Whether you are a new mama, future mama, or baby caretaker, this is an up-to-date baby basics blog to help guide you with the best newborn practices! These are a few basic hospital practices mixed with professional practice TIPS to help you in your newborn journey.
3 GOALS To Prepare Before Discharge Home:
Research and choose a Pediatrician! Depending on your birth hospital/setting, they may have a list of Pediatricians in network.
Create an emergency contacts list including a Pediatrician, Police/Fire Departments, you and your partners’ (if applicable) work/cell phone numbers, and the poison control center.
Talk to your discharge planner (MD, Nurse or Midwife) for follow-up appointments.
HOT TIP: It is never too early to start getting organized! You will most likely be exhausted and overwhelmed. Start creating a list and calendar to help stay on top of important things such as feeding and medication schedules, well-baby checks, immunizations, etc. You can create a note on your phone with important phone numbers, dates, doctors etc.
SAFETY
While you can’t anticipate every situation that could arise regarding your infants’ safety, there are some tips you should know and share with others who will be care taking for your baby.
A FEW SAFETY BASICS
♡ Properly support your baby’s head and neck
Instead: Place the bottle or sealed container of milk into a bowl of warm water or hold it under warm, but not hot, running water for a few minutes. Test the milk's temperature before feeding it to your baby by putting a few drops on your wrist.
♡ Explain your baby’s needs to older siblings
♡ Lock away all medicine cabinets and household cleaners
♡ Practice crib safety by not using drop-down cribs or putting stuffed animals or pillows in the crib
♡ Practice toy safety (balloons are the leading cause of toy-related deaths)
♡ Maintain a smoke-free environment for baby and install smoke detectors
BABY ESSENTIALS FOR FIRST 3 MONTHS
Car seat
Onesies, or other soft outfits
Baby sleepers or sleep sacks
Baby socks
Newborn hats, depending on climate
Disposable diapers or cloth diapers (and detergent for washing)
Disposable wipes or 12 cloth wipes
Diaper rash cream
Waterproof pad for diaper changes
Diaper pail or receptacle
Baby washcloths
Hooded towels
Baby sponge
Baby bath wash
Baby lotion
Baby bath tub
Baby nail clippers
Digital thermometer
Medicine dropper
Bulb syringe/nasal aspirator
Crib, cradle, or bassinet
Fitted sheets and mattress cover for crib, cradle, or bassinet
Burp cloths
Bottles, if you're bottle-feeding and bottle brush
A variety of bottle nipples, in different sizes
Breastfeeding pillow, nursing pads, and nipple cream
Breast pump
SAFE SLEEP "DO'S AND DON'TS"
Setting up a safe sleep area for your baby can be done before baby is home. It is recommended that the baby’s sleep area is in the same room, next to where parents sleep for observation. The sleep surface should be firm and flat, such as a mattress in a safety-approved crib, covered by a fitted sheet. For the safest environment, babies should never sleep in an adult bed, on a couch, or in a chair alone, with you or anyone else.
When putting your baby to bed, remember to keep soft objects, toys, and loose bedding out of the sleep area and that nothing is covering the baby’s head. Do not use a loose blanket, (to avoid occluding baby's airway and be sure not to over-bundle. A wearable blanket (sleep sack) is great for sleepwear and swaddling is recommended for safe sleep.
ALWAYS PLACE BABY ON THEIR BACK TO SLEEP FOR NAPS AND NIGHT
SAFE SLEEPS DO'S TO REDUCE SIDS RISK
♡ Always place baby on their BACK to sleep.
♡ Use a firm and flat sleep surface.
♡ Share your room with baby but on a separate surface designed for infants, ideally for baby’s first year but at least for the first 6 months.
♡ Breastfeed your baby if possible for the many health benefits and to reduce the risk of SIDS.
♡ Give your baby a pacifier for naps and nighttime sleep.
♡ Give your baby plenty of tummy time when they are awake and someone is watching.
SAFE SLEEP DONT'S TO REDUCE SIDS RISK
♡ Do not smoke during pregnancy or allow smoking around your baby or in their environment.
♡ Do not put soft objects, toys, crib bumpers or loose bedding under baby, over baby, or anywhere in baby’s sleep area.
♡ Avoid products that go against safe sleep recommendations and exercise special caution on products that claim to prevent or reduce the risk for SIDS.
♡Do not use heart or breathing monitors in the home as a way to reduce the risk of SIDS.
♡ Do not let your baby get too hot during sleep.
HOW TO PERFORM CPR ON A BABY
It is always good to feel prepared in case of an emergency. Here is a great video to help you understand and practice CPR in case you may need it for your baby. This is also a skill to share with other caretakers of your baby (grandparents, family members, sitter etc.)
SWADDLING
Swaddling is a traditional practice of wrapping a baby up gently in a light, breathable blanket to help them feel calm and sleepy.
A swaddle helps your baby feel safe and secure as she adjusts to life outside the womb.
Swaddling helps prevent her from flailing her arms and legs, which can trigger her startle reflex and potentially cause her to wake up.
A swaddle keeps your baby cozy and warm until her internal thermostat kicks into gear.
The idea is that being swaddled will help your little one feel snug and secure, just like in your womb. It’s true that swaddling isn’t entirely risk-free. But the American Academy of Pediatrics (AAP) says that swaddling can encourage your newborn to snooze better — as long as it’s done correctly and practiced in accordance with other safe sleep guidelines.
To encourage healthy hip development, the bottom of the swaddle should be loose enough for your baby’s legs to stay bent up and out, like they naturally would in a newborn lying on her back without a swaddle. You'll also want to ensure the swaddle allows your baby to straighten and stretch her legs at will.
Wrapping your baby the right way will encourage your little one to sleep more soundly while giving you peace of mind (so you can get some sleep yourself!). Some important swaddling safety tips to keep in mind:
Swaddle snugly, but not too snugly. At the top of the swaddle, you should be able to fit two to three fingers between the blanket and your baby’s chest. The bottom of the swaddle should be loose enough so your baby’s legs stay bent and flared out.
Always put your baby to sleep on her back. It’s the safest position, whether you’re swaddling or not. Be sure to tuck the bottom of the blanket underneath your baby too.
Keep your baby normothermic. Swaddling could cause overheating, which can raise the risk of sudden infant death syndrome (SIDS). Keep the room at a comfortable temperature (between 68 and 72 degrees Fahrenheit year-round). And resist the urge to bundle your baby in extra layers — a pair of pajamas and the swaddle blanket are likely enough to keep her comfy. Sweating, damp hair, flushed cheeks, heat rash and rapid breathing are all possible signs that your baby might be too hot. As a general rule of thumb, dress your baby in one more layer than you would wear.
Swaddle for nighttime sleep and naps. Swaddling can help your baby sleep more soundly during the day and at night. If tucking her into a little burrito blanket for hours overnight makes you nervous, know that as long as you stick with safe swaddling and sleep guidelines, swaddling at bedtime isn’t any riskier than swaddling during naps. You’ll also have plenty of built-in opportunities to check on her, since she’s frequently waking to eat. But if checking her swaddle while she sleeps gives you extra peace of mind, feel free to peek more often.
Here's a step-by-step guide below for how to swaddle a newborn like a pro, the keys for sticking with safe swaddling techniques.
Day to Day
Feedings
Cues your baby is ready to feed:
Rooting (baby turns his/her head when the side of the cheek or face is stroked)
Baby demonstrates a good, strong suck on the pacifier
Baby is calm and stable during care time
Baby is awake or wakes up during care time
Baby demonstrates appropriate strength in their body (tone) alone or with swaddling and support, and can remain awake for several minutes at a time.
BREASTFEEDING (FIRST FEW WEEKS)
Nurse until baby self-detaches (some babies will need to be time-limited due to diagnosis and overexertion).
Nurse from one breast to ensure that your baby gets enough of the hind milk.
If your baby is still hungry, offer the second breast but be sure to burp the baby when they switch breasts.
The breast should feel softer following a feed.
You may need to pump after breastfeeding until at least your baby’s due date (NICU)
Breastfed babies will have at least 8-12 feeds in 24 hours (every 2-3 hours).
TIPS FOR TRANSITIONING FROM BOTTLE TO BREAST
The key to a successful transition is to give it time, patience and persistence! In fact, it takes some women several weeks to transition from bottle to breast. I can’t recommend a lactation consultant enough if you are transitioning from bottle feeding to exclusively breastfeeding. They are a great resource, as each situation is unique!
BOTTLE
Bottle-fed infants will feed every 3-4 hours (which is 6-8 feeds in 24 hours).
Like breastfed infants, bottle-fed infants should sleep well between feeds and have 6-8 wet diapers daily.
Burp your baby both during and after feeding (or every 1-2 ounces.) The air can cause gas and make the baby uncomfortable.
If doing a combination of bottle and breast, breastfeed first, offer a bottle after breastfeeding and pump for 10 minutes (triple feeding protocol).
If you are exclusively pumping, pump for 20 minutes both sides 8x in 24 hours.
HOT TIP: use your phone. Place a timer on every 3 hours to help keep you on track
TIPS FOR PROPER BREAST MILK STORAGE
Before expressing or handling breast milk:
Wash your hands well with soap and water. If soap and water are unavailable, use an alcohol-based hand sanitizer containing at least 60% alcohol.
Mothers can express breast milk by hand or with a manual or electric pump.
If using a pump, inspect the pump kit and tubing to ensure it is clean. Discard and replace moldy tubing immediately.
If using a shared pump, clean pump dials, power switch, and countertop with a disinfectant wipe. (NICU)
BREAST MILK STORAGE TIPS Clearly label the breast milk with the date it was expressed.
Do not store breast milk in the door of the refrigerator or freezer. This will help protect the breast milk from temperature changes from the door opening and closing.
If you don’t think you will use freshly expressed breast milk within 4 days, freeze it right away. This will help to protect the quality of the breast milk.
When freezing breast milk:
Store small amounts to avoid wasting milk that might not be finished. Store in 2 to 4 ounces or the amount offered at one feeding.
If you deliver breast milk to a child care provider, clearly label the container with the child’s name. Talk to your child care provider about any other requirements for labeling and storing breast milk.
Breast milk can be stored in an insulated cooler with frozen ice packs for up to 24 hours when you are traveling. At your destination, use the milk right away, store it in the refrigerator, or freeze it.
Safe Thawing of Breast Milk
Always thaw the oldest breast milk first. Remember first in, first out. Over time, the quality of breast milk can decrease.
There are several ways to thaw your breast milk:
In the refrigerator overnight.
Set in a container of warm or lukewarm water.
Under lukewarm running water.
Never thaw or heat breast milk in a microwave. Microwaving can destroy nutrients in breast milk and create hot spots, which can burn a baby’s mouth.
If you thaw breast milk in the refrigerator, use it within 24 hours. Start counting the 24 hours when the breast milk is completely thawed, not from the time when you took it out of the freezer.
Once breast milk is brought to room temperature or warmed, use it within 2 hours.
Never refreeze breast milk after it has thawed.
Swirl the breast milk to mix the fat, which may have separated.
If your baby did not finish the bottle, use the leftover milk within 2 hours after the baby is finished feeding. After 2 hours, leftover breast milk should be discarded.
TRANSITION TIPS FROM A LACTATION TEAM
Massage your breasts or hand express to start milk flow before putting the infant to breast.
Pay close attention to the position, especially supporting the baby’s head to your breast. Place your baby’s belly to your belly while holding them close for a great deep latch.
Ensure your baby has an effective latch by listening for swallowing.
Allow baby to self-detach. For example, if baby pulls away from breast after 10-15 minutes of sucking and appears to be content and satisfied.
Log the baby’s output during this transition and get frequent weight checks by either your pediatrician or lactation consultant.
After baby self-detaches, your baby may be given pumped breast milk if they show hunger cues.
Pump after breastfeeding as you may not completely empty. You may need to do this the first few weeks or until the baby’s due date.
As your baby matures and becomes more efficient, you will be able to increase the length of time at the breast and the number of feedings in 24 hours.
SHOP NEWBORN ESSENTIALS ON AMAZON
BURPING
While feeding, if your baby doesn’t burp after several minutes, continue feeding, and don’t worry. When the feeding is finished, attempt again and keep the baby upright for 10-15 minutes to prevent spit up. Make sure you don’t bounce baby after feeding. If the baby cries a lot before the feeding, it may be beneficial to burp the baby before the feed or early in the feeding.
DIAPERING
Let’s talk about diapering your baby, diaper rash and elimination patterns.
Start the habit early of checking your baby’s diaper with every feeding. When changing, clean genitals with a washcloth and warm water or fragrance-free baby wipes. For girls, remember to wipe baby from front to back (or TOP to BOTTOM) and for boys to start at the tip of the penis and then wipe the rectal area last. If the baby is uncircumcised, do not attempt to pull back from the foreskin of the penis. After cleaning, lift the scrotum and clean underneath.
Keep the skin clean and dry with frequent changes to avoid diaper rash. If a rash does occur, wash with mild soap only after a bowel movement while avoiding wipes with alcohol or fragrances. Expose the bottom to air. (Oxygen can help heal the skin).
WHAT ARE TYPICAL ELIMINATION PATTERNS WITH A NEWBORN?
Your baby should have 6-8 wet diapers daily, many stool with diapers but some once a day (or every few days). The color and consistency may vary from bright yellow (breast milk-fed infants) to light greenish-brown (formula-fed infants). Monitor the diaper for blood, pus, or diarrhea.
Call your pediatrician if your baby has fewer than 6 wet diapers a day or has two dry diapers in a row, has diarrhea, or is constipated for 48 hours.
BATHING TIPS
Once the umbilical cord or circumcision site heals, you can give your baby a tub bath.
Bathe baby 2-3 times a week.
Bath before a feed or at least one hour after bedtime.
Gather all of the supplies you will need before beginning the bath.
Never leave a baby alone in a bath, not even for a minute. Babies can drown quickly in a few inches of water.
Make sure the room is warm as babies get cold easily.
Fill the tub BEFORE you put the baby in it. Water should feel warm, not hot on the inside of your wrist.
Ensure your water heater is set no higher than 120F (if you can control the temperature).
Never put a Qtip in your baby’s ear.
For preemies, bath time can be stressful. Swaddle and wash one area gently at a time.
BATHING: WHAT YOU NEED
3-5 baby washcloths
1-2 towels (hooded if you have one)
1 baby sponge
1 bottle of baby bath wash
1 bottle of baby lotion
A baby bathtub
TEMPERATURE-TAKING AND SUCTIONING
I encourage you to ask your bedside RN how to take your baby’s temperature and how to use a bulb syringe! They are there to support YOU and answer any care questions you may have.
HOW DO I USE A THERMOMETER?
Take temperature when the skin feels warmer or cooler than normal, when your baby is not acting like their usual self and before calling your doctor. (They will want to know the baby's current temperature)
Place the tip in your baby’s armpit.
Hold the arm in the position for 5 minutes or as long as the thermometer instructions say.
For newborns, do not use the pacifier, forehead, or ear thermometers per AAP.
HOT TIP! Bring your thermometer into the hospital to practice with the nurse. Practice with it at the bedside to get a feel for the device and how to properly use it.
Normal temperature range for baby should be 97.6 - 99.6
TIP: Dress your baby according to how you feel!
Use a bulb syringe to suction your baby’s mouth and nose when necessary (stuffy nose, baby vomits, spit up, etc). Sneezing is normal for a baby, but coughing is not. If your baby vomits, remember to suction the mouth then the nose. To prevent gagging place the tip of the bulb into the side of cheek to suction. Clean the bulb syringe after using warm water and mild detergents.
BEDDING AND SLEEP NEEDS
Whatever bed you choose for your newborn (crib, cradle, bassinet, co-sleeper), it is recommended by the American Academy of Pediatrics that your baby sleeps in the same room with you for the first 6-12 months of life. In addition, bumpers, blankets, pillows, and soft toys are no longer recommended in baby beds. Think minimalistic.
BEDDING: WHAT YOU NEED
Crib, cradle, bassinet, co-sleeper, or other safe sleep space for baby. If the crib has been used before, make sure it has all of its pieces and meets current safety standards
Crib mattress, or a mattress that fits properly in the cradle or bassinet
Fitted sheets for crib, cradle, bassinet, or co-sleeper
Waterproof crib mattress cover, unless your crib mattress is already fully sealed, or a waterproof pad to lay under the crib sheet
Baby monitor
DEVELOPMENTAL CONSIDERATIONS
There are three common terms when it comes to developmental age (especially for Preemies!)
Gestational age is the fetus’ age (calculated as the first day of mom’s last period)
Chronological age is counted from the day of birth (baby’s birthday)
Corrected age is defined as the chronological age minus the number of weeks or months baby is born early.
TO POSITION YOUR INFANT FOR OPTIMAL DEVELOPMENT: KEEP THESE IN MIND
♡ Hold baby with legs bent and arms forward
♡ Avoid leaving baby flat on back for long periods
♡ Wrap baby snugly with legs bent and hands placed close to face
♡ When awake, lay baby on their side rather than on their back with a large blanket roll for body support (only when supervised!)
Your baby should start rolling anywhere between 2-6mos old corrected gestational age and sitting up without support between 5-7mos old (corrected age).
Make time for tummy time! Tummy time should be when the baby is awake only, and should last 10-20 minutes once or twice a day. Start slowly and work your way up if baby dislikes it at first! You can use a rolled towel or blanket under the shoulders and upper chest to provide support.
When should you schedule a time to talk to your doctor about your baby’s development?
If your baby does not use one of their arms, legs or one side of body, their legs feel stiff when not actively stretching, they don't roll over or bear weight on legs, or if they don’t sit while supported or reach for objects-make an appointment with your pediatrician.
WHEN TO SCHEDULE A DOCTOR'S VISIT
Vomits repeatedly or forcefully two feedings in a row.
Refuses to eat more than two feedings in a row.
Has less than 4 wet diapers-24 hours in spite of frequent feedings.
Goes 48 hours without a bowel movement.
Has diarrhea or more than 12 large stools/day or has blood in stool.
If abdomen is distended and does not go down.
If difficulty breathing or makes unusual sounds when breathing.
If baby is lethargic and doesn’t arouse with touching or handling.
Excessive swelling or drainage around eyes.
Blisters or pustules on body.
Thrush or patches of white in mouth.
Congested cough, running eyes or nose.
Drastic behavior changes include extreme irritability, excessive crying without a known cause, extreme sleepiness, or floppy arms and legs.
CALL MD: Temperature under 97.6 or over 99.6 and doesn’t change with adding or removing clothes or blankets.
EMERGENTLY CALL FOR HELP
CALL 911 if blue lips and tongue
If you are uncertain or feel urgent care is necessary
I hope these Baby Basics help you as you transition to caring for your baby at home! Share these tips with a caregiver who wants to see babies THRIVE through best practices :)
REFERENCES:
Centers for Disease Control and Prevention. (2021). Sudden unexpected infant death and sudden infant death syndrome: Data and statistics. Retrieved June 1, 2021, from https://www.cdc.gov/sids/data.htm.
Shapiro-Mendoza, C. K., Camperlengo, L., Ludvigsen, R., Cottengim, C., Anderson, R. N., Andrew, T., et al. (2014). Classification system for the Sudden Unexpected Infant Death Case Registry and its application. Pediatrics, 134(1), e210–e219. Retrieved May 3, 2021, from https://pubmed.ncbi.nlm.nih.gov/24913798/.
Tori Meskin BSN RNC-NIC. Nurse. Blogger. Podcaster. Tori has been a clinician since 2012, works in acute care/inpatient NICU & Pediatric settings in southern California. She is a blogger, podcaster, NICU & Pediatric Critical Care RN, and Sponsored Capella University MSN student. She has obtained her National NICU Nurse Certification (RNC-NIC) & has previously worked as a travel nurse, pursuing bedside experiences in several NICU settings. Follow her as she shares her NICU journey married life & juggles work, school, content creation, & brings you top notch Tips & Tricks along the way. Find her at www.tipsfromtori.com or info@tipsfromtori.com
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