Health Services
Baby Care Tips
Expected Infant Behavior
Babies may sneeze frequently to clear their nose of lint and mucus. Hiccups are common. A few swallows of warm water or raising your baby's head are remedies to try. If you do nothing, however, they usually stop within 15 to 20 minutes.
Spitting up is when the baby brings up a mouthful of the feeding. Overeating or not burping frequently enough can cause this.
Vomiting is when the baby brings up the whole feeding. If your baby vomits once, wait awhile, and then feed again when the baby seems hungry. If the baby continues to vomit, you should call your physician.
Crying
Many parents believe they will "spoil" the infant if they promptly respond to crying or fussing. Research shows that the opposite is true. Ignoring the infant's crying and delaying a response reinforces crying and fussing. But if you respond quickly to the child's needs, you will help your baby develop confidence in you. As infants grow and develop, they will show their needs in ways other than crying. As you grow to know and understand your baby, you will recognize your child's cry and identify the need. Some babies are fussier than others are. Crying may mean your baby:
| • | Has a stomach ache |
| • | Is hungry |
| • | Is too warm or too cold |
| • | Needs a diaper change |
| • | Needs his position changed |
| • | Wants to be held |
Sleeping
There is a wide variation in the amount of sleep required by babies. For the first three months, most babies sleep 18 to 20 hours a day and three to five hours between feedings.
Dressing Your Baby
Dress your baby in a way similar to how you are dressed for indoor and outdoor temperatures. It is easy to overdress babies, and they may become uncomfortable. Your baby's hands may feel cool even when comfortably dressed. Feel the legs, arms and back of the neck to see if your baby is too warm or too cool.
Signs of Illness
The following are signs that your baby may be ill:
| • | Blood in bowel movements |
| • | Decreased amount of urine |
| • | Drastic change in a baby's personality (i.e., baby is suddenly fussy) |
| • | Fever over 100.6 degrees F (measured rectally) |
| • | Lethargic, less active |
| • | Refusal to eat |
| • | Vomiting |
Calling the Physician
Try to make calls to the physician during regular office hours unless it is an emergency. Before calling the physician:
| • | Check your baby for any rash, skin discoloration, etc. |
| • | Have a pencil and paper ready to write down instructions. |
| • | Have the telephone number of your pharmacy available. |
| • | Take your baby's temperature. |
| • | Write down any concerns or questions that you may have. |
When talking to the physician or nurse, be ready to answer these questions:
| • | Have you noticed any behavioral change? |
| • | How has your baby been eating? |
| • | How long has your baby been sick? |
| • | Is anyone who has been around your baby ill? |
| • | How many bowel movements has your baby had? |
| • | What is the color and consistency of the bowel movements? |
| • | What is your baby's temperature? |
Taking a Temperature
The thermometer should register below the normal mark (98.6 degrees F or 37.6 degrees C) before you use it. If it registers above normal, hold the thermometer tightly at the end opposite the bulb and, with a flick of the wrist, shake it sharply three to four times. To read the temperature, slowly rotate the thermometer at eye level until the solid line of mercury ends. Do not touch the bulb of the thermometer when reading it. Before replacing the thermometer in its case, shake the mercury below the normal mark again. Wash the thermometer with soap and cool water, and sterilize it by dipping it in alcohol.
Rectal Temperature
The shape of oral and rectal thermometers is different. The bulb of a rectal thermometer is short and round; the oral thermometer has a bulb that is long and slender.
Coat the bulb of a rectal thermometer with a water-soluble lubricant or petroleum jelly. Place the child on his stomach and spread the buttocks until the anal opening is visible. Carefully insert the thermometer about one-half to three-quarters of an inch into the opening. Hold the thermometer and the child tightly, preventing any unnecessary movement. After two to three minutes, read the thermometer.
You also may place the child on his back. Grasp both ankles in one hand and bend the knees forward until the anal opening is visible. Keep the ankles together and restrain the child.
Bowel Movements
Breast-fed babies' stools are usually a light yellow color and are the consistency of paste to thick cream. Breast-fed babies' stools are rarely hard. Bottle-fed babies' stools are often pasty and pale-yellow to a tan color. Some babies have stools that are curdlike lumps with a loose substance in between. The number of stools is usually unimportant if the consistency and color of the stool is normal, and the baby is comfortable and gaining weight.
Several loose, watery, often greenish and foul-smelling stools indicate diarrhea. Your physician should be called if this happens for more than a couple of bowel movements.
Constipation is when the stool is hard and formed, and the baby is straining to pass the stool. This could be very uncomfortable for the baby, and your physician should be called. It can be normal, however, for your baby to go several days without a bowel movement.
Genitalia Care
If you have a baby girl, you may see a clear, cloudy or bloody type of vaginal drainage. This is normal and due to hormones that were passed to the baby during pregnancy. No special care is required – just keep the area clean. To clean the area, use a soft cloth, soap and water. Gently separate the labia (lips) and clean from front to back.
If your baby boy is uncircumcised, clean the penis with soap and water. Ask the physician about moving the foreskin. Caring for a circumcised male infant depends on the type of circumcision that has been done. The physician or nurse will give you instructions on caring for the circumcision. There may be some yellow drainage from a circumcised penis. This is a normal part of the healing process. Do not try to wash off this drainage.
Immunizations
Immunizations are necessary to give your child protection against certain diseases and the side effects that accompany these infections. "Baby shots" are available at your physician's office or at your county health department for a minimal fee. Your physician or the nurse will discuss the schedule for immunizations with you.
Jaundice
Many newborns become jaundiced (yellow skin color) the first few days of life. If your baby is sent home with jaundice, you can be sure he is doing well if your baby is sucking eagerly, is alert and has at least six to eight wet diapers a day. If your baby becomes jaundiced while in the hospital, your physician may order blood tests to check the baby's bilirubin, the substance that causes jaundice.
Cold Sores, Fever Blisters
If anyone who comes in contact with your baby has a cold sore, be sure they do not kiss the baby. Dispose of all tissues that have come in contact with the sore, and wash your hands after touching it. This sore, caused by a form of the herpes virus, can cause serious illness in an infant.
Warming Formula
Do not use a microwave oven for warming formula in plastic bottles or plastic bottle liners. There is a danger of the milk overheating, rupturing the bottle liner and scalding the baby. Always check the formula temperature before feeding your baby. You can check formula temperature by dripping a little on the inside of your wrist. If it is comfortable to your skin, it is the correct temperature for your baby.
Diapers
If you use disposable diapers, please dispose of them as recommended on the package, especially if the baby has been ill. Others could become sick if they come into contact with the dirty diapers. Be sure the tabs on the diaper are in the back where the infant's bottom will be. The crotch is fused and should be left that way. The front of the diaper should be folded down, plastic side in, so urine will not keep the umbilical cord wet.
If you are using cloth diapers, wash the diapers in mild detergent such as Ivory® or Dreft®. Rinse dirty diapers before soaking or washing them. Borax® can be used in the soaking water to rid the diapers of stains and odors. If your baby develops a rash, rinse the diapers and clothing twice to be sure the soap and ammonia in the urine are gone.
When pinning a diaper, be sure the pins point away from the baby. After taking the pins out of a diaper, close them and put them out of the reach of the baby. You can push the pins into a bar of soap to help lubricate them for easier insertion into a diaper.
Position Changes
When your baby is sleeping, you should place him on his back. This is the safest position, and there is no evidence that sleeping on the back causes choking. Also, keep the baby's room at a temperature that is comfortable to you. Make sure your baby is not too warm.
When your baby is awake, place him on his stomach to learn head control and develop muscles. Also, it's a good idea to alternate the position from side to side so your baby's head will develop a round shape. A rolled up blanket behind the back will provide good support so your baby doesn't roll over.
Bulb Syringe
Always squeeze the air out of the bulb syringe before putting it into your baby's nose or mouth. Do this by squeezing the bulb together. Letting go of the bulb will suck out the mucus, vomit, etc., from the baby's nose or mouth. A bulb syringe will be sent home from the hospital with you. It can be cleaned with soap and water. Rinse and squeeze the water out to dry.
Feeding Schedules
Both bottle-fed and breast-fed babies can be fed on a two- to five-hour demand schedule during the day. Do not go longer than five hours; awaken your baby to eat. At night, feed your baby before you go to bed and let your baby awaken you. If your baby sleeps all night, this is fine. But do not expect this to happen the first few weeks at home.
Nutrition During Breast-feeding
While breast-feeding, the foods you eat are important to you and your baby. Your body needs good nutrition for good health and to produce enough milk for your baby. Nursing uses many calories. Just as important as the quantity of foods you eat, however, is the quality of your diet. It directly affects the quality of your breast milk.
You should eat well-balanced meals. Meat, eggs, fish, milk, cheese, citrus fruits, green and yellow vegetables, whole grain cereals and breads, with a minimum of starches, fatty foods and sweets provide an adequate nutritional intake.
While you are breast-feeding, you will need approximately 500 extra calories per day. Milk is very important because it is high in calcium and other important minerals that allow the development of bones and teeth. Four cups of milk per day is adequate intake. Yogurt, cheese, ice cream and cottage cheese may replace part of the milk requirement. Also, drink plenty of liquids to provide the water necessary for milk production. Besides milk and water, you may use fruit juices and soups.
Choose foods from each of these food groups daily:
| • | Breads and cereals: Five or more servings |
| • | Meat: At least two 3-ounce servings |
| • | Milk: At least four servings |
| • | Protein and calcium |
| • | Vegetables and fruits: Four to six servings |
| • | Vitamins and minerals |
Most foods that are good for you are good for your baby. If some foods are eaten in large quantities, however, they may flavor breast milk. Some babies may dislike specific tastes and refuse or resist nursing.
Breast-feeding mothers should avoid foods that seem to bother their babies. A food takes approximately four to six hours to be tasted in breast milk, and the effects of the food usually last about 24 hours.
Your physician may prescribe an iron supplement, vitamins and/or fluoride. The breast-feeding mother also may be advised to continue her prenatal vitamins for the duration of breast-feeding. Lactating mothers should consult their physicians before taking any type of medication or drugs. Many medications and drugs may pass through breast milk to the baby.
Cigarette smoking also should be avoided while breast-feeding. Exposure to nicotine and other substances inhaled from cigarettes may be potentially harmful to the baby.
Good eating habits will benefit you and your baby. Give careful attention to your diet because your eating habits will affect your baby's health and your own.
Baby Bath
The room in which you bathe your baby should be warm (between 75 and 80 degrees F) and draft free. Never leave your baby alone during the bath.
Supplies needed:
| • | 70-percent alcohol (rubbing alcohol) |
| • | Blanket or absorbent towel |
| • | Clean clothes and diaper |
| • | Cotton balls and cotton-tipped applicators |
| • | Soft brush |
| • | Soft washcloth or sponge |
Bathing instructions
- Fill a small basin with warm water. Always test the water with your hand before using it on your baby. It should neither feel hot nor cold.
- Remove your baby's clothing. Leave the diaper on. Wrap your baby in a blanket or absorbent towel.
- Wash the eyes first, each one separately. Using a different piece of moistened cotton for each eye, wipe from the nose to the outer corner. You may use a very small amount of a mild soap on your baby's face, if desired.
- Wash the outside of each ear and behind each ear. Do not clean the ear canal.
- Moisten a cotton ball with plain water, and gently twist to form a point. Remove dried mucus from each nostril.
- Place the baby's body between your left arm and your left side. Support the baby's body with your left arm. Hold the head in your left hand (use your right arm if you are left-handed).
- Hold your baby's head over the basin. Wet the hair with the washcloth. Add soap (you may use shampoo as your baby gets older and the hair thickens). Wash gently with the soft brush over all areas of the head, but avoid getting soap on the face. Rinse the hair by holding your baby's head over the basin and squeezing a washcloth of plain water over the hair. Rinse thoroughly. Soap and water will run off the back of the baby's head. Rub hair dry with a towel.
- Lay your baby down and unwrap the blanket or towel. Remove the diaper. Place a small amount of warm water and soap on a soft cloth or in your hand. Gently lather the baby's body from the neck down. Use a soapy washcloth for your baby's buttocks and genitals. Avoid wetting the navel area until the cord has fallen off and the area has completely healed. Be careful to wash all creases and skin folds. Lather the back by setting your baby up as if to burp and leaning the baby over your hand.
- Rinse by squeezing a washcloth with plain water over your baby. Again, remember to avoid wetting the cord area. Be careful to rinse all creases and skin folds thoroughly.
- Wrap your baby in an absorbent towel or blanket; dry all creases and skin folds thoroughly.
- Unwrap your baby to expose the cord area. Apply the 70-percent alcohol to the cord with a cotton-tipped applicator. Be sure to cleanse the base of the cord. Report any foul odor or drainage from the cord to your baby's physician. Also, reapply alcohol to the cord two to three times daily until the cord falls off (two to three weeks). Be sure to fold the diaper so it's below the cord.
- Use a safety hold to place your baby in and out of the tub when you begin to tub bathe after the cord has fallen off and the circumcision has healed. Slip your right hand under your baby's shoulders with your thumb over the right shoulder and fingers under the right armpit. Support the buttocks with the left hand, grasping the right thigh with your thumb and fingers.
Infant Safety
Bathing
Always check the temperature of the water with your wrist or elbow before using it on your baby. Keep your hot-water heater below 120 degrees F. Keep water faucets off at bath time. Do not leave your baby alone for any reason in the bath. Keep one hand on your baby at all times during bathing.
Burns
Buy only children's flame-retardant sleep wear. Check to be sure that the garment has been treated to comply with the U.S. Product Safety Commission's Flammability Standard. Keep hot liquids, hot foods and electric cords out of reach of your baby. Place guards in front of open heaters and fireplaces, around steam radiators, hot-air registers and floor furnaces. Never put your baby under a hot-water faucet that could be turned on accidentally.
Car seats
Iowa and Illinois laws mandate that all infants must travel in an approved car seat. Check to see that the car seat you use complies with the Federal Motor Vehicle Safety Standard. Follow the manufacturer's instructions for installation and for securing your baby in the seat. Remember: You will need a car seat to take your baby home from the hospital. If you do not have a car seat, talk to a Woman and Family Center nurse about your options.
Choking
Never leave your baby propped up with a bottle. The milk may get into the lungs and cause your baby to choke or develop an infection. When your baby begins to eat solid foods, do not leave him alone when eating. Babies also choke on things other than food.
Cotton swabs (Q-Tips®)
Do not use cotton swabs around your baby's eyes or nose; your baby may turn quickly and be hurt. Cotton swabs may be used in the outer ear, but never insert a cotton swab into the ear canal. Use cotton swabs only once.
Falls
The only safe places to leave an infant alone are in a playpen and in a crib with the sides up. Even newborns may wiggle or roll off surfaces when unattended. Block stairs to prevent the crawling infant from falling.
Poisons
Keep all medicines and poisons out of reach and in a locked cabinet. Have a small bottle of syrup of ipecac available at home should the Poison Control Center or your baby's physician advise inducing vomiting after your baby has swallowed a poisonous substance. Make sure all baby furniture and toys are finished with a lead-free paint.
If you suspect your baby has swallowed poison:
| • | Try to determine what was swallowed. |
| • | Immediately notify your baby's physician or the Poison Control Center (1-800-272-6477 in Iowa only) for advice on first-aid treatment. |
Suffocation/Strangulation
Do not allow your baby to chew or suck on a balloon, small objects or large pieces of food. Do not put necklaces or pacifier cords around your baby's neck. A pillow is dangerous and unnecessary for a baby. It is possible for your child to turn face down and suffocate. Never allow an infant to handle a plastic bag. Keep the crib and playpen away from mini-blind cords. Buy toys without sharp edges, that are too large for your baby to swallow and too tough to break.
Toys
Buy toys without sharp edges that are too large for your baby to swallow and too tough to break.