Taking Your Baby Home - St Peter's Hospital · Waking a Sleeping Baby …L Urine and Stool Patterns …L Signs of Illness ... Helpful Hints …M Medication Safety …FF Table of Contents

Taking Your Baby HomeDischarge Instructions and Tips

baby discharge booklet_booklet 12/15/2014 10:09 AM Page 1

Bathing …2

Cord Care …3

Skin Care …3

Nail Care …3

Diapering …3

Circumcision Care …4

Dressing …4

Temperature Taking …4

Use of Bulb Syringe …5

Safe Sleep …5

Tummy Time …6

Crying/Soothing …6

Waking a Sleeping Baby …7

Urine and Stool Patterns …7

Signs of Illness …7

Hand Washing …8

Car Seat …8

Jaundice …8

Helpful Hints …8

Medication Safety …11

Table of Contents

Taking Your Baby HomeDischarge Instructions and Tips


1

We have enjoyed caring for yourbaby and are pleased he or shecan finally go home. We havecompiled the following informa-tion to help make your family’stransition home smooth, safe and enjoyable.

Bath time can be a great time to bond withyour baby. Although some parents maybathe their infant every day, until the child is crawling or getting into messes werecommend a bath every 2–3 days. It is important to wash the baby’s face, handsand neck at least once or twice a day, andthoroughly clean the diaper area with eachdiaper change. When you do bathe thebaby keep a good grip on them as they can be slippery. Keep bath time under 10minutes so that infant does not get cold.

• Gather your supplies (washcloth, towel,soap, diaper, clothes)

• Bath water should be warm on yourelbow or wrist

• Use mild soap• Until the umbilical cord falls off usesponge bath only

• If a boy is circumcised, use a spongebath until circumcision is healed

• After umbilical cord falls off you cangive baby a tub bath

Face: Wash the face doing the eyes first.Dip a corner of the washcloth into plainwater and squeeze out the excess. Wipethe eye from the inside corner away fromthe nose. Repeat on the other eye with aclean corner of the washcloth. Do not usesoap on the baby’s face. Wash one side at a time to avoid covering the face whichmay frighten a baby.

Body: Use a mild soap to wash the neck,chest, back, arms, hands and feet. Rinsebaby with clean water. Dry the baby thor-oughly with a soft towel, especially in thecreases of arms, legs and neck.

Diaper Area:Wash with mild soapywater. Wash the area from front to back.Rinse well, dry and apply a clean diaper.

Uncircumcised boys: The uncircumcisedpenis does not require any special care.Do not force the foreskin back, you canmove it slightly back and forth. It willdetach as the baby grows. Clean withmild soap and water.Circumcised boys: Clean the area withclean water until healed. Once the areais healed, bathe with soap and water as usual.

Bathing Your Baby


Baby girls: Spread the labia and gentlywash from front to back. Use a cleanpart of the washcloth for each wipe. Be sure to dry well.

Scalp/Hair:Wash the scalp last to preventthe baby from getting cold. Swaddle andhold the baby securely. Wet the hair withclean warm water. Apply a small amount of tearless shampoo/baby wash. Rub witha firm but gentle motion, keeping theshampoo out of the baby’s eyes. Rinse withclean, warm water and towel dry well.

Never try to pull the cord off. The umbilicalcord usually falls off within 10–21 days. It isimportant to keep the cord clean and dry. If your baby still has a cord you should onlygive sponge baths until the cord falls off.Fold the baby’s diaper below the cord toprevent rubbing of the cord.

Contact your pediatrician if:

• the cord smells bad• there is drainage from the bottom of the cord

• the belly button and surrounding areaare red or swollen

A baby’s fingernails grow quickly and canbe sharp. A newborns skin grows up underthe fingernail so you should not cut thenails. Use a clean, non-metal nail file tosmooth the edges and shorten the nails.This may be more easily done when a babyis sleeping.

Babies have delicate skin. Use mild, non-perfumed soap. Some babies develop tinywhite bumps or yellow spots across theirchins called milia. They will go away ontheir own. Another common rash is new-born acne which goes away in 6-8 weeksand does not require treatment

Change your baby’s diaper in a safe place. Infants can roll off any raised surface in seconds. Always have all your supplies inreach. Wipe the baby from front to backusing a clean wipe each time to help pre-vent infection. Make sure to clean betweenskin folds.

Cloth or disposable diapers are fine.

Cord Care

Nail Care

Skin Care

Diapering

2


3

The penis can be red and swollen for a fewdays after the procedure. Over the courseof a few days it will slowly change to apinker, flesh-color. It should heal fullywithin 10-14 days. There may be a LITTLEbleeding. This should stop in 24 hours. Yellowish discharge on the head of thepenis is normal – do not wipe it off.

If your son’s circumcision was done withthe plastibell do not take the ties or ring off the site. These will naturally fall ofwithin a week.

Use gauze with Vaseline on it to cover thesite with each diaper change. This is to ensure that the diaper does not stick to thesite, and that the site stays free of stool.

Call your pediatrician if:

• you notice bright red bleeding (morethan a few drops)

• there is thick green drainage• there is a foul odor around the area

As general rule infants need to be dressedin the same type of clothing as an adultwould to be comfortable, plus one additional layer (onesie or light receivingblanket).

Summer:When going out in the warmweather a brimmed hat or some type ofshading to protect from the sun is recom-mended. Babies can burn easily make sure

they are covered in light clothes when indirect sunlight. Ask your pediatrician aboutthe use of sunscreen before 6 months.

Signs that your baby may be too warm include:

• hot, sweaty neck• bright pink cheeks• skin warm to touch• red raised rash – heat rash

Winter: In the cold it is best to dress yourbaby in layers. Babies lose most of theirheat through their head, so have a warmhat when going outside. Cover feet withsocks. Dress baby in warm footed pajamasor sleepers at night.

Signs that your baby may be too cold include:

• mottled skin• blue or gray lips or extremities

If your infant has labored breathing, isstruggling to breathe, or appears blue orgray, CALL 911 immediately!!

You do not need to check your baby’s tem-perature unless you feel they may be sick.You should use a digital thermometer. A baby’s average temperature under thearmpit is 97.6 – 98.8 degrees. Never takethe temperature right after he/she has hada bath. Do not take a rectal temperature.

Circumcision Care

Dressing Temperature Taking


4

To take the temperature:

• The thermometer should touch onlyskin (not clothing)

• Insert thermometer into dry armpit• Hold arm down to hold the thermome-ter in place

• Wait until you hear the appropriatebeep

• Clean the thermometer after each use.

The bulb syringe is used to clear your baby’s mouth or nose of mucus. Clean bulbsyringe after each use using hot soapywater and let it air dry.

To use the bulb syringe:

• Squeeze bulb• Gently place in opening of nose or inside cheek and release

• Remove bulb and discard what youhave suctioned out

• Repeat as necessary

A safe sleep environment is essential as ithas been proven to lower the risk of suddeninfant death syndrome (SIDS).Healthy ba-bies should sleep on their back. One of themost important things you can do to helpreduce the risk of SIDS is put your healthybaby on his or her back to sleep.

• Always place your baby on their backto sleep for naps and at night, unlessyour doctor has told you otherwise

• Place your baby on a firm mattresscovered by a fitted sheet

• Turn your baby’s head one side to the •other side with each nap

• Never use pillows, loose blankets, orcrib bumpers

• Avoid stuffed animals in the sleep area • Keep all objects away from your baby’sface

• Never place the baby in a bed withother adults or children

• Consider a clean pacifier when puttingbaby to bed, but don’t force them touse it. If the pacifier falls out there is noneed to replace it. (If breastfeeding, youmay want to wait until your child isused to breastfeeding before introducinga pacifier)

Newborns sleep an average of 16 or morehours a day, usually for 2–4 hours at a time.Newborns do not sleep through the night.They need to be fed every few hours andshould be awoken if they have not been fedfor four to five hours.

Safe Sleep

Bulb Syringe Use


5

Tummy time — placing a baby on his orher stomach while awake and supervised —can help your baby develop strong head,neck and shoulder muscles and promotecertain motor skills. Tummy time can alsoprevent the back of your baby’s head frombecoming flat.

You can begin giving your baby tummytime when he or she is a newborn. Start bylaying your newborn on his or her tummyacross your lap two or three times a day forshort periods of time. As your baby growsstronger, place him or her on a blanket onthe floor. Arrange age-appropriate toyswithin his or her reach. As your baby getsused to tummy time, place your baby on hisor her stomach more frequently or forlonger periods of time.

Never leave your baby unattended duringtummy time. If your baby becomes fussy orsleepy during tummy time, change his orher activity or place your baby to sleep onhis or her back in the crib.

Crying is the only way babies can commu-nicate their needs. When you respond toyour baby’s needs quickly they develop a trust in you. Most babies have a fussy period around the same time every day forno apparent reason. Sometimes you will beable to comfort your baby easily and atother times nothing may work. It is ok tofeel frustrated, but it is never ok to shakea baby!!

Tips to comfort a fussy baby:

• Check to see if the baby is hungry orneeds a diaper change

• Try swaddling your baby or wrappingthem snugly in a soft blanket

• Pat or rub your baby’s back to helpthem calm down or to burp them

• Babies like movement; try rocking,walking, playing soft music and dancing

• Go for a walk with the stroller or a ridein the car

• Try giving the baby a pacifier or a cleanfinger to suck on

• Provide a calm quiet area for you andbaby – reduce stimulation

• Try providing a form of skin to skincontact

Ask your partner or a friend to take over fora while, or if all else fails, put your babydown in a safe place and give yourself sometime to calm down. Try to soothe your babyagain when you are calm

Remember, never shake a baby!

Tummy Time Crying/Soothing


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In the early sleepy days, you may need towake your baby for feedings.

• Unwrap baby from blanket• Put baby skin to skin• Talk to baby, gently stroke head or bottom of feet

• Gently stretch baby’s arms and legs• Rub baby’s back• Change the diaper, even if not soiled

Starting at day 5 baby should have 6–8 wetdiapers with pale yellow or clear urine. Ifbaby is breastfed they generally have 2–4stools a day. Formula fed babies generallyhave 1–2 stools a day.

If your baby has decreased urine or nourine, or the urine is dark yellow or amberin color they may not be getting enoughmilk. Other signs of dehydration include drylips and gums, less than 5 wet diapers in 24hours, decreased activity and increasedsleepiness.

You are the best person to realize whenyour baby is getting sick. Often times a parent will realize that their baby is just not acting like themselves. Call your pedia-trician if your baby appears to be ill or isacting differently to you. Babies can get sickvery quickly so early detection is better.

• Temperature greater than 100.4 underthe arm or less than 97.0

• Color changes such as yellow, very paleor blue-gray tint to skin

• Unusually sleepy or hard to wake upunable to wake up for feedings

• Sharp, high pitched cry for no reason,or unusually fussy

• Less than 5 wet diapers in 24 hours• Vomiting of 2 consecutive feedings, orvomiting forcefully

• Infant refuses 2 or more feedings• Oozing or drainage from baby’s eyes,umbilical cord or circumcision

• Bulging or sunken soft spot (fontanel)on top of head

• Diarrhea• Breathes in a different way (faster,noisier or slower)

• Has very yellow color to the eyes orskin

If your infant has labored breathing, isstruggling to breathe, or appears blue orgray, CALL 911 immediately!

Waking a Sleeping Baby

Urine/Stool Patterns

Signs of Illness


7

Hand washing is the best way to preventillness. Always wash hands before touchingbaby, before and after changing a diaper.Wash hands before breastfeeding or pump-ing. Instruct your visitors to wash theirhands before touching baby.

It is not safe or legal for a child to travel in a car unless secured in a car seat. Babiesborn at less than 37 weeks gestation willundergo a car seat challenge before goinghome. This is done to monitor the baby inthe car seat they will be going home in tomake sure they are safe in it.

Please do not place any inserts or strapcovers in the car seat that it did not comewith. They are not tested, and we can’t usethem in your car seat for the car seat chal-lenge or at the time of discharge.

It is recommended that car seats:• have a five-point restraint system

• are installed in the back seat• are rear-facing until manufacturersweight limit

• are not expired• are replaced if they have been in an accident

Jaundice is a yellowing of the skin. It iscommonly seen in many newborns 3–8days after birth. It begins on the head/faceand chest and moves down towards thetoes.

Call your baby’s doctor:

• If you notice yellowing in white of eyes• If your baby’s arms, legs or stomachbecome yellow

• If baby is more tired than usual• If baby is having difficulty eating

Smoking: don’t allow anyone to smokearound your baby

Avoid large crowded environments initially

No visitors who have signs of illness

Have everyone wash their hands beforetouching baby

Keep immunizations up-to-date

Keep baby away from drafts, open windows,and air conditioners

Avoid direct sunlight

Hand Washing

Car Seats

Jaundice

Helpful Hints


Learn your baby’s hunger cues. Crying is thelast sign of hunger. Your baby may showhe/she is hungry by making noises, movinghis/her arms or legs, being alert, rooting,sucking or having fingers or fist in mouth.

Babies can also give cues that they need abreak from a feeding. These include lookingaway, arching the back, pulling away, spit-ting up, choking or crying. If these happenlet your baby rest. Your baby will start feed-ing again when he/she is ready.

Cues that show your baby may be full in-clude relaxing arms alongside of the body,opening hands or relaxing fingers. If babiespush away, arch their back or fall asleepthey may also be telling you they are full. At this time stop the feeding, if the babyonly wants a break they will demonstratehunger cues again when they are ready.

Burping Even when babies are fed properly they willusually swallow some air. In the middle andat the end of a feeding, you need to try andburp the baby. This will get rid of any airthat is swallowed.

• Position the baby on your shoulder, orsitting on your lap.

• Gently rub and pat the baby’s back

Keep a list of your baby’s medications withyour baby at all times. Use medicationsonly as directed. Keep medicine bottlesaway from small children.

• Know why your baby needs to take themedication

• Know the dose and how often the babyneeds the medication

• Observe for any type of reaction to themedication

• Call your pediatrician if baby has a reaction to a medication

REFERENCES

Agency for Healthcare Research and Qual-

ity (2013)

Transitioning Infants from NICU to Home

www.ahrq.gov

American Academy of Pediatrics (2009)

Caring For Your Baby and Young Child

Office on Womens Health (2010)

Newborn Care and Safety

www.womenshealth.gov

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Feeding Medication Safety



12/2014


Documents

Taking Your Baby Home - St Peter's Hospital · Waking a Sleeping Baby …L Urine and Stool Patterns …L Signs of Illness ... Helpful Hints …M Medication Safety …FF Table of Contents