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Caring For
Your Baby
Caring For Your Baby
Ge t t in g t o Kn o w Yo u r Ba b y
Long before your baby’s birth, you probably thought about how your baby would look and what his personality would
be. Often parents form pictures in their minds based upon babies they see on TV, in magazines, and in public.
Now is the time to get to know your baby. No other baby is exactly like yours, yet every baby has some common
characteristics and needs. The information outlined will help to make caring for your baby easier.
are normal. You and your new baby need time to get to know each other. Talk and sing to your baby. Gently massage
your baby’s belly and tiny toes. You’ll learn his first likes and dislikes. Before too long, your baby will know you, and he
will respond to your touch and the sound of your voice.
Ne wb o r n A p p e a r a n ce
If your baby doesn’t have much hair, has short arms and legs, and a head that looks too big, your baby looks pretty
maybe the baby just doesn’t fit the picture of the baby you dreamed about - the “Gerber Baby” you saw in magazines
and television. Keep in mind that the baby has lived in a bag of water for 9 months, has been through labor, and a
trip through the birth canal. Babies come in all sizes and shapes, but some normal newborn characteristics are:
Head
The baby’s head is still too heavy
to be fully supported by the neck
muscles so it is important to support
the head and neck when holding your
baby. The head may look lopsided,
elongated, or bruised - a temporary
condition caused by squeezing in
the birth canal. The head will begin
to take on the correct shape within
a week or so. There are two “soft
spots” called fontanels. The skull
bones move to allow the head to fit
through the birth canal and to allow
for growth of the brain. The triangular
fontanel is near the back of the head,
which closes by 6 - 8 weeks and the
diamond-shaped one is above the
forehead, which closes between 12
- 24 months. These areas are well protected by a tough membrane and are not harmed by shampooing, massaging,
combing, or brushing the head. Some babies have a firm knot on the top of their head called a cephalhematoma. It is
a large bruise which forms when the baby pushes against the mother’s bones during the birth process. It may take 1 -
2 months to disappear, but it is not harmful.
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Hair
Some babies are born with thick hair and others are nearly bald. Neither the color nor the quantity of hair at birth
predicts final appearance. Hair color may change from dark at birth to blond in a couple of months. Some babies lose
their hair and then start a new growth. Permanent hair grows in by the 4th or 5th month.
Face
A newborn usually has puffy and bulging cheeks, a small and receding chin, and a broad, flat nose. These temporary
characteristics serve a useful purpose: to provide the infant with an obstruction free profile for breastfeeding. Initially,
the baby’s face may be swollen, or bruised, and the nose may be flattened to one side. This improves within a few
days.
Eyes and Vision
Caucasian baby’s eyes are usually gray-blue at birth, while darker skinned babies have gray-brown eyes. Eye color
may change anytime up to a year and sometimes even later. A newborn’s eyelids may be puffy from the pressure
of the birth process. Puffiness disappears within a few days. Some babies have reddened areas on the white of the
eye. The squeezing of the head during labor and birth causes the breaking of small blood vessels in the eye. This will
disappear in 1-2 weeks. Tear ducts are usually plugged for the first 1-3 months so your baby’s crying may be tearless
at first. If the baby seems to have a lot of eye drainage, gently massage the inner corner of each eye, down each
side of the nose. Do this 3-4 times a day, making sure your hands are clean. Many newborns look cross-eyed at first.
Often their nervous system and eye muscles are just immature and need time to develop. They will focus and become
coordinated within a few weeks.
Babies can see light, dark, and color and are sensitive to brightness differences. They prefer black and white patterns
and bright colors and are drawn to the human face. They see best at 8 to 12 inches, the distance from you when you
are cuddling them.
Ears and Hearing
The earlobes contain springy cartilage which may be bent in different directions from pressure during birth. Normal
shape returns quickly.
Babies can hear immediately at birth. Your baby has been able to hear since about 26 weeks into your pregnancy.
This is why the baby turns its head toward your familiar voice. Babies prefer human voices, soft sounds, and music.
When your baby hears a sudden, loud noise, he should make a quick, jerky movement and may cry.
Approximately 1 of every 1000 children is born deaf. Early identification and management of hearing loss significantly
improves a hearing impaired child’s ability to develop normal speech, academic, social, and emotional skills. If you
have questions about your baby’s hearing, talk to your baby’s doctor. (See “Hearing Screening.”)
Lips and Mouth
Your baby will suck on anything that touches his lips. Babies may have “sucking blisters”, especially on the top lip.
Babies have a well-developed sense of taste at birth. They can distinguish sweet, bitter, and sour, and prefer sweet.
Skin
A baby’s skin color is usually pinkish, although the hands and feet may be pale or slightly blue. The color ranges from
pale pink to reddish. When the baby cries hard, the whole body becomes very red. If the parents are dark-skinned, the
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baby may have highly-pigmented areas on the lower back, called “mongolian spots”. They are bluish in color, but they
are not bruises. These spots are seen over the body, arms, and legs, but most frequently on the lower back. They will
disappear within the first 4 years. Dry, peeling skin normally is present, especially the hands and feet. Some newborn’s
skin is covered with a white, cheesy substance, called vernix, that protects the baby’s skin before birth. This coating
dries and flakes off in a few days. Baby skin is very sensitive and you may notice various conditions:
the neck. These are commonly called “salmon patches” or “stork bites” and will disappear within the first
year.
themselves, so do not squeeze them.
is normal. The rash moves about the body and is called newborn rash. The rash will disappear in 7 to 10
days.
Any rash that looks like blisters, filled with clear fluid or pus, a rash that gets worse or does not go away, or a rash on
a baby who has a fever or cough or eats poorly should be reported to the baby’s doctor.
Hands and Arms
Awake or asleep, a newborn flexes its arms and usually clenches its hands in a tight fist. The thin, but fully formed
fingernails may cause facial scratches. To keep your baby from scratching his face, you can cover his hands using the
end of the t-shirt sleeves (mitts). See Fingernail Cutting.
Chest and Breathing
Babies’ breasts (both boys and girls) may be enlarged for a short time after birth. They may even secrete a small
amount of clear to milky white fluid. This is caused by the mother’s hormones passed through the placenta and will
disappear without treatment several days after birth.
Babies breathe with their chest and abdominal muscles. Their breathing is rapid and shallow and is often irregular and
uneven. Sometimes you may notice a small bulge in the middle of the chest when the baby takes a breath. This is
normal and caused by the soft cartilage at the bottom of the breast bone.
Abdomen
The baby’s abdomen is usually large and rounded and will rise and fall as the baby breathes.
Legs and Feet
The newborn usually holds its legs flexed against the abdomen. The legs may appear bowed or the feet may appear
to turn in. These conditions are frequently due to the infant’s cramped living space while in the uterus. Most of these
conditions are resolved without need for medical treatment. The feet may look flat because of protective fat on the
soles.
Genitalia
A baby boy’s scrotum (testicles) may be large and swollen. This is usually normal and the swelling will go away. A
baby girl’s labia may appear swollen. She may have some whitish or even bloody discharge from the vagina. This is
all normal. The discharge is caused by the transfer of the mother’s hormones to the placenta and will disappear on its
own.
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Heart
The infant’s heart rate is normally rapid. Occasionally, a newborn has a mild heart murmur, which usually disappears
within a few hours or days. The doctor will evaluate the heart murmur on follow-up visits.
Weight
Most infants lose a few ounces in their first couple of days. The weight loss may equal 7-10% of their birth weight. This
is fluid loss and is normal. Babies, then gradually gain weight at 1/2 to 1 ounce daily. By the end of 2 to 3 weeks,
most babies regain their birth weight.
Ne wb o r n A ct iv it y
For a few hours immediately after birth, most infants are very active and eager to feed. Then the baby enters a period
where he is sleepy for 12-24 hours and are not interested in feeding. Your baby may sleep for a total of 16-20 hours
a day. Babies sleep to meet their needs, which may be unpredictable. The baby may wake you when you would rather
be sleeping. However, they gradually develop a schedule that is more predictable by 6 weeks of age. In the meantime,
sleep when they sleep.
Your baby has different levels of sleeping and waking, called
“states”. Babies behave in different ways during each state.
Babies have 6 different Sleep/Awake States:
If you can tell the state your baby is in, you can get to know
your baby better. For instance, being able to tell when your baby
is fully awake will help you know the best time for feeding or
playing. When you know about sleep states, you can judge the
times to let your baby sleep.
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S le e p S t a t e s
Quiet Sleep
Your baby’s eyes are firmly closed and motionless, and little or no body activity (except for occasional sucking
movements) occurs. The baby breathes deeply and regularly and noises do not disturb him. Your baby will be very
hard to wake up during this state. This is not a good time to feed. However, this may be a very good time to trim your
baby’s finger and toe nails.
Active Sleep
During active sleep, your baby breathes more irregular and faster. There is some body activity such as sudden jerking
or twitching, and movement of the eyes beneath the closed lids. Your baby may suck or smile, or may make brief fussy
or crying sounds. These sounds may not mean your baby is ready to eat. The newborn baby spends about half of their
sleeping time in active sleep (the older baby only 20-25% of the time).
Drowsy
This state comes before waking. You will notice smooth body movements and your baby will startle easily. Your baby’s
eyes may open and close and, when open, look very glazed. It may be difficult to tell if your baby is awake or asleep
in this state. If you leave the baby alone, he may go back to sleep. However, your baby will be easier to awaken in this
state if he needs to eat. To wake up your baby, give him something to see, hear, or suck.
Each baby has its own sleep pattern. Learning and adjusting to your baby’s sleep-wake states will make life easier
for everyone during the hectic early days. As the weeks go by and your baby becomes more responsive to the family
environment, the baby’s sleeping patterns will conform to your own.
You may want the baby in your room at first. Within a few months, you may prefer the baby sleep in its own room,
where you can hear the cries without being disturbed by every movement. Keep the baby’s room temperature fairly
Sleeping Position and Sudden Infant Death Syndrome (SIDS) Prevention
Reason for SIDS are still undetermined, but current research is investigating an incorrectly developed, or a delay in
maturation, of the area of the brain responsible for arousal in life-threatening challenges during sleep.
Providing a safe sleeping environment is the single most important step you can take to reduce your baby’s risk of
SIDS, suffocation and accidental infant death. Following these ten safe sleep steps recommended by First Candle/
SIDS alliance and the American Academy of Pediatrics could mean the difference between life or death for your child.
1. ALWAYS place your baby on his back at nap and nighttime. Tummy and side sleep positions are not safe and
should not be used.
2. Babies should sleep in their own crib or separate safe sleep area and not in an adult bed or on sofas or chairs.
Every year hundreds of babies die of SIDS and accidental suffocation while sleeping with a parent or others.
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3. Do not expose your baby to any second hand smoke. Babies that are exposed to second hand smoke are two to
three times more likely to die of SIDS.
4. For sleep, use a safety-approved crib with a firm, tight fitting mattress covered only by a sheet. There should be
NOTHING else in the crib.
5. Do not use soft materials or objects such as quilts, comforters, or sheepskins under a sleeping baby.
6. Do not use loose blankets in a baby’s crib. Instead, layer clothing or use a wearable blanket to keep baby warm
and safe during sleep.
7. Remove all soft bedding and other soft items from the crib when baby is sleeping. This includes blankets, pillows,
stuffed animals, and soft or pillow-like bumper pads.
8. Encourage babies to use a pacifier at nap and nighttime for the first year. Use the following guidelines to avoid
concerns about breastfeeding challenges and long-term dental complications.
established.
9. Take care not to overheat your baby with too much clothing or too warm of a room temperature. Layer clothing
Research has shown infants unaccustomed to sleeping on their tummy that are then put on their tummy for sleep,
frequently by a non-parental caregiver, have a much higher risk of SIDS.
Bed Sharing
Otherwise known as co-sleeping or co-bedding, is the practice of adults sleeping on the same surface as children and
is not recommended. This activity creates the risk for the baby becoming trapped by the bed or smothered by an
adult or larger child, causing severe injury or death. If you are considering this practice, please talk to your infant’s
physician first about specific ways to reduce the risk of injury or death. Research is being done in this area.
Tummy Time
Some parents have complained their babies have
flattened heads from sleeping in this position. Placing
infants on their backs refers to sleeping infants. A
certain amount of “tummy time” while the baby is
awake and being watched is beneficial for normal
growth and development.
Sleep Time
The average newborn sleeps about 16-20 hours a
day, divided about equally between night and day.
The baby’s longest sleep period will generally be 4
or 5 hours, but some infants sleep only 2 hours at a
time. The sleep time gradually shifts toward night:
sleep during the day and 10 hours at night, usually with an interruption or two.
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By the end of the first year, the total sleep time decreases to about 13 hours, 10 to 11 hours plus two naps (1 to 2
hours each).
Napping
Most babies will nap both mornings and afternoons for periods anywhere from 20 minutes to 4 hours. If your baby
sleeps a lot during the day, he may stay awake more at night. You may want to start the baby’s nap earlier in the
afternoon and wake him after an hour or two.
Night Waking
Babies generally begin sleeping through the night between 4 and 6 months of age, but at first it may consist of a
stretch only from 12 midnight to 5 a.m. And, occasionally, babies who have been sleeping through the night may go
through spells of night waking. Try not playing with your baby during night feedings. Night time feedings, focused on
the task of feeding, may help your baby sleep better at night.
Sleep Problems
Early on it is a good idea to settle your baby into a bedtime routine. They eventually learn to fall asleep by themselves
and a good-night ritual is a reassuring send-off. A bedtime story, even for an infant, can be a nice way to end the day.
These bedtime rituals help children develop a bedtime pattern. However, if your baby is waking up 5-6 times a night
after 6 months of age, there may be a problem and you should contact the baby’s doctor.
A wa k e S t a t e s
These three wake states fill up about 4-6 hours of the newborn’s day:
Quiet Alert State
Your baby will be awake and alert only intermittently, during daily cyclical periods called “Quiet Alert” states. The
overstimulation by a slowing of responses. During the quiet alert state, your
newborn is receptive and tuned into the surroundings, looking around with
eyes wide open. During this intense concentration, the baby keeps its body
and face relatively inactive. Your baby will focus on your face, voice, or
baby. Giving your baby something to see, hear, or suck will keep the baby in
an alert state. The key is to go slowly, and allow for your baby’s need to rest
and look away.
Active Alert State
The “Active Alert” state usually follows each quiet alert state. The baby is
more active during this state, moving its extremities along with mild, but
continuous, vocalization. Typically, this fussy stage is a signal that your baby
is beginning to feel hungry, tired or uncomfortable, or wants to be held. Your
baby is telling you he needs a change of pace. Try feeding him. If you have
already fed him, he may be signaling you that you need to slow down or stop
what you are doing with him.
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Crying State
As the discomfort grows, the sounds increase to outright crying and rapid movement of the extremities. Crying tells you
your baby has had enough. You need to stop whatever you are doing. You may need to help soothe your baby. The
“crying state” usually comes to an end when the infant’s hunger or discomfort is resolved.
Cr y in g
baby.
Babies cry for many reasons and, at first, the cries all sound alike. But by the end of the second month, a mother or
father can usually recognize the distinctive crying patterns that are caused by the different sources of distress:
Hunger
This is the most common cause of crying in the early weeks. Parents usually recognize this cry as a rhythmic howl
with a series of cries broken by brief pauses. If the cries are left unanswered, they usually turn to a steady howl. It is
usually best to feed them without delay. Babies are not too patient, as a rule.
Pain
When your baby is hurting, he will cry in an unmistakable way. The cry begins as a shrill scream, followed by a silent
quite painful. To relieve this gas discomfort, try holding your baby across your lap, tummy down, gently pressing
the baby’s stomach against your knees. You should be alert, too, for signs of some illness that may be causing the
baby’s physical distress. If fever, diarrhea, or other symptoms of illness are present, or if the baby continues crying in
apparent pain, call the baby’s doctor.
Discomfort
some babies are bothered by this and others are not. Maybe your baby is too warm or too cold. Feel the baby’s
warmer. Some babies cry because they are undressed. Put a blanket over the baby’s tummy until you redress him.
Overstimulation
Overstimulated/overtired babies usually cry with a whine. They may also sneeze and hiccup a lot. They can be
soothed by rhythmic sounds - of soft music, talking, singing, or humming. Some mothers and fathers use recordings
of a human heartbeat to quiet the baby. Even a steady drone of a fan or vacuum cleaner can be soothing. Repetitive
motions, such as rocking and patting, are also effective for these babies. Sucking on a thumb, fingers, or pacifier is
another repetitive motion that calms many children.
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Loneliness
If your baby stops fussing when you pick him up, he may simply want to be held. Remember, the baby was in a snugly
womb, hearing a heart beat for 9 months, so his need for closeness is very real. Babies need physical contact just as
much as food and warmth. When you put the baby down and he starts crying again, this is his way of telling you that
he misses the secure feeling of being held in your arms. You might try taking the baby for a walk in a backpack or
chest carrier, where he will be snug against your body and can listen to your heartbeat.
A newborn baby CANNOT be spoiled by attending to his needs or by cuddling him when he is fussy. Picking him
up and soothing him reassures the infant that his needs will be met and allows him to gain trust and confidence
in his parents. This leads to the development of a greater sense of security. The ability to comfort their crying
infant is a great confidence-builder for new parents, as well. Cuddling is good for the whole family.
As you begin to recognize other behaviors with your baby’s cries, sorting out the meaning of his different cries will
become easier. For example, if he appears to be “rooting” searching for food, he may be hungry. If he has just eaten,
the problem may be a need to burp, a need for a diaper change, the need to suck more, or simply, the need to
release tension before sleep.
Keep in mind, after the first 6 months, babies cry less frequently. Now, babies not only cry to communicate needs,
they also cry to convey emotions, as well. As babies try out new motor skills,
they often cry when they are unable to go where they want or do what they
afraid when confronted with new people, places, or experiences.
Co mfo r t in g
Comforting a crying baby is important to a child’s well-being. The bond between
you and your child is strengthened each time he cries and you respond. Even
if the crying doesn’t stop, your baby will be aware of the warmth and soft
voice of the loving parent who is trying to make them feel better. Crying is your
baby’s way of telling you that he needs you.
Suggestions for Comforting Your Baby
try to help. Your baby can be very good at calming down without any
help.
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the moisture in the room may settle him.
pat his back.
arm, with your hand under his tummy.
Or, hold baby so he can look around to
see things.
the car seat.
she has other ideas. There may be a
medical reason why your child is crying.
S h a k e n Ba b y
Keep in mind that what helps one baby may
not help another, and what works one time may
not work the next. Some babies have a fussy
period which recurs daily at the same time. If all efforts fail, try to stay calm. Your baby will sense your frustration and
become more upset. If you know your baby is clean, dry, and fed, place him safely in his crib and distract yourself
close to you for support. Check after 10 minutes to see that he is safe and reassure him of your presence. If he is still
crying, pick him up and console him.
Co lic
If your baby cries and cries, no matter how you try to comfort her, the cause may be colic. About one-in-five babies
develop colic, usually between one and four months of age. They cry constantly, often extending or pulling up their
legs, or passing gas. Sometimes their tummies are enlarged with air and gas from crying. There’s no one cause
of colic, but there are many different ways to ease your baby’s discomfort. One way is to walk her in a soft-sided
baby carrier that you strap to the front of your body. You can also try laying him tummy-down across your knees
and gently rub his back. The pressure against his tummy may relieve his discomfort. Breastfeeding moms can ask
their pediatricians about a change in diet or eliminating specific foods since your baby’s colic may stem from food
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sensitivity. Keep in mind that colic usually disappears by four months of age, no matter what treatments you try.
(American Academy of Pediatrics, 12/1/2006)
When you have done your best to comfort your baby, and he is still crying, remember it is not your fault or the baby’s
fault and you will both survive the experience. Maintaining a sense of humor can do wonders at these times. Seek
advice from your baby’s doctor if crying persists.
Ot h e r A ct iv it ie s
Sneezing
Sneezes, snorts, and coughs are frequent activities of newborns and are not signs of illness unless accompanied by
difficult breathing. Babies sneeze to clear their nasal passages because they are unable to blow their nose yet.
Hiccups
Hiccups are also common and are not harmful. They are probably more troublesome to parents. Young babies hiccup
they help bring up air bubbles. Nothing really needs to be done about them, although offering a few more swallows
from the breast or bottle may help hiccups to stop.
Ne wb o r n Ca r e
The basic physical care of a newborn often seems like a mountain of work. Initially you may feel “all thumbs” when
handling your infant. In the early weeks, life seems like a merry-go-round of repetitive activities - feeding the baby,
changing diapers, bathing the baby, comforting the baby, and attending to his every need. Sometimes, by the end of
the day, new mothers are exhausted, wondering where the time has gone. Take comfort, however, in those seemingly
insignificant tasks in your baby’s day. At no other time in your baby’s life are you physically closer to him as when you
are doing all those mundane tasks associated with normal newborn care. These are all special moments of getting to
really know your baby. By the end of the first year, you will find that you and your baby know each other very well and
love each other very much, which makes these moments of newborn care the most quality time anyone could ask for.
Baby Bath
There is, perhaps, no other infant care activity that worries new parents
more than giving their new baby a bath. Babies are so slippery and
that work best for you. Research shows that giving a newborn a tub
bath and getting the umbilical cord wet does not increase the risk
of infection or the time it takes for the umbilical cord to heal. (Tub
bathing means placing your baby inside a tub of water to bathe him.)
Giving a tub bath is also more soothing to a newborn then doing a
traditional sponge bath. Because of this new research, we recommend
that you do a regular tub bath with your newborn from the first day
he is born. Here are some helpful hints that may make you more
comfortable with your baby’s first bath:
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Supplies needed:
the best.
or deodorant is acceptable. Some suggested types are Johnson and Johnson Baby Wash, Dove (unscented),
Neutrogena, and Alpha Keri. Ivory soap is too drying for infant skin. Your baby’s doctor may want you to use
plain water, at first, because newborn’s skin is very sensitive.
wash the baby’s body.
Tub Bath
A complete daily bath is not necessary for a newborn baby, as it may dry your baby’s skin. Until your baby is able
to crawl on the floor, he does not have much chance to get dirty. Therefore, it is recommended to only bathe your
newborn baby 2-3 times a week. When your baby starts to crawl or starts to feed himself, a daily bath will probably
become a necessity.
parents may be home and you have an extra pair of hands. Bathing your baby just before a late night feeding may
make him relaxed for bed and help him to sleep a little longer at night. If you bathe him right after a feeding, he’s
more likely to spit-up.
Bath time can be a stimulating playtime for your baby. Some babies need to be convinced of this and may take some
time before they are thrilled with the experience. As your baby gets older, he will probably enjoy the bath. The majority
of babies find it a real delight and show their enjoyment with nonstop swishing and splashing. As he is touched and
rubbed with the washcloth, he experiences tactile stimulation. The bath is one of the few places your baby can stretch
and move all of his body parts, providing good exercise. As the baby gets older, he becomes more mobile in the
bath tub, squirming around. Bath toys will help focus the baby’s attention on fun in the water and may cut down on
attempts to squirm and stand up.
Steps of the Tub Bath
must never leave him alone. The possibility of the baby slipping and drowning in just a few inches of water is
far too great to take a chance.
and grasp him under one arm. Hold his thighs with your other hand, cradling his legs and bottom.
hand to wash and rinse the baby. (Even after the baby can sit up unassisted, keep a hand on his arm, or at
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least close enough so that you can move quickly to assist him if he loses his balance.)
to the outside (ear side) of the eyes, using a clean corner of the washcloth for each eye.
reach with your finger. DO NOT use cotton-tipped swabs in the ear canal. Earwax will naturally work its way
out of the ear. Remember to clean behind his ears also.
dressing into clean clothes.
forget to wash between his fingers and toes.
Boys
(Uncircumcised) Gently wipe the penis, make sure to clean under the scrotum.
(Circumcised) If your son was recently circumcised, do not use any soap in the water, plain water will clean him well
enough. Do not wipe any scabs or blood clots off his penis. They will fall off on their own. In a couple of days, when
the circumcision is healing well, soap can be used in the bath.
Girls
Carefully separate the labia (folds of the skin) around the vagina. Using a washcloth, wipe from front to back. Stool
should be removed from the folds, but vernix may be left. Don’t try to rub it off, this may irritate the baby’s skin. A
mucousy, white or pink discharge may be present. Gently wipe it away, but don’t worry if you can’t remove it all. This
discharge will decrease over a few weeks and is normal.
products may irritate your baby’s skin. You may apply Vaseline or diaper rash ointment to the diaper area.
hair last. Once your baby’s body is bathed, take your baby out of his tub and thoroughly towel dry. Hold
your baby’s head over the basin of clean water, supporting his head and neck with your hand and arm, in a
“football hold.” Wet his hair, shampoo his scalp with a gentle circular motion, and rinse thoroughly. Massage
and comb or brush the baby’s scalp (even if he’s bald) to increase circulation. (Daily scalp massage with
help prevent “cradle cap”, a condition which appears as yellow, scaly, oily skin on baby’s scalp. Cradle cap
is caused by overactive oil glands. You may apply baby oil to soften the scaly areas and then comb through
and shampoo.) Dry the hair by gently rubbing with a towel.
Umbilical Cord Care
The cord does not need any special treatment. Keep it clean and dry. You may wash it with soap and water if it
becomes soiled.
or bloody drainage at the time of separation. This separation is a little like losing a scab. If at any time you notice a
yellowish-green, foul smelling discharge, redness, or swelling at the cord’s base, contact the baby’s doctor. These are
signs of infection and additional treatment may be necessary.
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Bulb Syringe
During the first 24-48 hours after birth, mucus may accumulate in your baby’s nose and mouth. This is normal and
can be easily removed by using a bulb syringe furnished by the hospital. Sometimes the amount of mucus can be
excessive and may interfere with your baby’s breathing. If your baby begins to gag or his skin color begins to have a
bluish tint, take the following steps:
To use the bulb syringe, squeeze out the air in the bulb and place the tip between the cheek and gum. Then release
the bulb gradually to create suction. Remove the syringe from the baby’s mouth and squeeze the bulb to remove the
contents into a cloth. Follow the same procedure for suctioning the nose. The only change is that you place the tip
into each nostril. Avoid continuous suction to one area
of the nostril. If you are not sure how to use the bulb
syringe, your nurse will demonstrate its use. Make sure
you clean out the bulb syringe by squeezing warm
soapy water and rinse after each use.
Diapering/Care of Bottom
Changing diapers is nobody’s favorite task, but it is not difficult and becomes second nature after a short time.
Cleaning the diaper of a newborn infant is not nearly as distasteful as many parents expect. Parents often find
diapering a good time to have face to face chats or play games with their babies. Prolonging the time the diaper area
is exposed allows the baby’s bottom to have a chance to air. If your baby is a boy, you may want to have a cloth or
extra diaper handy to cover the penis because exposing his bottom often encourages him to urinate. When your baby
gets older and squirmier, you may need distracting songs, games, or toys to keep him still for any length of time.
You will need to change your baby’s diaper frequently, whenever it is wet or soiled. At first babies use 8-10 diapers
daily. As your baby grows, he will need fewer diapers each day. It is necessary to clean and dry the diaper area
thoroughly each diaper change. When the baby has a bowel movement, it is important to wash the area with warm
water. Baby wipes are handy, but be aware that they may irritate the skin of some infants.
Diaper-changing Technique
(Clean thoroughly from front to back, taking care to clean under the scrotum and in the folds).
bathroom sink, after an initial wipe off.
Section 3 ~ Caring For Your Baby
Cloth diaper
Cloth diapers have become much more user friendly in the last couple of years. Almost all cloth diapers use snaps or
Velcro to close and go on similar to disposable diapers. Follow the manufacturers instructions on how to correctly use
and clean the diapers.
Disposable Diapers
pull it snugly, but not to bind the baby too tightly.
Diaper Decisions
You will need to decide whether to use cloth diapers or disposables. Or, like many parents, you may end up using
both. Whether you choose to use disposable or cloth diapers, the best insurance against diaper rash is to change
them frequently.
Disposing of Diapers
Some manufacturers claim their disposable diapers can be safely flushed down the toilet. However, it is not
Urination/Stools
Your baby should urinate within the first 24 hours. If you are breastfeeding, your baby may not have many wet diapers
at first. You can expect this to increase each day. It is normal for a breastfed baby to only have 1 wet diaper at 1 day
of age, 2 wet diapers at 2 days of age, and so on, until the baby reaches 6-8 days of age. At this point, your baby
should be having a minimum of 6-8 wet diapers each day. This is the best way to determine that your baby is getting
enough breastmilk.
The baby’s urine should be clear or very pale yellow. During the first week, some babies pass uric acid crystals which
leave a reddish-orange stain on the diaper. This usually means the baby’s urine is a little concentrated. As soon as he
gets a little more fluids, the uric acid crystals will disappear.
The first stool your baby has after birth will be dark black and sticky, like tar. It is called meconium. Most infants pass
their first meconium stool within the first 24 hours after birth. This type of stool may last for the first few days. As your
infant eats more, the stools will change in color. By the second or third day, the stools change to “transitional” or
looser, greenish brown. Eventually, the stools become yellowish, seedy, or curdy. Formula fed babies tend to pass a
more formed stool. Breastfed infants have a looser, softer yellow stool.
The number of stools an infant will have varies with each baby. They may have a stool after each feeding, or once
every few days, or once a week. Constipation refers to stools that are hard and difficult to pass, not to the length of
time between stools. Many babies strain, grunt, and turn red when having a bowel movement. This does not mean
they are constipated.
Section 3 ~ Caring For Your Baby
Diaper Rash
Diaper rash is uncomfortable for babies and very disturbing for parents. It usually starts out as a red area of irritation
caused by a strong bowel movement or a wet diaper left on too long. Diaper rash can also be caused by perfumes or
chemicals in baby products, or by infection. Sometimes, a baby’s super sensitive skin breaks down even with the most
meticulous care. If your baby develops a diaper rash, do the following:
Circumcision
Circumcision is a surgical procedure in which the sleeve of skin (the foreskin) that covers the head (glans) of the
penis is removed. It is the most commonly performed surgical procedure in the United States. Routine circumcision is
a controversial topic. After much research and discussion with experts, there appears to be no medical indication for
or against the procedure. Therefore, circumcision has become a matter of personal parental choice. Parents have the
exclusive legal right and responsibility to make that decision. Regardless of the reason for circumcision, it is important
that you make your decision only after you have the available facts and sufficient time to review the options. If you
have specific questions about your choice, we recommend that you discuss it with the baby’s doctor.
Care of the Circumcised Penis
Care of the circumcision is designed to control bleeding and prevent infection. The penis should be washed gently with
water to remove urine or stool and a clean vaseline gauze should be applied to the penis with each diaper change for
24 hours. After that, put a small amount of Vaseline on the diaper or directly on the head of the penis for 4 to 5 days
after discharge. This will help prevent the penis from sticking to it. Avoid prepackaged wipes that contain alcohol when
cleaning the diaper area.
It is safe to tub bathe your son after he has been circumcised. The only difference is not to use any soap in the bath
water for the first couple of days after the circumcision.
The head of the penis, normally dark red in appearance during healing, becomes covered with a yellowish, wet scab
in 24 hours. This is part of the normal healing process and is not a sign of infection. No attempt should be made to
remove the scab, which persists for 2-3 days. In some instances, the physician uses a Plastibell (a plastic ring that
remains on the penis) to perform the circumcision.
In this case, no special dressing or vaseline is required, and the baby can be bathed and diapered just as if he
had not been circumcised. The plastic ring usually drops off 5-8 days after circumcision. A dark brown or black rim
encircling the plastic ring is normal and will disappear when the ring falls off.
Caring for the Uncircumcised Penis
The foreskin of the newborn requires no attention. Most newborn males have erections, thus retracting the foreskin
naturally. It normally takes 3 to 4 years before the foreskin can be easily retracted. Therefore, parents SHOULD NOT
force the foreskin back. This may be painful and can cause scarring and adhesions which may make circumcision
necessary. If you have any other questions about care of your uncircumcised baby, please contact your baby’s
physician.
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Swaddling
Newborn babies are usually more content when they are swaddled snugly in a blanket. This reminds them of being
“snuggled” tightly inside of their moms. Use a square blanket with one corner folded down. Lay the baby with the neck
on the fold. Wrap one arm in and tuck the blanket around and underneath the body. Bring the bottom of the blanket
up and tuck it under the baby. Bring the other side around the baby. This swaddling will often calm a fussy newborn
Fingernail Cutting
We do not cut the baby’s fingernails in the hospital. You may cut your
baby’s nails as needed.
emery board and file the nails, instead of cutting.
easiest when the baby is sleeping or right after a feeding, with
the baby in an infant seat. Nails are soft and easy to clip after
the bath.
careful because the skin is usually attached very near to the
end of the nail).
Temperature Taking
In the hospital, your baby’s temperature will be taken frequently. This is because, initially, newborns have some
difficulty maintaining their temperature. It is necessary to keep them dressed warmly. To determine if your baby is
dressed warm enough, feel his back or tummy. It should feel comfortable, not hot or perspiring or cool to the touch.
(Baby’s hands and feet are normally cool, so they are not a good indication of his temperature).
After you take your baby home, you will only need to check the baby’s temperature when you think the baby might be
sick. A fever may be the only noticeable sign of illness in a young infant. Your baby’s doctor will want you to call if the
temperature is higher than 100˙F or lower than 97˙F (axillary). Be sure you check the temperature before calling the
doctor.
A digital infant thermometer will be sent home from the hospital for your use. Other tools such as tympanic (ear),
pacifier, or forehead strip thermometers are not accurate for newborns and very young infants.
Axillary Method (under the armpit)
The axillary method is an appropriate method to use.
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Rectal Method
Only use this method if your health care provider requests this of you.
movement.
one hand firmly on the child’s back and, with your other hand, insert the thermometer and hold it securely in
place.
A mercury and glass thermometer should NOT be used to take a temperature. Mercury is a toxic chemical and can be
very dangerous if the thermometer is broken. Do not throw a mercury thermometer into a regular trashcan. Instead,
dispose of them at a household hazardous waste collection facility. Contact public health if you need more information
or assistance with disposal.
Infant Clothing
Dressing Infant - Dress your baby appropriately for the weather. Babies cannot easily control their temperature, so it is
better to overdress them than to underdress them. You can always remove extra clothes. In cool weather, always put
on a hat and socks because babies lose the most heat through their head and feet. When you go out, always bring
extra clothes.
Laundering Infant Clothes - It is important to wash all new clothing with a mild detergent before your baby wears them.
If your baby’s skin becomes irritated or red, rinse the clothes twice.
W e ll Ba b y Ca r e
Your baby’s doctor will not only treat your baby for illnesses, but will also provide well-baby care.
Follow-up Appointments
The baby’s doctor usually examines the newborn in the hospital within 24 hours of birth and continues to see the baby
in the office periodically throughout the first year. During these follow-up visits, the doctor will do a physical exam, offer
guidelines for nutrition and daily care, monitor the baby’s growth, look for advances in mental, emotional, and social
development, and suggest ways to stimulate development.
The first follow-up visit is usually scheduled within a few days to 2 weeks after birth. Your baby’s doctor will inform you
of this time frame prior to leaving the hospital. The follow-up visits are a good time to ask questions you may have
Section 3 ~ Caring For Your Baby
about your baby. You can prepare for the next visit by keeping notes on your baby’s feeding and sleeping schedule
and general behavior. (See Breastfeeding Diary.)
Vaccinations
An important part of well-baby care includes vaccinations. Vaccinations can be given to your baby at the doctor’s
office or at the Public Health Vaccination Clinic. These clinics are held monthly throughout the county. The natural
immunity your baby received from you wears off very soon after birth. To maintain protection from many harmful
diseases, immunizations are required. A vaccine is a tiny dose of the virus that causes a disease. Giving it through
a shot, or sometimes by mouth, lets the immune system learn to fight it off. Vaccines do not cure the diseases, they
PREVENT them. A person who receives vaccines benefits from the protection they provide. But when many people are
vaccinated, EVERYONE benefits because the chance for spread of disease is reduced. To protect the health of children,
Wisconsin law requires students in kindergarten through grade 12, and children in licensed day care centers, to be
immunized according to schedule. Proof of immunization will be required when your child enters school. Waivers are
available for medical, religious, or personal conviction reasons.
During the first two years after birth, babies need immunization against eleven serious diseases. These diseases are:
Hepatitis B Vaccine (Hep B)
The American Academy of Pediatrics and the Center for Disease Control (CDC) recommend that all babies receive
the Hepatitis B vaccine shortly after birth. The vaccine (a series of three shots) will protect your child against a
highly contagious and sometimes fatal disease of the liver. You will receive information about this vaccine with your
admission to the Birthing Center. The baby must receive all three vaccinations in order to be protected. The first dose
is usually given within the first 12 hours after birth, the second dose at 1 month of age, and the third dose at 6
months of age. If you have questions about the vaccine, please talk to the baby’s doctor. We need your consent to
begin the series in the hospital.
Polio (IPV)
This disease used to severely cripple many children. The only reason this disease is now rare is because we have a
vaccine for it. Your child can only be protected by receiving the vaccine. The polio vaccine is given by injection or by
mouth.
Diphtheria (DTaP)
Diphtheria is an infectious disease of the throat that may progress to the windpipe and lungs, making breathing
difficult. Life-threatening complications, such as heart failure and muscular paralysis, may develop in other parts of the
body. The period of greatest risk of exposure to this disease is in early childhood. The diphtheria vaccine is given in a
shot form, combined with the tetanus and pertussis vaccines.
Tetanus (Td)
This is a disease that can result from contaminated puncture wounds, burns, and surgical wounds. It causes a wide
Section 3 ~ Caring For Your Baby
variety of symptoms ranging from “lockjaw”, or stiffening of the jaw, to seizures, paralysis, and sometimes death. The
tetanus vaccine is given with the diphtheria and pertussis vaccines.
Pertussis (DTaP)
Pertussis is often called “whooping cough” because it usually occurs as periods of harsh, continuous coughing, ending
in a “whoop” as the child gasps for breath. The coughing may interfere with breathing and often causes vomiting.
Complications such as pneumonia, convulsions, or even death, may occur. Pertussis vaccine is given with diphtheria
and tetanus vaccines.
Measles (MMR)
Measles is a serious disease that is easily passed from one person to another. It causes a high fever, cough, and a
rash and usually lasts for 1-2 weeks. Complications such as an ear infection and pneumonia, or even death, may
occur. Measles can also cause an infection of the brain that could lead to convulsions, hearing loss, and mental
retardation. Babies who catch measles are often much sicker and are more likely to suffer longer or die than school
age children and teenagers. The measles vaccine is combined with the mumps and rubella vaccines.
Mumps (MMR)
Mumps causes fever, headache, and swollen, painful glands under the jaw. It lasts for several days and it is easily
passed from person to person. Complications of mumps are a mild or severe inflammation of the coverings of the
brain and spinal cord (meningitis) and hearing loss. In males, a very painful inflammation of the testicles may also
occur. The mumps vaccine is given with the measles and rubella vaccines.
Rubella (MMR)
Rubella is also called “German measles”. It is usually a mild disease that lasts for a short time. If a pregnant woman
catches the disease however, it is very dangerous to her unborn baby. It may cause miscarriage, heart disease,
blindness, and deafness of the newborn. People who catch rubella usually have a mild fever, swollen glands in the
neck, and a rash that lasts up to 3 days. Rubella may cause soreness and swelling in the joints. The rubella vaccine is
given with the measles and mumps vaccine.
Streptococcus Pneumoniae (PCV)
Streptococcus Pneumoniae is a bacteria that is the most common cause of meningitis, pneumonia, sinus infections,
and ear infections in children. Children younger than 5 years of age have 2 - 3 times higher risk of getting this bacteria
if they are in “out-of-home” care settings. The PCV vaccine will help protect children from this bacteria.
Haemophilus influenza b (Hib)
H. influenza b is a type of bacteria that is responsible for a number of serious diseases in young children. It used to
be the most cause of meningitis, a life-threatening disease involving the membranes that cover the brain and spinal
cord. Meningitis causes death in 5% of infected children and 38% suffer permanent brain damage. The second most
common condition caused by H. influenza b is epiglottitis, an inflammation of the flap of cartilage that prevents food
from entering the windpipe. Epiglottitis can result in suffocation if not treated quickly. Other conditions caused by H.
influenza b are pneumonia, blood infections, and arthritis.
Varicella (Var)
Varicella virus causes chicken pox. Children susceptible to chicken pox may receive varicella vaccine anytime after
their first birthday.
Section 3 ~ Caring For Your Baby
Following these immunization schedules is important to the future of your children.
Centers for Disease Control and Prevention
Recommended Immunization Schedule for Persons Aged 0–6 Years—
Age Birth 1 2 4 6 12 15 18 19–23 2–3 4–6
Vaccine month months months months months months months months years years
Hepatitis B 1
HepB HepB see HepB HepB Series
footnote 1
2
Rotavirus Rota Rota Rota Range of
recommended
Diphtheria,Tetanus,Pertussis3 DTaP DTaP DTaP DTaP DTaP ages
Haemophilus influenzae type b4 Hib Hib Hib4 Hib Hib
PCV Catch-up
Pneumococcal5 PCV PCV PCV PCV
PPV immunization
Inactivated Poliovirus IPV IPV IPV IPV
Influenza6 Influenza (Yearly)
Certain
Measles, Mumps, Rubella7 MMR MMR high-risk
groups
Varicella8 Varicella Varicella
Hepatitis A9 HepA (2 doses) HepA Series
Meningococcal10 MPSV4
This schedule indicates the recommended ages for routine administration of currently licensed other components of the vaccine are not contraindicated and if approved by the Food and Drug
childhood vaccines, as of December 1, 2006, for children aged 0–6 years. Additional information Administration for that dose of the series. Providers should consult the respective Advisory
is available at http://www.cdc.gov/nip/recs/child-schedule.htm. Any dose not administered at the Committee on Immunization Practices statement for detailed recommendations. Clinically significant
recommended age should be administered at any subsequent visit, when indicated and adverse events that follow immunization should be reported to the Vaccine Adverse Event
feasible. Additional vaccines may be licensed and recommended during the year. Licensed Reporting System (VAERS). Guidance about how to obtain and complete a VAERS form is
combination vaccines may be used whenever any components of the combination are indicated and available at http://www.vaers, hhs.gov or by telephone, 800-822-7967.
83
Keep a Record
Keep an up-to-date record of your child’s immunizations at home. Record all of the immunizations by month, day,
and year. If you do not have an immunization record, ask the doctor or nearest public health department for a form to
record immunizations.
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Risks of the Vaccines
Most people who get vaccinations will not have a problem. Others will have minor problems, such as a sore or red
spot at the site of the shot that lasts for 1-2 days. Some babies will run a low-grade fever. Rarely, a person may have
a serious problem. If problems occur, they almost always happen after the first shot. Experts agree that the benefits of
the vaccines are far greater than the possible risks. These diseases make some people very sick.
What You Can Do After the Shot -
after receiving a vaccine.
When the Vaccines should be Delayed or NOT Given - If your baby does not get the vaccine because of one of the
reasons below, check with the baby’s doctor about getting the vaccines at a later time. Discuss these situations
with the baby’s doctor:
vaccination until the baby is better.
the
attention of the doctor.
it
required treatment by a doctor.
cancer, leukemia, lymphoma, or HIV.
prednisone or steroids that make it hard for the body to fight infection.
The future health of your child depends on the decisions you make now. Although these diseases may not seem to
be an immediate health risk, children who are not vaccinated are at an increased risk of catching these diseases. If
insurance coverage or finances are a problem for you, consult your local health department for its schedule of reduced
cost immunization clinics. DO NOT skip these immunizations - the cost of treating the disease will far outweigh the cost
of the immunizations.
Section 3 ~ Caring For Your Baby
In fa n t Illn e ss
No matter how healthy your baby is at birth or how meticulous you are
about his physical care, inevitably he will have an illness. Your baby is still
susceptible to colds and other infections. A year will rarely pass during
which your child will not experience some sort of illness. The most frequent
ailments are usually not very serious, and they are easily handled in
consultation with your baby’s doctor.
When to Call the Doctor
Parents often wonder if their baby is “sick enough” to call the doctor. Some
basic advice: WHENEVER you are concerned about the health of your child,
CALL. In addition, the following signs of illness should alert you to call the
baby’s doctor:
“Sleep Patterns.”)
Remember that you know your baby best. Sometimes you will just sense things are “not right”. Be observant. Make
note of the things which seem unusual. Also, be prepared to give routine information when you call the doctor.
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The doctor will want to know:
Try to make non-emergency calls in the day time hours.
In Case of an Emergency
In case of any serious emergency, and your baby’s physician is not immediately available, DO NOT waste time - take
your child to the nearest Emergency Department, or call your local emergency medical service (EMS), if you feel it
necessary to do so.
Common Medical Conditions
There are several temporary conditions that commonly develop during the first month. Ask your doctor about anything
that worries you or any condition that persists.
Jaundice
Jaundice refers to a yellowish tint to the baby’s skin and is fairly common among newborns. The yellowish coloration
is caused by an excess amount of bilirubin in your baby’s blood. Bilirubin is released into the bloodstream when
red blood cells are broken down. The bilirubin is processed in the liver and eventually excreted from the body. It is
a natural process for your baby’s body to rapidly break down red blood cells. Also, your baby’s liver is immature
(not functioning to total ability yet) and cannot process the bilirubin as quickly as he will be able to in a few days.
Thus, there is some delay in excreting the bilirubin, causing the yellow skin color. This is called physiologic jaundice
and is usually seen around the second or third day after birth. It usually starts fading about the fourth or fifth day of
age. Most jaundice in newborns is a normal event and is not serious. In most cases, it will disappear without any
special treatment. If your baby looks jaundice in the first few days after birth, your doctor or nurse may use a skin
test or blood test to check your baby’s bilirubin level. In some situations, the bilirubin gets to high and your baby’s
doctor may decide to treat the jaundice with a Bilirubin Reduction Light. The bililight helps the baby to get rid of
bilirubin found just below the surface of the skin. If treated in the hospital, the bililight is placed over the baby. The
baby is unclothed to provide maximum skin exposure. The baby may be under the bililight for a few days. Laboratory
tests and physical appearance guide the doctor in the evaluation of the baby’s progress. (See Section I - Home
Phototherapy)
Kernicterus
Infants with excessively high bilirubin levels can develop Kernicterus. Kernicterus is caused when the bilirubin
moves out of the blood and into the brain tissue. Some signs that tell you to seek immediate treatment for your
infant are:
Section 3 ~ Caring For Your Baby
Thrush
In the first few weeks after birth, some infants develop a mouth infection called thrush. It is caused by a fungus
(yeast) that may be transmitted by unwashed hands or bottles or from mothers who had a yeast infection during
delivery. Thrush looks like a white coating of cottage cheese inside the mouth and covering the tongue. It is usually
not painful and may clear up on its own, in time. Sometimes you may also notice a rash on the baby’s bottom that
does not clear up with air drying and skin care. The infection can be treated with antifungal medication to speed
recovery and to prevent thrush from spreading to the mother’s breasts during breastfeeding.
Sucking Blisters
Vigorous sucking on fingers in utero, bottles, and pacifiers may cause sucking blisters to develop on the upper lip
of some newborns. They are not serious and will disappear on their own.
Epstein’s Pearls
Harmless white cysts may also appear on the roof of the baby’s mouth or gums. These are normal and
noninfectious and will disappear on their own.
Protruding Navel
A weakness in the newborn’s abdominal muscle wall may result in an umbilical hernia, a painless swelling near the
naval. Although these hernias cause some parents some concern, they should not be compressed in any manner.
Most heal within a year without treatment.
Natal Teeth
Occasionally a baby is born with a tooth already in place, usually on the lower gum. If the tooth is loose and has
weak roots, removal may be recommended to prevent swallowing it during a feeding.
Blocked Tear Duct
Tears usually drain from the eye into the nasal passage through a duct at the inside corner of each eye. If the duct
is not fully open or is blocked by mucus, tears overflow and dry to a yellowish white crust that may cake the eyelids
together. In some cases, the duct becomes infected, causing redness and a pussy discharge. The baby’s doctor
may recommend a massage technique to open the tear duct.
Heat Rash
Heat rash occurs when pores are unable to bring sweat to the skin’s surface. A bright rash of tiny red pimples
appears, usually in skin folds or on the cheeks, neck, chest, or diaper area. This condition may appear during hot,
humid weather or when your baby has a fever or is dressed too warmly. Give your child a lukewarm bath and dress
him in loose-fitting clothes. If the rash does not go away in a few days, or if blisters appear, call the baby’s doctor.
Screening Tests
The first 24 hours of age are critical in determining how well your baby will adjust to life outside of you. There are
several screening tests routinely performed to minimize the possibility of any serious problems.
Apgar Score - an assessment to measure 5 newborn vital signs (heart rate, breathing, muscle tone, reflexes, and skin
color). This score is given exactly at 1 minute and 5 minutes of age. The scores range from 0 - 10. A low initial score is
not necessarily cause for alarm. A healthy infant usually has a score of 7 - 10 at 5 minutes of age.
Section 3 ~ Caring For Your Baby
Coombs Test - a blood test performed on newborns of mothers whose blood type is O positive or Rh negative. The
sample of blood is taken from the umbilical cord and is tested for a blood incompatibility between mother and baby.
Blood Sugar Level - a blood test conducted on all babies after birth. Children of diabetic mothers or infants with
symptoms of low blood sugar (irritability, jitteriness, poor feeding) will be tested again to make sure their levels are
high enough. Low blood sugar can be easily treated with frequent feedings.
Neonatal Screen - a blood test drawn by gentle pinprick from infant’s heel. The test screens for different metabolic
disorders by state law. The blood sample is sent to Madison to the state lab. The baby’s doctor receives the screen
results within a few weeks. The screening test is not a diagnostic test. It only screens for those patients who have the
likelihood of developing the disease. Further testing is required. In some cases, a doctor’s decision based on these
test results can prevent complications that, if left untreated, could result in irreversible defects.
Hearing Screen - The ability to hear is vital for infants. Precious learning time can be lost if a child cannot hear well.
To provide your baby the best start the Birthing Center, through the support of our hospital volunteers, offers a hearing
screening to all newborns before discharge. If your baby does not pass the hearing screen, you will be scheduled with
an audiologist and notified of appointment time. You will also be provided with a community support person who can
help answer questions about the importance of retesting your baby’s ears.
In fa n t S a fe t y
Your baby is completely dependent on you for protection.
Infant CPR
Infant safety/CPR classes are available through the Perinatal Education program of the Birthing Center. Basic Life
Support certified instructors teach ”hands-on” care of a choking baby or child and one who needs CPR. This class can
be taken after the baby is born, so contact the Birthing Center for more information.
Car Seats
Which car safety seat is the best?
No one seat is the “best” or “safest.” The best seat is the one that fits your child’s size, is correctly installed, and is
used properly every time you drive. When shopping for a car safety seat, keep the following in mind:
seats available for sale in the United States must meet government safety standards.
it fits properly and securely in your car.
Important safety rules
up.
Section 3 ~ Caring For Your Baby
handy, and follow them at all times.
A car seat can only protect your baby if you use it on every ride. You may be a very safe and careful driver, but you
can’t be sure of the other drivers on the road. Many car accidents occur within 2 miles of home at speeds less than
30 miles per hour.
Car Seat Safety Inspections
Child safety seats are 71% effective in reducing deaths for infants in passenger cars, and 54% effective in children
ages 1-4. The Safe Kids Wausau Area Coalition provides free car seat inspections and installations for anyone in
the community to make sure your child’s safety seat is properly installed. Along with the Aspirus Women’s Health
Birthing Center’s Baby Fair (1st Wednesday of every month, 4 PM - 6 PM) SAFE KIDS is available to inspect, install
and educate you on the proper use of your child’s car seat and along with the Wausau Police Department the 3rd
Wednesday of every month at Saturn of Wausau, 11AM - 1 PM & 4 PM - 6 PM.
Ch ild P a sse n g e r S a fe t y
Wisconsin Child Passenger Safety—Booster Seat Law
How to comply with the law
Children must be properly restrained in a child safety seat until they reach age 4 and in a booster seat until age 8.
The law includes the following four-step progression for effective child safety protection in vehicles.
1. Rear-facing child safety seat in the back seat* is required when the child:
2. Forward-facing child safety seat in the back seat* is required when the child:
3. Booster seat is required when the child:
4. Safety belt is required when the child:
*child safety seat must be in the back seat if the vehicle is equipped with a back seat
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Exemptions:
Children whose body-size, physical condition or medical condition makes safety restraints unreasonable are
still exempt from the booster seat and safety belt laws.
attend to the child’s personal needs, such as feeding or diapering, while the vehicle is moving.
Ty p e s o f Ch ild S a fe t y S e a t s
Always read the child safety seat instruction manual. Each manufacturer provides specific instructions regarding proper
use and installation of his/her safety seats.
Rear-facing seats
All infants should ride rear-facing until they have reached at least 1 year of
age and weigh at least 20 pounds. That means that if your baby reaches
20 pounds before her first birthday, she should remain rear-facing at least
until she turns 1 year old. It is best for children to ride rear-facing to the
highest weight or height allowed by the manufacturer.
There are 2 types of rear-facing seats: infant-only seats and convertible
seats. Convertible seats can be used rear-facing for infants, and then
turned forward-facing once your child is old enough and big enough to do
so safely.
Infant-only seats
to install the base each time you use it.
Convertible seats (used rear-facing)
and at least 20 pounds. It is best for
children to ride rear-facing to the highest weight or height allowed by the manufacturer, usually 30 pounds or
more for all new convertible seats. Check your car safety seat instructions to find the weight and height limits
for rear-facing.
Have higher rear-facing weight limits than infant-only seats and are good for bigger babies.
Section 3 ~ Caring For Your Baby
Features to look for in rear-facing seats
Harness slots. Look for a seat with more than one set of harness
slots to give your baby room to grow. The harness should be in
the slots at or below your baby’s shoulders when your baby is
rear-facing.
Other helpful features. Angle indicators and built-in angle
adjusters can help you get the proper recline.
Head support systems can help your baby fit in the seat properly.
5-point harness
the hips, 1 at the crotch.
Forward-facing seats
Once your child is at least 1 year of age and weighs at least 20 pounds,
he can ride forward-facing. However, it is best for him to ride rear-facing
until he reaches the highest weight or height allowed by the car safety seat. There are many types of seats that can be
used forward-facing: convertible seats, built-in seats, combination forward-facing/booster seats, and travel vests.
Convertible seats (used forward-facing)
Convertible seats can be used forward-facing by children who are at least 1 year of age and weigh at least 20 pounds.
To switch the seat from rear- to forward-facing, be sure to follow these steps:
1. Move the shoulder straps to the slots that are at or above your child’s shoulders. On many convertible seats,
the top harness slots must be used when the seat is in the forward-facing position. Check the instructions to
be sure.
2. Move the seat from the reclined to the upright position if required by the manufacturer of the seat.
3. Make sure the seat belt runs through the forward-facing belt path.
When making these changes, always follow the car safety seat instructions.
Built-in seats
Built-in forward-facing seats are available in some cars and vans. Weight and height limits vary. Read your vehicle
owner’s manual or contact the manufacturer for details about how to use these seats.
Combination forward-facing/booster seats
Some car safety seats can be used as both a forward-facing seat and a booster. These seats come with harness
straps for children who weigh up to 40 to 65 pounds (depending on the model). Once your child reaches the weight
or height limit for the harness, you can use the seat as a booster by removing the harness and using your vehicle’s
lap and shoulder seat belts. Keep in mind that when using the harness straps, the seat can be secured with a lap and
shoulder belt or a lap-only belt. However, once you remove the harness, you must use a lap and shoulder seat belt.
Children must never ride in a booster seat using a lap belt only because serious injury can result.
Section 3 ~ Caring For Your Baby
Travel vests
Travel vests can be used for a child who has outgrown his seat with a harness but is not yet ready for a booster seat
or cannot use a booster seat because the vehicle only has lap seat belts in the rear.
Booster seats
Booster seats are designed to raise your child so that the lap and shoulder seat belts fit properly. This means the
lap belt lies low across your child’s upper thighs and the shoulder belt crosses the middle of your child’s chest and
shoulder. Correct belt fit helps protect the stomach, spine, and head from injury in a crash. Both high-back and
backless booster seats are available. They do not come with harness straps but are used with the lap and shoulder
seat belts in your vehicle, the same way an adult rides. Booster seats should be used until your child can correctly fit
in lap and shoulder seat belts.
Your child should stay in a car safety seat with a harness as long as possible before switching to a booster seat. You
can tell when your child is ready for a booster seat when one of the following is true:
and are also included in the instruction booklet.)
A warning about seat belt adjusters
There are products for sale that attach to the seat belt and claim to make it fit better. These products may actually
interfere with proper lap and shoulder belt fit by causing the lap belt to ride too high on the stomach and making the
shoulder belt too loose, and may even damage the seat belt itself. There is no federal standard for the performance
of these products, and most vehicle and car safety seat manufacturers do not recommend their use. Until there are
federal safety standards for these products, the American Academy of Pediatrics (AAP) recommends they not be used.
As long as children are riding in the correct restraint for their size and age, they do not need to use any additional
devices.
Installing a car safety seat
There are 2 main things to remember when installing a car safety seat.
1. The seat must be buckled tightly into your vehicle.
2. Your child must be buckled snugly into the seat.
Ask yourself the following questions to make sure both are done correctly. If you are not sure, check the instructions
that came with your car safety seat, or contact a certified CPS Technician for help.
Is the car safety seat buckled into the vehicle correctly?
Section 3 ~ Caring For Your Baby
attach the seat, have you attached the straps to the correct anchor points in the vehicle?
side or front to back, it’s not tight enough.
safety seat back a little. Your car safety seat may have a built-in recline adjuster for this purpose. If not,
wedge firm padding, such as a rolled towel, under the base.
seat. If the seat belts in your car move freely even when buckled and there is no way to lock them, you
need a locking clip. If you’re not sure, check the manual that came with your car. Locking clips are not
needed in most newer vehicles and in vehicles with LATCH.
are only available from the vehicle manufacturer. Check the manual that came with your car for more
information or visit a car safety seat inspection station.
Is the child buckled into the car safety seat correctly?
shoulder straps in place?
to allow for thicker clothes, but make sure the harness still holds the child snugly. Also, remember to
tighten the straps again after the thicker clothes are no longer needed.
Never place them under or behind your baby.
the crotch strap with rolled up diapers or blankets.
Installation made safer and easier
There are several ways to make car safety seat installation safer and easier, including the following:
(Lower Anchors and Tethers for Children) is an attachment system that eliminates the need to
use seat belts to secure the car safety seat. Vehicles have at least 2 sets of small bars, called anchors,
located in the back seat where the cushions meet. Car safety seats that come with LATCH have a set of
attachments that fasten to these anchors. Nearly all passenger vehicles and all car safety seats
made on or after September 1, 2002, come with LATCH. However, unless both your vehicle and the car
safety seat have this anchor system, you will still need to use seat belts to install the car safety seat.
tether is a strap that attaches to the top of a car safety seat and to an anchor located on the rear
window ledge, on the back of the vehicle seat, or on the floor or ceiling of the vehicle. Tethers give extra
protection by keeping the car safety seat and the child’s head from moving too far forward in a crash
or sudden stop. Tethers are part of the LATCH attachment system, though they should not be confused
attachments are located at or near the base of the seat.
Section 3 ~ Caring For Your Baby
All new cars, minivans, and light trucks have been required to have tether anchors since September 2000. Most new
forward-facing car safety seats and a few rear-facing car safety seats come with tethers. For older car safety seats,
tether kits are available. Tethers are recommended because they greatly improve the protection of your child in a
crash. Check with the car safety seat manufacturer to find out how you can get a tether for your seat if yours does not
have one.
Ca r S e a t s a n d A ir Ba g s
All new cars come with air bags. When used with seat belts, air bags work very well to protect teenagers and adults.
However, air bags are very dangerous to children, particularly those riding in rear-facing car safety seats and to child
passengers who are not properly positioned. If your car has a passenger air bag, infants in rear-facing seats must ride
in the back seat. Even in a relatively low-speed crash, the air bag can inflate, strike the car safety seat, and cause
serious brain and neck injury and death.
Toddlers who ride in forward-facing car safety seats also are at risk from air bag injuries. All children up to age 13
years are safest in the back seat. If you must put a child in the front seat, slide the vehicle seat back as far as it will
go. Make sure your child is properly restrained for his age and size and stays in the proper position at all times. This
will help prevent the air bag from striking your child.
Air bag on/off switches can be used in the few cases in which an infant must ride in the front seat. Most families don’t
need to use the air bag on/off switch. Air bags that are turned off cannot protect other passengers riding in the front
seat. Air bag on/off switches should only be used if all of the following are true:
On/off switches also must be used if you have a vehicle with no back seat or a back seat that is not made for
passengers.
Ca r S e a t Use A ft e r a Cr a sh
If the car safety seat was in a moderate or severe crash, it needs to be replaced. If the crash was minor, the seat does
not automatically need to be replaced. The NHTSA considers a crash minor if all of the following are true:
If you are unsure, call the manufacturer of the seat.
Section 3 ~ Caring For Your Baby
Use d Ca r S e a t s
Avoid used car safety seats, especially if bought from a yard sale or a thrift shop because you won’t know the seat’s
history.
Never use a car seat that:
Is too old. Look on the label for the date it was made. Many manufacturers recommend that car safety seats
only be used for a certain number of years. Check with the manufacturer to find out how long the company
recommends using their seat.
Has any visible cracks in the frame of the seat.
Does not have a label with the date of manufacture and model number. Without these, you cannot check
to see if the seat has been recalled.
Does not come with instructions. You need them to know how to use the seat. You can get a copy of the
instruction manual by contacting the manufacturer or looking on the Internet.
Is missing parts. Used car safety seats often come without important parts. Check with the manufacturer to
make sure you can get the right parts.
Is a shield booster. Although shield boosters are still around, the AAP recommends against their use. Major
injuries have occurred to children in shield boosters. The only time shield boosters should be used is if the
shield is removed and the seat is used with a lap and shoulder belt as described previously.
Was recalled. You can find out by calling the manufacturer or by contacting the following:
Auto Safety Hotline: Toll-free: 888/DASH-2-DOT (888/327-4236), from 8:00 am to 10:00 pm ET, Monday
through Friday
National Highway Traffic Safety Administration (NHTSA):
www-odi.nhtsa.dot.gov/cars/problems/recalls/childseat.cfm
If the seat has been recalled, be sure to follow the instructions to fix it or to get the parts you need. You also may get
a registration card for future recall notices from the hotline.
A lwa y s r e a d a n d fo llo w m a n u fa ct u r e r ’s i n st r u ct i o n s
If you do not have the manufacturer’s instructions for your car safety seat, write or call the company’s customer
service department. A representative will ask you for the model number, name of seat, and date of manufacture. The
manufacturer’s address and phone number are on the label on the seat.
Section 3 ~ Caring For Your Baby
Ch ild p r o o fin g Yo u r Ho me
Each year more children die from accidents in the home than from all childhood diseases combined. Most accidents
in the home are really not the fault of small children, who are merely following their natural curiosity, but of an
environment that is arranged with only adults in mind. Your home contains dozens of danger zones, but you can
“childproof” your home to make it a safe environment for your baby.
Baby Furniture Safety
Cribs
choke.
metal edges or splinters.
paint).
mattress and the sides, get a better fitting mattress.
the rail down.
stuffed toys, and other soft products from the crib. This includes bumper pads.
objects can serve as steps for climbing out of the crib.
the baby can get his head caught under the side.
inch above the crib’s sides. These could trap a child or clothing and lead to strangulation.
to them.
of a recall.
Section 3 ~ Caring For Your Baby
Playpens
caught.
could cause choking or suffocation.
or lowering its sides.
safety hazard.
High Chairs
Changing Tables
Strollers
upholstery. Check to see that the brakes are working properly and make sure the wheels
are fastened securely.
Section 3 ~ Caring For Your Baby
Walkers
Baby walkers are dangerous, even with supervision. Baby’s can roll down the stairs, get burned on stoves, drown
and be poisoned in walkers. Baby’s move too fast in walkers and parents simply cannot move quick enough to keep
them safe. Baby walkers do not help your child to learn to walk, but instead can delay normal muscle control and
development. Do not use a baby walker. Instead, use a stationery “exer-saucer” as a safe alternative.
Toy Safety
older sibling’s toys out of an infant’s reach).
could easily endanger a child. They should be
removed when your baby is 5 months old or when
he can push up on hands and knees.
or parts that could entrap little fingers.
caught in a baby’s throat and he won’t be able to
breathe.
squeaker can be removed.
pacifiers, to crib, stroller, or playpen with elastic,
string, or ribbon. They may entangle the baby.
points or edges that can’t be repaired, throw them
away.
hold the lid up in any position.
Section 3 ~ Caring For Your Baby
Pacifier Safety
durability to withstand reasonable force, even after repeated boiling.
It should not break down into easily swallowed pieces.
from inserting the nipple too far into their mouths.
the pacifier from wrapping around the neck.
cannot be forced into the mouth of the baby if the baby should fall or roll on his face.
danger of choking.
cracked (the normal lifespan for a pacifier is about 2-3 months).
may wish to limit the use to encourage verbal development.
Kitchen Safety
pull open drawers.
from opening.
from the wall when not in use. Do not let cords hang over the edges of the counters.
the back burners whenever possible.
Section 3 ~ Caring For Your Baby
Bathroom Safety
happen to get to the faucets, he will not get hot water immediately.
electrical appliance.
heater is greater than 120-130 degrees.
Entire House
Scatter rugs and waxed floors are extremely dangerous.
toddler.
Section 3 ~ Caring For Your Baby
Chemicals/ Medications
them.
putting them in the trash can.
get instructions for its use.
Plant Safety
in which it is potted, or water from a vase.
Fire Safety/Burns
meets the U.S. Product Safety Commission Flammability Standard.
Pet Safety
baby goes home, your pet will start to get used to the baby’s smell.
acquainted with each other later on.
Section 3 ~ Caring For Your Baby
Ba b y sit t e r s
Some pointers for you and your babysitter:
caring for infants and with whom you feel comfortable
leaving your child.
acquainted with your child.
where the telephone, light switches, and diapers are
and how doors lock, etc.
(first aid supplies, fire extinguisher, flashlight, portable radio).
and leave written instructions, as well. (Prepare bottles in advance).
your check-in calls.
emergency.
take advantage of these resources.
Section 3 ~ Caring For Your Baby
P a r e n t in g
Love
What your baby needs most from you is LOVE. Babies
that receive a lot of love are healthier, happier babies.
Very soon your baby will show his love for you by turning
toward your familiar voice, following you with his eyes,
and kicking excitedly when he sees you.
also touching, holding, and talking to your baby. Physical
contact is one of the best ways to communicate love to
your baby.
Importance of Touch
Touching is very important to babies. Research shows that it is vital to the baby’s healthy growth and development.
Through touch, there is emotional communication between the parent and child. When you play with him or tenderly
hold him, he gets a much-needed feeling of well-being, comfort, and security. Each day you care for your baby, you
have many opportunities to show him the touch of love. Gently hug and rock him while he eats. Take a few extra
minutes to softly stroke his back or tummy before laying him down on his back for a nap or bedtime. Try some special
loving touches, like a baby massage. Gently rub or stroke his arms, legs, back, and tummy. Your hands are very
soothing. The extra time these massages take helps to make your baby feel comfortable and loved.
Conversations with your Baby
Talking to your baby is also very important. Your baby cannot actually understand your words, but he is sensitive to
the tones and rhythms of your voice and the expression on your face. Often when you talk to your baby, he will make
gestures with his arms and legs in response. He may even open and close his mouth. You can help your baby’s growth
and development by talking to him frequently each day. Although he can’t talk back, he’ll enjoy every word you say.
Reading and singing to your baby also stimulates brain growth and development.
Prevention of Child Abuse
There will be times when you will feel overwhelmed with your parenting responsibilities. No matter what you do, you
cannot calm your baby. Lack of sleep may get the best of you. You will need a lot of patience as a parent.
When you get angry as a parent, it doesn’t mean that you are a bad parent or that you have a bad child. Babies don’t
cry to get even or just to be bad. They are too little to know how to do that and too little to be able to tell you what’s
wrong.
Some parents direct their anger toward their children. Angry words and actions can be very hurtful to your child. When
pressures build up, don’t take it out on your child. Try any or all of these alternatives:
Section 3 ~ Caring For Your Baby
Talk to someone you trust - good friend, religious leader, doctor.
Children need lots of loving, hugging, and cuddling. They need this tender-loving care to grow healthy and strong. Make
sure your child feels SAFE, LOVED, and WORTHWHILE.
(“You have big ears.”).
If you are having a hard time giving this care to your child, please reach out for help. Parenting classes and
information are available at the Family Resource Center. (715-845-6747).
Shaken Baby Syndrome
Babies or small children who suffer injury or death from severe shaking or jerking are victims of what is called “shaken
baby syndrome.” Sometimes a young child’s crying or need for attention can be more than tired parents or caregivers
can handle. In frustration, without knowing the dangers, they may shake a small baby or child to get his attention or to
make him stop crying.
Children under 2 can easily be injured from shaking, because their weak neck muscles are not yet strong enough to
fully control their head movements. When a child is shaken, the head whips back and forth slamming the fragile brain
tissue against the hard skull causing bruising, bleeding, and swelling inside the brain. When the shaking is combined
with throwing the child against a crib mattress or pillow, even more force is applied to the brain and more damage
can occur. Half of the children who have shaken baby syndrome die from their injures. Other results vary depending on
the age of the child and the severity of the shaking. They include learning disabilities, delays in development, speech
problems, impaired use of arms and legs, brain damage and seizures, hearing loss, partial or total blindness, spinal
injury, paralysis, and mental retardation.
Section 3 ~ Caring For Your Baby
If you or someone else shakes your baby, the most important step is to get medical care right away. Immediately take
your child to the pediatrician or the emergency room. Don’t let embarrassment, guilt or fear get in the way of your
child’s health or life. If your baby’s brain is damaged or bleeding inside from severe shaking, it will only get worse
without treatment. Getting medical care right away may save your child’s life and prevent serious health problems
from developing.
Shaken baby syndrome can be prevented. Follow these important steps and remember:
NE V E R S HA KE A BA BY! BA BIE S CA N DIE FR OM BE ING S HA KEN!
Even a brief moment of vigorous shaking can cause serious and permanent damage.
relatives, babysitters, child care providers, brothers and sisters, and especially anyone who has little or no
experience caring for babies or young children.
infant to do the same.
jog with a young infant on your back.
Remember: It is normal to feel upset and angry. Taking care of a baby can be tiring and sometimes frustrating. But
there are ways to comfort him and yourself, and there are people nearby to help.
TA KE A BRE A K - DON ’T S HA K E !
1-800-4-a child (National Abuse Hotline)
Free 24 hour help
Section 3 ~ Caring For Your Baby
Gr o wt h a n d De v e lo p me n t
The first 12 months after birth are a time of remarkable physical growth and behavioral change. In one short year
your baby’s birth weight triples and develops from a person who is asleep most of the time into one who spends
most hours awake. Most significant of all, your baby is developing a mind and personality all his own during these
12 months. A baby’s personality and temperament have an effect on when and how he passes through stages
of development. No two babies develop at the same rate, but the milestone developments tend to occur at fairly
them as rigid timetables. Remember, each child develops at a different pace. Allow your child to set the pace.
1 Month
2 Months
3 Months
objects between fingers and palms.
4 Months
Section 3 ~ Caring For Your Baby
6 Months
9 Months
fingers.
10-12 Months
thumb and first two fingers.
Section 3 ~ Caring For Your Baby
He a lt h y De v e lo p me n t
As a parent, you provide key ingredients for your infant’s healthy development:
Although each child develops at their own pace, if you are concerned about your child being delayed in development,
contact your baby’s doctor. Under state law, children from birth to age 3 are entitled to early intervention services if
there are significant developmental delays.
Talking to Your Baby
One of the most important things you can do to stimulate your child’s
development is to talk to your baby from the very beginning. Your voice
him at ease when he is uncomfortable. Your baby can distinguish your
voice from all others within days of his birth. Even though he does not
understand what you are saying, the mere sound of words is a powerful
force that will shape his learning. Your voice sings and soothes, plays
and entertains, and tells your baby he is loved. Your voice is security and
reassurance.
Reading to Your Baby
Reading to your baby is a great way to use your voice as a learning tool.
Even the tiniest of babies enjoys being read to. Research has shown that
children who were regularly read to as babies do better once they enter
school. The library has specially designed “board books” for babies. They
are bright in color, small in size, and sturdy in construction. These picture
books will delight you as well as your child. Enjoy the wonderful pictures
and stories as you share time together.
By six to nine months of age, your baby’s eyesight is developed enough
and he may try making sounds. This may be a good time to try a simple board book with bright pictures. Again, it is
the sound of your voice, along with the pictures that will make your baby react with giggles and grabs. He will enjoy
the finger games. Peek-a-boo will be a favorite game you can play together. Talk to him as you feed him, change him
and dress him. He will be your best listener. And keep reading to him. You can give your baby a love of reading and
learning. Start now. Read to your baby every day.
Creating an Interesting Environment
It is also important to make your child’s environment interesting to all his senses. Give him a variety of things to touch
and handle, things that visually hold his attention, and things that produce pleasant sounds and noises. Sing lullabies,
nursery rhymes, and poems to your baby. He’ll react by turning his head towards the sound of your voice, many times
stopping his crying to listen to you. He will not understand your words, but he will hear you and respond to the words
and rhythms of poetry and songs that you say or sing to him. He’ll listen intently, gurgle, coo, laugh and even seem to
imitate sounds. Playing games with rattles, balls, and toys are helpful also, but in the beginning, the best “toys” are
mom and dad. Give him lots of playful and affectionate attention.
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