Adjusting to your Baby

• Needs several weeks to adjust to the outside world
• May have no schedule or may be unpredictable for a few weeks
• Will go through many changes
  • active at birth, quiet for a few days, then more active again
• Normal things your baby might do
  • cry a lot, be restless
  • breathe in an irregular pattern
  • sneeze, choke, spit up, vomit sometimes
  • be startled often

You will

• Be busy caring for your baby
• Enjoy and learn about your new baby
• Develop a relationship with and adjust to a new family member
• Need to recover from the labor and delivery
• Be tired--rest whenever possible
• Want to use help that is offered by family and friends

Understanding your Baby

• Get to know your baby: babies are like snowflakes, no two are alike.
• Learn about your baby's personality: this can help you meet your baby's special needs.
• Your baby may be quiet, adjust easily, and let you know his needs.
• Or, your baby may not be easy: unpredictable, irregular in feeding and sleeping, and difficult to comfort.

Feeding your Baby

• Always wash your hands before preparing your baby's formula and bottles.
• Wash the bottles, caps, and nipples in clean water and dishwashing soap. Use a bottle brush or dishwasher.
• Mix the formula according to the package directions.
• If you use water from a well, have it tested to make sure the water is safe.
• In Iowa, call the University of Iowa Hygienic Laboratory at (319) 335-4500 to have your water tested for bacteria and nitrates.
• Fluoride supplements may be needed. Discuss this at your next visit.
• Hold your baby close in your arms with his head a little higher than the rest of the body.
• Feed your baby when he is hungry
  • usually 3-4 hours apart during the day
  • 3-5 hours apart during the night
  • for a total of about 6-8 times in a 24-hour period
• Can feed on demand when he is gaining weight well.
• If your baby does not take all the formula, do not force him to drink it.
• Formula can be refrigerated and used again one time. Do not put fresh formula in the used bottle.
• Offer your baby about 3 ounces of formula at each feeding.
• When your baby empties the bottle 2 or 3 times a day add another ounce to make 4-ounce bottles

Breast feeding

• Find a comfortable place for you and your baby.
• Hold your baby comfortably across your lap with the baby's entire body turned to face your body.
• Touch your baby's cheek or lower lip with your nipple to allow your baby to open his mouth, then move him quickly to your breast.
• Allow your baby to grasp the darkly colored part of your breast in his mouth.
• When you are ready to stop nursing, break the suction by placing your finger in the corner of your baby's mouth.
• Feed at both breasts for 10-20 minutes per side every 2-3 hours.
• It is normal for your baby to nurse 8-12 times every 24 hours.

Mother's concerns

• Your breasts only need to be cleaned with plain water.
• Milk may leak from your breasts between feedings.
• Place a small, clean pad in your bra and change as needed to keep nipples dry.
• If your breasts become swollen and painful
  • let your baby nurse more often
  • try a warm towel or shower
  • try to hand express some milk
• Early signs of breast infection
  • tender red area
  • feeling like you have the flu
• If you have these symptoms, call your doctor or clinic right away

Burping

• Burping helps remove air that is swallowed during feeding from your baby's stomach.
• Burp your baby half way through the bottle and again when your baby is finished eating.
• Place him over your shoulder or lay him across your lap on his tummy or sit him up on your lap. Pat gently or rub his back.
• Most babies spit up some or even a lot of formula after a feeding. This is not a problem, just messy.

Caring for your Baby

• Bathe your baby every 2 to 3 days
  • if your baby has dry skin, bathe him less often
  • if he has oily skin bathe him more often
• Your baby's skin makes its own natural oil, so baby lotions, powders, or oils are not needed.
• Do not use talcum powder due to the chance of choking.
• Use only water on your baby's face.
• Clean eyes by wiping from the inner comer out, using separate corners of the washcloth.
• Clean ears with a washcloth. Do not use Q-tips.
• Shampoo your baby's hair with each bath.
• Use a soft bristle baby brush, tooth brush, or comb to comb your baby's hair with every bath if your baby has cradle cap (a flaky coating that can develop on the scalp)

Cord care

• Clean your baby's cord thoroughly to prevent infection. The cord does not have any feeling so be sure to lift UP the cord and clean all around it
• Wipe the cord (especially at the base) with an alcohol soaked Q-tip or cotton ball with every diaper change.
• Fold the diaper below the cord and secure it on either side to keep the cord clean and dry.
• No tub baths until after your baby's cord falls off.
• Give a sponge bath until this happens.

Diapering

• Your baby should have 6 to 8 wet diapers a day.
• Your baby may have from 1 bowel movement a day to 1 with each feeding.
• Bowel movements will be lighter than the first few days, yellow-green, less sticky, and soft to runny.
• As long as the stool is not watery, you don't need to worry.
• Change diapers often and soon after a bowel movement to prevent diaper rash.
• If a rash occurs, clean bottom well with mild soap and water--leave open to air.
• Zinc oxide or similar products may be applied to diaper area if it becomes red.
• Clean your baby's bottom with every diaper change.

Girls

• Wipe front to back.
• A white vaginal discharge may be normal for the first few weeks.

Circumcised Boys

• Apply Vaseline gauze to the tip of the penis for about 5 to 7 days or until the site is healed to prevent the diaper from sticking to the penis.
• Gently clean the penis daily with water.
• Use mild soap if stool is present.
• A yellow white discharge may form (this is normal) and should not be wiped off.

Uncircumcised Boys

• Wash and rinse daily.
• Do not retract the foreskin.

Clothing

• Dress your baby according to what you would wear (if it is cool and you have on a sweater, make sure your baby is warm enough with a blanket or sweater).
• Overdressing or overwrapping your baby in blankets can cause overheating and fussiness.
• Feel the back of your baby's neck to see if he is too hot or too cold because your baby's hands and feet are usually cold.

Safety

Your baby may be able to move or scoot already

• Avoid falls - never leave your baby alone on any elevated surface such as a changing table or sofa
• If you must step away - put your baby in the crib or carry him with you

  Prevent fires and burns

• Install smoke detectors, fire extinguisher, and rope ladder in your home
• Have a plan to evacuate the house and a meeting place outside the house in case of a fire
• Protect your baby's skin and eyes from the sun by using a bonnet
• Do not allow cigarette smoke near your baby - second hand smoke can increase your baby's chances of having lung or ear infections

  Prevent choking and suffocation

• Do not have pillows, large floppy toys, or plastic sheets in the crib
• All parents should learn CPR so that you know what to do if your baby starts choking or stops breathing
• Contact your local Red Cross or fire department (at their routine business number) for CPR lessons near you
• Call 356-2888 for information about weekly CPR classes given by the Pediatric Nursing Department

  Car safety

• It is the law in Iowa that all children under the age of 3 must be in a car seat when in a car
• Have a car seat that is easy to use and use it every time your baby is in the car.
• Make a family rule: everyone buckles up before the car moves.
• Use a semi-reclining car safety seat and have it face the seat until your baby weighs 20 pounds.
• Make sure the car seat is anchored in the back seat of the car.
• Do not place rear facing car seats in the front seats of cars with passenger-side air bags.
• Fasten the shoulder straps and seat belt snugly around your baby.
• Pad the sides of the safety seat with rolled towels to prevent small babies from slouching.
• Never feed or let a fussy baby out of a safety seat while the car is moving.
• If your baby needs a break, or to be fed, stop the car and feed or calm him.
• Keep soft toys, rattles, or pacifiers on hand in case your baby gets fussy.
• Never leave your baby alone in a car.
• Protect your baby from a hot safety seat by covering it with a cotton blanket or towel in warm weather.
• Protect your baby's skin and eyes from the sun by using car window shades.

Development

Your baby's five senses are improving every day. He has a large heavy head and weak neck muscles.

• Hold his head up for a few minutes when he is on his tummy
• Drop head forward if he sits
• See best 7 to 9 inches away
• Enjoy looking at faces and bright contrasting colors
• Follow movement of an object for a short distance
• Hear and be startled by loud noises
• Enjoy the sound of your voice and is comforted when you talk to him
• Feel, taste, and smell
• Know the odor of his mother

What you can do

• All babies need warmth and love to help them grow. You cannot spoil your baby by holding him too much.
• Support your baby's head with the palm of your hand when you hold him.
• Hold him close so he can see your face.
• Pick him up, cuddle and love him.
• Show him things with bright contrasting colors.
• Talk and sing to him.
• Use a front carrier or baby swing.

Sleep

Sleep patterns vary greatly among babies. During the first month you can expect your baby to:

• Sleep a total time of 15 to 18 hours a day
• Be alert and content for about 30 minutes in a 4-hour period
• Not know the difference between day and night
• Slowly develop a daily pattem of waking and sleeping
• Eventually sleep
  • 1 to 3 hours at a time during the day
  • 3 to 6 hours at a time during the night

What you can do

• Have your baby sleep on a firm mattress. Avoid bean bags or water beds.
• Place your baby on his back or side for sleep.
• Don't place him on his stomach or prop on side with pillows behind his back.
• If you are frequently awakened at night, try to take a nap during the day when your baby is sleeping.
• Make a clear difference between daytime and nighttime. Promote sleep at night.
  • Keep nighttime interactions brief, calm, and quiet as possible.
  • Play with your baby and be more active to stimulate him during the day.
• If your baby is sleeping more during the day, wake him earlier and stimulate by undressing him or washing him with a cool cloth.

Levels (States) of Alertness

Sleep and waking patterns are different in babies than in adults. Knowing about the sleep states may guide you in your interaction with your baby.

• Deep sleep
  • eyes closed, little body movement, and slow regular breathing
  • difficult to awaken, won't be easily disturbed by the noises of normal household activities
• Light sleep
  • dreaming, eyes closed and moving under eyelids (rapid eye movement)
  • may have gentle body movement and irregular breathing
  • spends about half of sleeping time in this state
  • if awakened, can usually fall back to sleep, but you can also awaken him out of this state
• Quiet alert
  • eyes open, bright and focused on moving objects
  • body and face relaxed and still, breathing irregular
  • is in touch with his environment and can learn on his own
  • a good time for feeding, talking, singing, or playing with your baby
• Active alert
  • eyes open looking around, active body movement, and irregular breathing
  • a time to learn about interaction
  • if getting too much interaction your baby will "turn you off" by turning his head, looking away, or crying

Crying

• Crying is one way your baby communicates with you.
• In the early weeks, some babies may cry a total of 2 to 3 hours per day.
• Crying may increase during the first 6 to 8 weeks.
• Some babies may cry 10 to 15 minutes before they fall asleep.
• Babies develop different cries for different things.
• Respond quickly to your baby's cry so he learns to know you are there.
• At this early age, it is impossible to spoil a baby by responding to the crying.
• You will begin to tell which cry means hunger or the need for a diaper change, but there may not be a clear reason for all crying.
• As your baby gets older, you do not need to feed him every time he cries
  • try a pacifier
  • talk or sing to him
  • walk around with your baby and gently bounce him
• You will learn by experience when to pick up and comfort your baby and when to feel confident that crying will stop in a few minutes if left alone
• Never shake your baby. This can cause head and neck injury
• If you have fed him and changed his diaper, or picked him up, and no matter what you try, the crying continues, it is all right to put him in the crib to cry for awhile.
• Check on him every few minutes until he calms down.

References

Committee on Psychosocial Aspects of Child and Family Health, 1985-1988
American Academy of Pediatrics. 0 988). Guidelines for health supervision (2nd ad.) (pp. 19-24; 132-133). Elk Grove Village, IL: Author.

Dworkin, P. 0 982). Pediatric croup practice manual of anticipatory guidance (pp. 1-8) (Available from West Virginia University School of Medicine).

Huggins, K. (1990). The nursing mother's companion. Boston: Havard Common.

Ross Laboratories. 0 994). The first year.

Satter, E. (1986). Child of mine. Palo Alto, CA: Bull Publishing Co.

Schulman, J., Henley. K. (1987). Anticipatory guidance: An idea whose time has come (pp. 85-116). Baltimore, MD: Williams & Wilkins.

UIHC Department of Nursing. (1991). Normal Newborn Instructions. Available from UIHC of Nursing, Iowa City, IA).