scrubbing can prevent the development of cradle cap, which is thick, dry, scaly skin on the scalp.

  • Clean the baby's gums gently with a soft cloth or piece of gauze once or twice a day.

IMMUNIZATIONS

The newborn should have received the birth dose of Hepatitis B vaccine prior to discharge from the hospital.

It is important to remind a caregiver if the mother has Hepatitis B, because a different vaccination may be needed.

TESTING

  • The baby should have a hearing screen performed in the hospital. If the baby did not pass the hearing screen, a follow-up appointment should be provided for another hearing test.

  • All babies should have blood drawn for the newborn metabolic screening, sometimes referred to as the state infant screen or the "PKU" test, before leaving the hospital. This test is required by state law and checks for many serious inherited or metabolic conditions. Depending upon the baby's age at the time of discharge from the hospital or birthing center and the state in which you live, a second metabolic screen may be required. Check with the baby's caregiver about whether your baby needs another screen. This testing is very important to detect medical problems or conditions as early as possible and may save the baby's life.

BREASTFEEDING

  • Breastfeeding is the preferred method of feeding for virtually all babies and promotes the best growth, development, and prevention of illness. Caregivers recommend exclusive breastfeeding (no formula, water, or solids) for about 6 months of life.

  • Breastfeeding is cheap, provides the best nutrition, and breast milk is always available, at the proper temperature, and ready-to-feed.

  • Babies should breastfeed about every 2 to 3 hours around the clock. Feeding on demand is fine in the newborn period. Notify your baby's caregiver if you are having any trouble breastfeeding, or if you have sore nipples or pain with breastfeeding. Babies do not require formula after breastfeeding when they are breastfeeding well. Infant formula may interfere with the baby learning to breastfeed well and may decrease the mother's milk supply.

  • Babies often swallow air during feeding. This can make them fussy. Burping your baby between breasts can help with this.

  • Infants who get only breast milk or drink less than 1 L (33.8 oz) of infant formula per day are recommended to have vitamin D supplements. Talk to your infant's caregiver about vitamin D supplementation and vitamin D deficiency risk factors.

FORMULA FEEDING

  • If the baby is not being breastfed, iron-fortified infant formula may be provided.

  • Powdered formula is the cheapest way to buy formula and is mixed by adding 1 scoop of powder to every 2 ounces of water. Formula also can be purchased as a liquid concentrate, mixing equal amounts of concentrate and water. Ready-to-feed formula is available, but it is very expensive.

  • Formula should be kept refrigerated after mixing. Once the baby drinks from the bottle and finishes the feeding, throw away any remaining formula.

  • Warming of refrigerated formula may be accomplished by placing the bottle in a container of warm water. Never heat the baby's bottle in the microwave, as this can burn the baby's mouth.

  • Clean tap water may be used for formula preparation. Always run cold water from the tap to use for the baby's formula. This reduces the amount of lead which could leach from the water pipes if hot water were used.

  • For families who prefer to use bottled water, nursery water (baby water with fluoride) may be found in the baby formula and food aisle of the local grocery store.

  • Well water should be boiled and cooled first if it must be used for formula preparation.

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

  • Formula and bottles do not need sterilization if the water supply is safe.

  • The newborn baby should not get any water, juice, or solid foods.

  • Burp your baby after every ounce of formula.

UMBILICAL CORD CARE

The umbilical cord should fall off and heal by 2 to 3 weeks of life. Your newborn should receive only sponge baths until the umbilical cord has fallen off and healed. The umbilical chord and area around the stump do not need specific care, but should be kept clean and dry. If the umbilical stump becomes dirty, it can be cleaned with plain water and dried by placing cloth around the stump. Folding down the front part of the diaper can help dry out the base of the chord. This may make it fall off faster. You may notice a foul odor before it falls off. When the cord comes off and the skin has sealed over the navel, the baby can be placed in a bathtub. Call your caregiver if your baby has: 

  • Redness around the umbilical area.

  • Swelling around the umbilical area.

  • Discharge from the umbilical stump.

  • Pain when you touch the belly.

ELIMINATION

  • Breastfed babies have a soft, yellow stool after most feedings, beginning about the time that the mother's milk supply increases. Formula-fed babies typically have 1 or 2 stools a day during the early weeks of life. Both breastfed and formula-fed babies may develop less frequent stools after the first 2 to 3 weeks of life. It is normal for babies to appear to grunt or strain or develop a red face as they pass their bowel movements, or "poop."

  • Babies have at least 1 to 2 wet diapers per day in the first few days of life. By day 5, most babies wet about 6 to 8 times per day, with clear or pale, yellow urine.

  • Make sure all supplies are within reach when you go to change a diaper. Never leave your child unattended on a changing table.

  • When wiping a girl, make sure to wipe her bottom from front to back to help prevent urinary tract infections.

SLEEP

  • Always place babies to sleep on the back. "Back to Sleep" reduces the chance of SIDS, or crib death.

  • Do not place the baby in a bed with pillows, loose comforters or blankets, or stuffed toys.

  • Babies are safest when sleeping in their own sleep space. A bassinet or crib placed beside the parent bed allows easy access to the baby at night.

  • Never allow the baby to share a bed with adults or older children.

  • Never place babies to sleep on water beds, couches, or bean bags, which can conform to the baby's face.

PARENTING TIPS

  • Newborn babies need frequent holding, cuddling, and interaction to develop social skills and emotional attachment to their parents and caregivers. Talk and sign to your baby regularly. Newborn babies enjoy gentle rocking movement to soothe them.

  • Use mild skin care products on your baby. Avoid products with smells or color, because they may irritate the baby's sensitive skin. Use a mild baby detergent on the baby's clothes and avoid fabric softener.

  • Always call your caregiver if your child shows any signs of illness or has a fever (Your baby is 3 months old or younger with a rectal temperature of 100.4° F (38° C) or higher). It is not necessary to take the temperature unless the baby is acting ill. Rectal thermometers are most reliable for newborns. Ear thermometers do not give accurate readings until the baby is about 6 months old. Do not treat with over-the-counter medicines without calling your caregiver. If the baby stops breathing, turns blue, or is unresponsive, call your local emergency services (911 in U.S.). If your baby becomes very yellow, or jaundiced, call your baby's caregiver immediately.

SAFETY

  • Make sure that your home is a safe environment for your child. Set your home water heater at 120° F (49° C).

  • Provide a tobacco-free and drug-free environment for your child.

  • Do not leave the baby unattended on any high surfaces.

  • Do not use a hand-me-down or antique crib. The crib should meet safety standards and should have slats no more than 2 and ⅜ inches apart.

  • The child should always be placed in an appropriate infant or child safety seat in the middle of the back seat of the vehicle, facing backward until the child is at least 1 year old and weighs over 20 lb/9.1 kg.

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

  • Be careful when handling liquids and sharp objects around young babies.

  • Always provide direct supervision of your baby at all times, including bath time. Do not expect older children to supervise the baby.

  • Newborn babies should not be left in the sunlight and should be protected from brief sun exposure by covering them with clothing, hats, and other blankets or umbrellas.

  • Never shake your baby out of frustration or even in a playful manner.

WHAT'S NEXT?

Your next visit should be at 3 to 5 days of age. Your caregiver may recommend an earlier visit if your baby has jaundice, a yellow color to the skin, or is having any feeding problems.