General Newborn Care for the First 6 Weeks
Proper Bathing and Skin Care
A newborn's skin is soft and delicate. Proper skin care and bathing can help maintain the health and texture of the baby's skin while providing a pleasant experience for both of you. You should wait until the umbilical cord falls off, and a baby boy’s circumcision heals, to give your baby a bath so you reduce the chances of infection. Until then, just give your baby a sponge bath.
Contrary to popular thought, most babies do not need a bath every single day. With all the diaper changes and wiping of mouth and nose after feedings, most babies may only need to be bathed two or three times a week or every other day.
Baths can be given any time of day. Bathing before a feeding often works well. Many parents prefer to bathe their baby in the evening, as part of the bedtime ritual. This works well especially if bath time is relaxing and soothing for the baby.
- Baby Products: A baby's soft and delicate skin needs special care. Generally, it is best to use products made especially for babies, but your baby's physician can advise you about other products. Products for adults may be too harsh for a baby and may contain irritants or allergens. Many parents like to use lotions for the sweet baby smell. However, unless the baby's skin is dry, lotions really are not needed. Powders should be avoided, unless they are recommended by your baby's physician. When using any powder, put the powder in your hand and then apply it to the baby's skin. Shaking powder into the air releases dust and talc which can make it hard for the baby to breathe.
- Rashes and Bumps: Many babies have rashes and bumps that are normal. Some rashes may be a sign of a problem or infection. Diaper rash can be irritating to the baby and needs to be treated. If you have concerns about a rash, or your baby is uncomfortable or has a fever, call your baby's physician.
- Laundry detergents may cause irritation to a baby's delicate skin. Even if you use a detergent marketed for baby laundry, it is a good idea to rinse the laundry an extra time to remove residues.
- Baby acne: About one-fifth of newborns develop pimples or have acne in the first month. These usually appear on the cheeks and forehead, and disappear within a few months. It is thought that maternal hormones cause these. Do not try to break open or squeeze the pimples, as this can lead to infection.
Umbilical Cord Care
The umbilical cord is the baby's lifeline to the mother during pregnancy. However, it is no longer needed once the baby is born. Within a few minutes after birth, the cord is clamped and cut close to the navel. The clamp helps stop bleeding from the three blood vessels in the umbilical cord - two arteries and one vein. A medication is sometimes applied to the cord as part of a baby's first care. This may be a purple dye or another type of antiseptic.
By the time the baby goes home from the hospital, the cord is beginning to dry and wither. The clamp can be removed when the cord is completely dry. The cord falls off by itself in about two to three weeks. Because the umbilical cord may be a place for infection to enter the baby's body, it is important to care for it properly.
Your baby's physician will give you instructions on how to care for your baby's umbilical cord, which include keeping it dry and exposed to the air.
Keep the cord on the outside of the baby's diaper. Some newborn-size diapers have special cut-outs for the cord area, but you can also fold down the top edge of the diaper. Call your baby's physician if there is:
- bleeding from the end of the cord or the area near the skin.
- pus (a yellow or white discharge).
- swelling or redness around the navel.
- signs that the navel area is painful to your baby.
Circumcisions performed by a qualified physician rarely have complications. Problems that occur are usually not serious. The most common complications are bleeding and infection. Proper care after circumcision helps reduce the chances of problems.
Your baby's physician will give you specific instructions on the care of the circumcision. It is important that you keep the area clean and well-lubricated with petroleum jelly and gauze:
- You should change the gauze dressing with petroleum jelly or an antibiotic cream with every diaper change until healed.
- The head of the penis may be very raw and red looking.
- There may be a small amount of blood at first or yellow-colored drainage later. These are part of normal healing.
- Your baby may have some discomfort with diaper changes the first few days.
- Keep the penis clean with soap and water.
- Circumcisions usually heal within one to two weeks.
Checking a Fever for a Newborn
Call your baby's physician immediately if your baby younger than 3 months old has a temperature of 100.4° F or higher.
Fever in newborns may be due to:
- Infection: Fever is a normal response to infection in adults, but only about half of newborns with an infection have fever. Some, especially premature babies, may have a lowered body temperature with infection or other signs such as a change in behavior, feeding, or color.
- Overheating: While it is important to keep a baby from becoming chilled, a baby can also become overheated with many layers of clothing and blankets. This can occur at home, near heaters, or near heat vents. It can also occur when a baby is over bundled in a heated car. Avoid placing a baby in direct sunlight, even through a window. Never leave a baby in a hot car even for a minute. The temperature can rise quickly and cause heat stroke and death.
An overheated baby may have a hot, red, or flushed face, and may be restless. To prevent overheating, keep rooms at a normal temperature, about 72º F to 75° F, and dress your baby just like you and others in the room.
- Low Fluid Intake or Dehydration: Some babies may not take in enough fluids which causes a rise in body temperature. This may happen around the second or third day after birth. If fluids are not replaced with increased feedings, dehydration (excessive loss of body water) can develop and cause serious complications. Intravenous (IV) fluids may be needed to treat dehydration.
Most babies will get a diaper rash at some time. Their bottoms are in frequent contact with moisture, bacteria, and ammonia, and there is rubbing from the diaper. Babies and toddlers are at risk as long as they are wearing diapers. Rashes are much easier to prevent than to cure. Many rashes can be treated by the following:
- Change Diapers Frequently: The most important thing is to keep the area dry and clean. Check the diapers often, every hour if your baby has a rash, and change them as needed. Check at least once during the night.
- Gentle Cleaning: Frequent and vigorous washing with soap can strip the baby's tender skin of the natural protective barrier. Wash gently but thoroughly, including the skin folds. Do not use diaper wipes if your child has a rash, as they can burn and increase the irritation. You can sit the baby in a basin or tub of lukewarm water for several minutes with each diaper change. This helps clean and may also be comforting. You can also pour warm water from a pitcher or use a squirt bottle. Do not use any soap unless there is very sticky stool, then a very mild soap is okay; wash gently and rinse well. Baby oil on a cotton ball can also be used.
- Pat Dry or Leave Diapers Off for a While: Let the skin air dry, or pat very gently with a very soft cloth or paper towel. A hairdryer set on cool can also be used. Leave the skin open to the air as much as possible. Fasten diapers loosely and do not use airtight rubber pants. If you use disposable diapers, it can help to punch holes in them to let air in.
- Skin Protection: Petroleum jelly (Vaseline®) provides a good protective coating, even on sore, reddened skin, and is easily cleaned. A number of other ointments are available commercially; see what works for your baby and what your baby's physician recommends. Be very careful with all powders; be sure the baby does not breathe them in. Do not use talcum powder because of the risk of pneumonia. Cornstarch reduces friction and may prevent future rashes.
Preventing diaper rash: Changing the diaper immediately and good cleaning are the best things you can do. Diaper rashes occur equally with cloth diapers and disposables diapers. Some children will get a rash from certain brands of disposable diapers, or from sensitivity to some soaps used in cloth diapers. If you use cloth diapers, bleach them by adding Clorox®, Borax®, or Purex® to the wash. Be sure to rinse the diaper thoroughly.
Urine and Bowel Movements
Urine: Babies wet their diapers with urine several times a day. The number of wet diapers is a helpful sign of how much fluid the baby is taking in. Although it is sometimes hard to tell when a disposable diaper is wet, generally, a baby should have at least seven wet diapers each day. Fewer wet diapers can mean the baby may not be taking in enough fluid.
Normally, a baby's urine is clear and yellow-tinged. Changes in the odor and color may indicate a problem. Dark yellow or even pinkish color urine may mean the baby is not getting enough fluid.
Bowel Movements: The first bowel movement of a newborn is called meconium. This is a sticky, greenish-black substance that forms in the intestines during fetal development. The baby may have several meconium bowel movements before this substance is completely gone from the baby's system. The next bowel movements are seedy-looking and are greenish-yellow.
Breastfed babies usually have frequent bowel movements, sometimes with every feeding, and even some in-between. These bowel movements are often loose, yellow, and seedy. Formula-fed babies have thicker bowel movements that are more beige in color.
Occasionally, babies become constipated. This rarely happens in breastfed babies. Firm or formed stools, that occur only once a day or less than once a day, may mean a baby is constipated. A baby may strain or fuss with constipation.
Very runny or watery bowel movements, especially if there is distinct change, may mean the baby has diarrhea. You should contact your baby's physician if this occurs.
Call your baby's physician if you have concerns about bowel movements or urine.
The first cries of a newborn baby are often music to the ears of parents. However, over the next weeks and months this "music" can become grating and painful. This is especially true when all attempts fail to stop the crying.
Surprisingly, crying does not produce tears until after the first month or two. Crying is the way babies communicate. They cry because of hunger, discomfort, frustration, fatigue, and even loneliness. Sometimes, cries can easily be answered with food, or a diaper change. Other times, it can be a mystery and crying stops as quickly as it begins.
You will soon learn differences in cries, from a cry of "I'm hungry" to "I've been overstimulated." It is important to respond to your baby's cries. Contrary to old wives' tales, young babies cannot be spoiled by being picked up when crying. Being held is reassuring and comforting when a baby cannot express him/herself any other way.
Some techniques to help console a crying baby include the following:
- Take care of physical problems first - hunger, diaper change, need to burp.
- Walk with baby in a sling or in a stroller.
- Rock your baby in a rhythmic, gentle motion.
- Try a baby swing or rocking cradle.
- Gently pat or stroke on the back or chest.
- Try swaddling the baby.
- Go for a ride in the car.
- Turn on some white noise (such as a washing machine or vacuum cleaner).
No matter how frustrated you may become, NEVER SHAKE A BABY. This can cause severe injury to the baby's fragile brain. If you become angry or frustrated, allow someone else to take over for a while. If you are alone, put the baby down in a safe place, such as the crib, and go to another room for a few moments. This will give you time to collect yourself. Then you can return to your baby and try a different tactic to comfort your baby.
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