About Baby

Call your baby’s healthcare provider if your baby:

• Has a temperature higher than 100.4 degrees F (38 degrees C)
• Has difficulty latching on when trying to breastfeed
• Goes longer than four hours between feedings
• Needs to be woken up often in order to feed
• Appears hungry even after feeding
• Shows signs of infection around the umbilical cord (crying when you touch the cord, the cord bleeds more than just a little, there is pus or drainage around the cord, the skin around cord looks red or irritated)
• Shows signs of infection around the circumcision (bright red bleeding from the circumcision site, he doesn’t urinate within 24 hours of the circumcision, there is unusual redness or swelling around the area, there is thick yellow or green discharge with a foul odor)
• Has watery foul-smelling stools or blood and mucus in the diaper (diarrhea)
• Has hard stools that look like pebbles (constipation)
• Has fewer than six wet diapers and three dirty diapers per day by day five
• Has dark-yellow urine
• Has a reddish stain in the diaper
• Has a dry mouth and lips
• Appears to have a lack of energy
• Cries constantly or with distress
• Vomits
• Chokes routinely during feedings
• Refuses to eat
• Is unusually sleepy or is hard to wake up
• Coughs frequently or has difficulty breathing
• Has yellow, pale, blue, or gray skin
• Is just not being himself

Sudden infant death syndrome (SIDS) is the sudden death of an infant under 1 year of age, which remains unexplained after a thorough investigation. The single most important thing you can do to prevent SIDS is to place your baby on her back to sleep. Babies sleep safer on their backs!

Additional ways to reduce the risk of SIDS:

• Keep soft objects, toys and loose bedding out of your baby’s sleep area
• Swaddle the baby loosely. It is important not to wrap the infant tightly at anytime, especially when sleeping.
• Place your baby on a firm mattress in a safety-approved crib.
• Do not place infants on water beds, sofas or other soft surfaces. Pillows, comforters or sheepskins should not be used under baby.
• Keep your baby’s head and face uncovered during sleep.
• Use sleep clothing with no other covering over the baby.
• Do not smoke before or after the birth of your baby
• Do not let others smoke around your baby

GRMC Recognized as a National Safe Sleep Hospital by Cribs for Kids

Guadalupe Regional Medical Center was recently recognized by the National Safe Sleep Hospital Certification Program as a Bronze Safe Sleep Hospital for our commitment to best practices and education on infant safe sleep.

The National Safe Sleep Hospital Certification Program was created by Cribs for Kids®, a national infant safe sleep organization. Headquartered in Pittsburgh, PA, Cribs for Kids is dedicated to preventing infant sleep-related deaths due to SUID and accidental suffocation. As a Nationally Certified Safe Sleep Hospital, GRMC is recognized for following the safe sleep guidelines recommended by the American Academy of Pediatrics (AAP) and providing training programs for healthcare team members, and family caregivers.

Some babies are born with long fingernails, and as a parent your first instinct is to cut or trim the nails to keep your baby from scratching her face. You should never cut or bite off your newborn’s nails. This can cause bleeding and possibly infection. The infant’s nails can be safely filed, using the smooth side of an emery board.

Newborn babies are often prone to a variety of harmless skin blemishes and rashes. A common condition is newborn acne, which mimics the teenage variety and likewise is caused by hormones. However, in this case, it is simply evidence of the mother’s hormones and will lessen in the first few weeks.

Your baby’s skin may be dry and peeling, particularly on the feet, hands and scalp. This is simply the shedding of dead skin and is best left alone since lotions tend to slow the elimination of these layers.

You may change your infant into clothes brought from home. If they become soiled, the nurse may change your infant back into a hospital T-shirt and place her outfit in their bassinet for you to take home to launder. In normal temperatures, there is no need to overdress your baby. Overdressing may cause the infant to become hot, thus leading
to fussiness. One way babies communicate that they are cold is by having blue hands and feet. Placing warm socks and a hat on your infant can help keep her warm.

Keep the cord area dry and exposed to air as much as possible. After bathing your baby, dry the cord area and expose it to air. Keep the diaper well below the cord area. The umbilical cord should fall off by the end of the second week. Evidence-based research shows alcohol no longer needs to be applied to the cord. It will dry and detach naturally. Notify your baby’s physician if you notice:

• Pus
• Foul odor
• Drainage or redness from the base of the cord
• The cord does not appear to be drying out within three weeks

Observe for skin irritation. If redness develops, leave diaper area exposed to air. Girls: Clean front to back. A white vaginal discharge is not uncommon. Slightly blood-tinged vaginal discharge may initially appear. This is in response to maternal hormones. Boys: Clean and dry under and around the scrotum.

Newborns should have at least two to six wet diapers a day for the first three to four days; then, expect six to eight wet diapers a day. Abnormal: Urine dark in color and fewer than five wet diapers a day by the fifth day.

Bowel movements can be as frequent as each feeding or as infrequent as once a day. Infant stools change color and have different textures over time.

• First stools are thick, black and sticky
• Stools then change to green and runny
• Finally, stools change to green or yellow-orange. Breastfed babies tend to have looser stools (seedy). Stools will decrease in number after about one month.

The following are descriptions of abnormal bowel movements. Please contact your baby’s healthcare provider if she experiences any of them:

• Significant increase or decrease in the number of stools
• Stools have a loose, watery consistency
• Stools are hard or “pellet-like”
• Stools contain blood or mucus
• Stools are extremely hard to pass

Keep the penis clean by gently washing with warm water and changing diapers often. Observe for pus or swelling. A light-yellow crusting on the tip of the penis is not uncommon.

At GRMC our physicians perform two different types of circumcision: Gomco and Plastibell.

Gomco

To keep the circumcision from sticking to the diaper, apply white petroleum jelly (Vaseline®) with gauze for the first 48 to 72 hours. After the first day, if you see persistent bleeding in the diaper that is larger than the size of a dime, call the infant’s primary care provider or return to the hospital.

Plastibell

Call the healthcare provider who did the circumcision if you see any of the following:

• Persistent bleeding that is larger than the size of a dime after the first day
• The ring is not off in eight days
• Your baby has not had at least one wet diaper in 12 to 24 hours after the circumcision

1. Hold your baby securely with one hand (a wet, wiggly baby can be hard to hold), and use the other hand to wash your baby.
2. Use a washcloth and clean water (no soap) to wipe your baby’s face, nose, ears and eyes. When cleaning her eyes, use one part of the washcloth for one eye, then change to another part of the washcloth for the other eye. In case your baby has an eye infection, this will help to prevent it from being spread to the unaffected eye.
3. Use a mild soap (pH 5.5 to 7.0) and washcloth or your hands to wash the baby’s body, arms and legs.
4. Rinse thoroughly.
5. Next wash the genital area gently and rinse with clean water.
6. We do not encourage the use of baby powder, oils or lotions.

We practice delayed bathing to help your infant regulate her glucose levels and temperature. Four to six hours after birth, newborns receive their initial bath.

Make bath activity safe by following these guidelines:

• Test the water temperature to make sure it is not too cold or hot
• Water temperature should be between 100 degrees and 104 degrees F
• Attend to your baby at all times. NEVER leave baby alone.
• Position your baby in the tub away from faucets so she will not
• accidentally turn the water on, possibly causing burns from hot water

Any baby can get jaundice. But severe jaundice that is not treated can cause brain damage. Your baby should be checked for jaundice in the hospital and again within 48 hours after leaving the hospital. All babies are screened with a simple skin test prior to going home. Ask your healthcare provider for more information.

Jaundice is caused when there is too much of a natural substance called bilirubin (pronounced “billy-roo-ben”) in the blood. Jaundice can make your baby’s skin and the whites of her eyes look yellow, but it is not easy to see jaundice in all babies. Jaundice affects babies of all races and ethnicities. The best way to tell if your baby has jaundice is with a bilirubin test.

All of us have some bilirubin in our blood. Before birth, a mom’s liver gets rid of bilirubin for the baby. After birth, the baby’s liver takes over. Sometimes it takes a few days for the baby’s liver to work well, and the baby may develop jaundice during this time.

All babies can get jaundice, but which babies are more likely to develop jaundice?

• Babies born preterm (before 37 weeks)
• Babies bruised during birth
• Babies with a brother or sister who had newborn jaundice
• Babies whose mothers are Rh negative and/or have type O blood
• Babies with Middle Eastern, East Asian or Mediterranean ethnicity

Be sure to talk to your healthcare provider if your baby has any of these risks factors, and ask about a jaundice bilirubin test.

Ask about a jaundice bilirubin test before you leave the hospital. The best way to measure bilirubin is by having a sample of your baby’s blood taken. Your healthcare provider will compare results from your baby’s jaundice bilirubin test to what is normal for a baby the same age (in hours). Some hospitals also use a special tool that can measure bilirubin when it is held to the baby’s skin. Bilirubin levels are usually the highest when your baby is 3 to 5 days old.

Some babies with jaundice might look yellow or even orange, but it is not possible to see jaundice in all babies, especially those with darker skin color. Talk to your healthcare provider immediately if your baby:

• Has fewer than four wet or dirty diapers in 24 hours
• Has trouble nursing or sucking from a bottle
• Is very sleepy and hard to wake, even to feed
• Cannot be comforted, has a shrill and high-pitched cry, or both
• Is limp or floppy

Kernicterus is a type of brain damage that can result when jaundice is not treated properly. A child with kernicterus can have cerebral palsy, hearing loss, problems with vision and teeth, and sometimes mental retardation. Kernicterus can be prevented if jaundice is properly treated.

Your baby might be put under special blue lights (photo therapy) to lower the bilirubin level. You should not put your baby in direct sunlight; this is not a safe treatment for jaundice and could cause sunburn. A baby with a very high bilirubin level might need a blood transfusion in the hospital.

Take jaundice seriously and stick to the follow-up plan for appointments and recommended care. Make sure your baby is getting enough to eat. The process of removing waste also removes bilirubin in your baby’s blood. If you are breastfeeding, you should nurse your baby at least eight to 12 times a day for the first few days. This will help you make enough milk for your baby and will help keep her bilirubin level down. If you are having trouble breastfeeding, ask your healthcare provider or board certified lactation consultant for help.

• Jaundice is noted in the first 48 hours of life
• A much deeper yellow color is noted from the day before
• Jaundice is noted down to the level of your baby’s thighs (jaundice progresses from the face downward)
• Your baby becomes sleepy, lethargic or unwilling to eat

The newborn infant usually sleeps from 15 to 17 hours per day during the first four to six weeks of life. By 1 year of age, the total sleep time has gradually diminished to approximately 12 to 16 hours. He may awaken every two to five hours for feedings, exercise or diaper changes, and then go back to sleep. Wakeful periods become progressively longer as the infant grows older. Schedules vary and change often with individual infants. Some infants sleep through the night (meaning a stretch of sleep that lasts about six hours) by the age of 12 to 18 weeks; however, they may normally continue to awaken for a feeding. Infants sleep through the night only after their nervous systems become mature enough

The newborn crying is a normal behavior in infants. It is a method of communication and can mean a number of things. They cry when they are wet, hungry, tired or uncomfortable. When your infant cries, first try to determine the cause of the crying. Using a mental checklist, determine if the baby is safe, comfortable, and clean:

• Is he hungry?
• Does he need a clean diaper?
• Does he need to change positions?
• Does he need to burp?
• Is he lonely?
• Does he have a fever?

• Gently rocking him
• Gently massaging his back or stomach
• Feeding him if it is time to eat
• Giving him a pacifier or teething ring
• Carrying him as you walk
• Talking or sing to him
• Playing soft music

If the crying persists, here are other suggestions for comforting your infant:

• Try burping the baby
• Use quiet, constant talking
• Change the way you are carrying your baby
• Gently touch, stroke or rub your baby’s back
• Help your infant "center himself" by gently drawing his arms inward toward the middle of his body
• Swaddle and cuddle
• Move in a rhythmic motion, such as holding and rocking, using a swing or stroller, or taking a drive in the car
• Allow your baby to release tension by sucking on a pacifier or teething ring
• Try to settle your baby for a nap
• Make sure your baby is not too hot or cold
• Sing to your baby or play music
• Take your baby outside for a few minutes
• Call someone else — sometimes a new face or voice can calm your baby
• If nothing else works, put your baby in a safe place and walk away. Check on him every five minutes or so.

An infant may vary in his response to your consoling efforts. One time he may quiet to your voice, while another time he may need to be held and rocked. Trying different comfort measures allows your baby to pick what feels best at that time.

If you are a parent of a new baby, there may be times when you will become frustrated and maybe even angry when your baby cries. You may have tried everything to comfort him, but nothing seems to help. Sleep is hard to come by, and you may find yourself at wit’s end.

Shaken baby syndrome is when a baby is "shaken" forcefully. The movement of the baby’s head back and forth can cause bleeding and increased pressure on the brain. A baby’s neck muscles are not strong enough to tolerate this "whiplash" motion, and the brain is too fragile to handle it. Shaken baby syndrome is one of the leading forms of child abuse. Many babies die. Many others have irreversible brain damage. Those who survive may be blind, have mental retardation, paralysis, seizure disorders, learning and speech disabilities, or neck and back damage.

Knowing what to do when your baby cries can keep you from being frustrated and help you become a more confident parent. When your baby cries, respond to him right away. There may be a simple reason why your baby is crying.

Shaken baby syndrome happens when a baby or young child (usually less than 1 year) is shaken. Shaking usually happens when a caregiver or parent becomes frustrated or angry and is not able to stop the baby from crying.

Babies have large, heavy heads. They have weak neck muscles, immature and fragile brains, and blood vessels that tear more easily than children’s or adults’. Shaking a baby, even for only a few seconds, can cause serious brain damage and death. When a baby is shaken, the head moves forward, backward and in a circular motion around the neck and chest, and this motion causes tearing of the delicate blood vessels in the head and eyes leading to bleeding. Brain bruising, bleeding and swelling cause increased pressure in the head. This can cause brain damage and heart and breathing problems. The baby may die if the swelling and bleeding are not stopped.

Babies or children who have been shaken can have minor or more serious signs such as:

• Poor feeding
• Weak movements or limp arms, legs and head
• Throwing up
• Weakness
• Can’t stop fussing or crying
• Hard to wake up
• Problems with breathing
• Coma
• Seizures
• Death

A digital thermometer uses a button battery and records temperature with a heat sensor. A digital thermometer measures quickly, usually in less than 30 seconds. The temperature is displayed on a small screen.

Obtaining an accurate measurement of your child’s temperature requires some practice. If you have questions about this procedure, ask a healthcare provider to demonstrate how it’s done and then observe you doing the same. Temperatures do not need to be routinely taken unless you suspect your baby has an illness. When you report a temperature reading to your baby’s healthcare provider, state the number and the method used. Do not add or subtract degrees. Instead, let the healthcare provider calculate the exact temperature.

• Place the tip of the thermometer in a dry armpit
• Close the armpit by holding the arm snugly against the baby’s body. The thermometer should remain in place for the time recommended by the manufacturer’s instructions (in the case of a digital thermometer, until it beeps)

Try to keep an even temperature in the baby’s room. On hot days, provide sufficient ventilation to prevent the room from feeling stuffy. On cold days, check your baby occasionally to see whether he is covered enough to be warm and comfortable and that there are no drafts. The house should be kept at a temperature that is also comfortable for other members of the family, usually 68 to 72 degrees F.

We recognize breastfeeding as the optimal method of feeding your newborn infant. We also realize there are reasons why some moms are unable to breastfeed. Talk to your healthcare provider about alternative methods for feeding your baby.

Your baby may swallow some air as she is being fed. Burping helps that air to escape from the stomach. Apply firm pressure to her tummy during burping to help air escape. If your baby stops sucking during a feeding, it may be because she needs to rest or be burped.

Three positions are recommended for burping:

• Hold your baby in a sitting position on your lap. Support her head with your hand under the chin and the heel of your palm against her chest. Support her back with your other hand and gently pat her back.
• Lay baby tummy-down on your lap with your knee putting pressure on her tummy. Support the head with one hand. Gently rub or pat her back with the other hand.
• Hold your baby upright with her tummy against your shoulder. Support her head and shoulders with one hand and gently pat the back with the other hand. Or, rub her back in an upward direction.

If your baby doesn’t burp, it may be because she doesn’t need to. Try to burp her for one to two minutes. If she hasn’t burped in that time, continue the feeding and try again when she is finished. Remember that it is not unusual for babies to spit up a small amount after feeding.

Going out/travel

It is perfectly safe to take your baby out of the house immediately after birth for walks outside, short trips or stroller rides as long as she is appropriately dressed. Keep in mind that in the first two months your baby is building her immune system so you may want to use caution when taking her to crowded public places or around ill family members.

State law requires that all babies be placed in an appropriate infant car seat. The American Academy of Pediatrics advises parents to keep their toddlers in rear-facing car seats until age 2, or until they reach their maximum height and weight for their seat. It is also advised that children will need to ride in a belt-positioning booster seat until they have reached 4 feet 9 inches tall and are between 8 and 12 years of age.

• The safest place for all children to ride is in the back seat.
• Set a good example: Always wear your seat belt. Help your child form a lifelong habit of buckling up.
• Remember that each car safety seat is different. Read and keep the instructions that come with or are included with your seat handy, and follow the manufacturer’s instructions at all times.

DO NOT leave your child unattended in a car safety seat. Children should never be left alone in a car whether they are in their car seats or not. The dangers of doing so include:

• Temperatures can reach deadly levels in minutes, and the child can die of heat stroke
• She can be strangled by power windows, sunroofs or accessories
• She can be taken during a car theft or kidnapped from the vehicle
• She can knock the vehicle into gear, setting it in motion

Put all poisons including medicines, household products and plants out of reach now. Keep the number to the American Association of Poison Control Centers help line in a place where you can quickly find it: (800) 222-1222. Information is also available at aapcc.org and poisonhelp.org.

• Poison on the skin. Remove contaminated clothes and flush the affected skin with water for 10 minutes. Gently wash with soap and water and rinse. Call your healthcare provider or the Poison Control Center.
• Inhaled poisons. Get your child in the fresh air, then call your healthcare provider or the Poison Control Center.
• Poison in the eye. Flood the eye with lukewarm water poured from a large glass positioned 2 to 3 inches from eye for 15 15 minutes. Encourage blinking as much as possible. Do not force eye open. Call your healthcare provider.
• Swallowed poison. Call your healthcare provider or the Poison Control Center.

• Never leave baby alone on top of changing table or counter
• Never leave baby alone in the bathtub. If the phone rings, take baby with you.
• Protect electrical outlets with installed covers
• Turn down thermostat on your water heater to 110 degrees F to prevent accidental burns
• Keep sides of the portable crib up and locked at all times
• Keep small objects off the floor; especially watch for toys belonging to other siblings

Call your baby’s healthcare provider to set up well-baby visits. Your baby should get her first checkup within the first two weeks after birth. At well-baby visits, your baby will be checked, weighed and measured and will get immunized. Immunizations, also called vaccines, are very important for keeping your baby well and are the safe way to protect your baby from many serious illnesses. For more information about well baby visits and immunization schedules, call your baby’s healthcare provider. Be sure to keep a record of when your baby gets each immunization, and keep this record in a safe place. You will need to show this record before your child can start school or enter day care.

The benefits of immunizations far outweigh the risks. When immunized, children are protected against very serious, even life-threatening, diseases. Most side effects are not serious. Some immunizations result in low-grade fever, rash or soreness at the injection site. In rare cases, a child may have a serious allergic reaction to an immunization. Signs of such a reaction include difficulty breathing, wheezing, hives, dizziness, fainting, an erratic heartbeat and weakness. This kind of reaction happens within a few minutes or a few hours after the shot. In very rare cases, an immunization can cause a high fever or seizure within a few days after the child has received the shot. Call your healthcare provider or go to the emergency room right away if your child has any of these symptoms.

View CDC Immunization Schedule by Age