BABY CARE - Patient Discharge TrainingTOBB ETU Hospital Created: 2016-02-15 13:32:23
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BABY CARE - Patient Discharge Training

Dear mothers and fathers; your baby was born, whom you have been yearning for. Congratulations.Your only target is to maintain level of care provided to your baby who had a perfect care during intra-uterine life.

BABY CARE - Patient Discharge Training

However, you have concerns about the way you should follow. We are completely aware of your concerns and we issued this brochure involving latest, most scientific and most practical details in order to provide you help on how you should care your baby.


BASIC PRINCIPLE OF BABY CARE IS WASHING HANDS.

When should you wash your hands?

You should wash your hands before and after breastfeeding, changing nappies, baby bath and other cares.

Eye Care

Eye lids can be swollen at early postnatal period; the swelling shall regress within several days. Eye color is gray —blue for the first several months. It may take 4-6 months to restore normal eye color. You may witness improper alignment of eyes particularly during breastfeeding or when your baby looks at an object in close proximity. This condition is not a real strabismus. If this condition is frequently observed, you may seek medical advice. There may be minor bleeding in the white portion (sclera) of eyes secondary to delivery. Such bleeding foci spontaneously regress within 10 days without requiring treatment. The baseline eye care of the baby is provided at the delivery room. You should avoid frequent touch and you should wash your hands frequently in order to prevent excess viscous crust formation around eyes. If crusts develop around eyes; dampen soft and ironed cloth with warm water, which was previously boiled, and you should provide eye care by gently wiping skin on and around eyes without rubbing starting with the white portion of the eye. The basic principle of the eye care is wiping skin on and around eyes at inside-outside direction and using clean part of cloth for each session. Eye care can be repeated twice or three times according to severity of the crust formation. If the crust formation persists despite eye care, you should seek medical advice and follow instructions of your physician.

Oral Care

If your baby is breastfed and there is no problem in the oral cavity, you do not need to provide your baby with oral care. Oral care is about eliminating formula residues for babies fed with formula and it is also a part of treatment in neonates with oral candidiasis (also known as "thrush"). When the baby is provided with oral care, you should wrap a clean cloth around your index finger and dampen the cloth with carbonated water (sodium bicarbonate), which can be supplied from pharmacies, and you should avoid re-dampening the part of cloth which had already touched intra-oral lesions.

Umbilical Care

When baby is born, the umbilical cord, the connection between mother and neonate, is clamped and cut. The umbilical cord is a bright and white structure which involves vascular structures. It is sufficient to keep umbilical stump dry and clean, if your doctor instructed no special care. Nappy should not cover the stump of the umbilical cord in order to avoid dampen and contaminate the umbilical stump. If the umbilical stump is contaminated despite all measures, you should wash the umbilical cord with soap and water and you should dry it. Usually, the umbilical stump breaks down within 7-14 days. It may occur before 7 days in some babies, while it may take longer in others. The point is the absence of inflammatory signs, such as erythema (redness on skin), swelling, discharge, bad odor or bleeding, on and around the stump site. You should seek medical advice if such symptoms and signs develop.

Changing the nappy

Changing the nappy changing and perineal care will be the most common care given to your baby. The nappy should be changed 10- 12 times per day within first several months.

We assume that stool and urine discharge occurs within 24 hours of the postnatal period. The stool is dark green/black and sticky for first 2-3 days; this stool is referred meconium. Meconium will convert into yellow and loose stool, which will include particles similar to fig seeds. This form of stool will persist as long as the baby is fed with mother's milk. When extra foods are started, characteristics of the stool will change, resulting with known characteristics of stool.

The nappy should be changed at 3- to 4-hour intervals and whenever the baby defecates.

Preferentially, the nappy should be changed before the baby is fed; necessary materials should be made ready before the nappy is changed.

Materials: disposable bed cover, cleaning cloth, cotton or alcohol-free wet wipe depending on the age of the baby and rash cream.

Powder or lotion should not be used after the nappy is changed. Rash cream can be used maximum 4 times a day. You should seek medical advice if rash had already developed.

For female babies, cleaning should be made at anterior-to-posterior direction. For male babies, all folds should be cleaned, ensuring that there is no urine or stool residue. You do not need to change nappy if the baby defecates while s/he is sleeping.

Vaginal discharge can be, sometimes, seen in female babies secondary to the maternal hormones; this is a normal condition. There may be very scarce orange spots on the nappy. These are caused by uric acid crystals and no treatment or care is required.

Clothes of the Baby

You should prefer wool, soft, easy-to-wear and comfortable clothes which do not restrict movements of the baby and does not well fit Seam lines should be as least as possible. You should cut labels, which may contact the skin of the baby, in order to protect the baby's skin.

For room temperature ranging from 22 to 24 °C, it will be adequate to make your baby wear two cotton clothes (one on the other).

You should avoid heavy, plumy and ornamented clothes, for which synthetic materials are used.

The cold hands and feet and even mildly purple color of hands and feet do not indicate that the patient is chilling. The baby should not be worn heavy clothes to eliminate these findings.

Clothes of the baby should be separately washed using products specifically manufactured for babies and you should iron all clothes. All clothes of the baby should be changed minimum once a day and season-dependent clothes should be preferred.

Baby Room

The baby room should be quiet, well exposed to sun and temperature and humidity of the room should be strictly controlled. The room should be ventilated once a day and it should be kept clean. The temperature should be 22-24 °C and the humidity range shall be between 30 % and 40 percent The baby should not be nearby heat sources such as stove, heater core and air conditioner. You should avoid access of sick people into the baby room in order to decrease infection risk.

You should prefer wall paper or liquid-based paint for the wall of the baby room. Pastel colors offer more quiet environment.

Bed linen should be made from 100% cotton cloth.

The depth of the baby bed should be adjustable to avoid risk of fall and the vertical distance between rails should be 2.5 cm —6 cm.

Bath of the baby

The temperature of the water and surrounding conditions should be appropriate for the dermatological health of the baby.

Bath Rules

I. You should never leave the baby alone!! You should ignore phone ring or doorbell in order to ensure safety of the baby.

2. Do not bath the baby if the temperature of the water may vary (under running water).

3. The temperature of the water should be constant and it should not irritate/bum the skin since the skin of babies is thin and sensitive.

Bathing recommendations for the baby and you:

I. The skin should be wiped until umbilical cord heals; the baby may have entire body bath 24 hours after the stump of the umbilical cord breaks down.

2. The bath should not last long and preferentially, the baby should be bath between two breastfeeding sessions.

3. All materials should be ready before the baby is undressed.

4. The baby should never be alone in the bathroom.

5. First, the body should be washed and finally, head should be washed.

6. Baby should be carefully held throughout the bath; head and neck should be protected.

7. The frequency of bath can be once a day or every other day depending on the conditions of the house.

Newborn bath (wiping the skin)

You should only smoothly wipe the skin of the baby in order to keep skin of the baby clean and healthy within first several weeks. General bathing rules apply to this form of bath. Materials: water (temperature should be checked), a skin-friendly cloth, towel, clean clothes and an appropriate humidifier.

For this form of bath, you should not use soap or shampoo.

For washing the head, you will need towel, shampoo and other care materials.

For wiping the skin of the baby, the room temperature should be 24-25 °C and there should not be air flow within the room. For wiping the skin of the baby, clear water and a skin-friendly cloth should be used to avoid injuring the skin. The baby should not be completely naked in order to avoid hypothermia; body portions should be separately cleaned, dried and humidified. The baby should be worn clean clothes.

Entire Body Bath

Your baby will enjoy the entire body bath if there is no symptom of infection or bleeding one day after the stump of umbilical cord breaks down. You should seek medical advice if the umbilical infection or bleeding occurs.

Following general bath rules, you may bath the baby. The one third of the bath tub should be filled with temperature-controlled water (temperature of the water should not exceed 37 °C). Baby should be placed on the bath net or on the arm of the mother and first, the feet should contact with the water. The baby should have bath at caudocranial direction (starting with feet) and all skin folds should be cleaned. Finally, the head should be washed and the baby should be wrapped in the towel.

Shampoo and soap should not be used; soap and shampoo can be used once or twice per week. The skin of the baby should be humidified by a baby care product after the bath.

Skin Care

The skin of babies is thin and sensitive. Bath should be avoided within first 48 hours, if there is no requirement

The skin may appear dry and desquamation may frequently occur within several days. Correct and balanced nutrition of the skin is not only important for the growth of baby, but it is also of importance in order to avoid infections. You should use a baby-friendly care product/humidifier to protect the sensitive skin of the baby and to ensure healthy growth.

Heat rash (also referred as miliaria) may develop on the skin of the baby particularly within first several weeks. For the miliaria, the pores draining the perspiratory glands to the skin are occluded since the secretion of the gland may not reach the skin. If your baby suffers miliaria, you should avoid soap and detergents, since they will aggravate the problem. For the prevention and treatment of miliaria, the baby should not be worn heavy clothes; light clothes should be worn which cool the baby; and the baby should be bathed regularly and the skin care of the baby should be taken into consideration. You should seek medical advice if inflammation develops on rashes.

Nail Care

The rapid growth of the nail is an indicator of normal growth for your baby. The nail may injure the skin and eyes. In addition, nails may exert the risk of infection. You may clip nails of the hand fingers once or twice a week and once in one or two weeks for toes. You may clip fingers after the bath in order to make it easier.

Using a nail clipper appropriate for the baby, nails of hand fingers should be cut in round form, while nails of toes should be cut in the form of flat top. It is appropriate to file nails using a baby nail buffer set in order to avoid injury of skin.

Gas discharge Your baby may suffer gas-related problems at postnatal period since the gastrointestinal system is not fully functional. The baby should be assisted to discharge gas at early postnatal period.

You should not deprive the baby of mother milk, which is an easy-to-digest nutrition with unique ingredients and is almost the most appropriate food for the gastrointestinal system.

For first several days, your baby will leam to hold the breast and s/he will swallow more air while s/he is crying the areophagia (the swallowed/ingested air) will cause discomfort. In order to avoid this condition, you should wind your baby as of the first day.

You should wind your baby regularly after you breastfed the baby and when the baby is switched from one breast to the other or when assisted nutrition techniques are used (baby bottle, syringe etc.).

You may gently tap on the back of the baby, who is placed on your shoulder or lap, and thus, you can wind the baby. Winding should be maintained for several minutes when the baby is switched from one breast to the other or by changing positions once in 1-2 minutes after the baby is fed until the baby discharges gas. You should keep the baby upright for 10- I 5 minutes after the baby is breastfed and thus, you may avoid vomiting.

Why do babies cry?

It is known that babies cry for 1-4 hours (mean) a day. According to the studies and researches, the pattern of crying varies depending on discomfort and needs (soiling nappies, pain, gas or hungry). Crying is the language of babies and they convey messages to mothers.

If the crying baby is immediately responded, the baby will feel safe. In addition, babies also cry to make mother fulfill the non-physical needs. If the baby is crying although all physical needs are met, you may take the baby on your lap and the kangaroo care (the infant is held, skin-to-skin, with the mother) will relax the baby.

Safety of Baby

  • Wash your hands before and after you contact with the baby.
  • Your nails should be appropriately cleaned and filed
  • Support the head and back when you hold the baby
  • Do not sleep in the same bed
  • Do not smoke if you are breastfeeding
  • Do not allow smoking where your baby resides; you should ensure that smokers wash hands and mouth before they touch the baby
  • Do not use scents when you breastfeed the baby
  • Do not allow use of perfume and scents in the baby’s room.
  • Do not obstruct mouth and nose of the baby
  • Do regular checks while the baby is sleeping
  • The baby should travel in the baby seat, which is positioned on rear seats of the vehicle.

Safe Sleep

Infants may not recognize the difference between day-time and the night; they will sleep for 16-18 hours a day. Meanwhile, they will wake up and need to suck mother in every 2.5 to 3 hours since the capacity of stomach is low. In addition, the babies fed with mother milk may wake up at shorter intervals to see the mother in comparison with the babies fed with formula Following the first month, it is not required to wake the baby up to feed, if adequate weight gain is achieved. The time of sleep will also decrease as the baby grows. For 6-months old baby, the night sleep will usually last 12 hours; the baby will have day-time sleeps for three times at 1- to 2-hour intervals. When the baby is I year old, s/he will sleep for 1 0- 12 hours at night and they will have day-time sleep twice at I - to 2-hour intervals. Many babies have day-time sleep only once when the baby is 18 months old. Many mothers are concerning about when she will have a sound sleep. A sound sleep lasting 6-8 hours will be usually possibly only when the baby is 4 months old; however, it may vary.

One of the most challenging problems will be about the baby falling asleep spontaneously. Behaviors of the baby change when the baby feels sleepy; you may help her/him to fall asleep if you recognize those changes.

Feeling sleepy, the baby will start yawning, rubbing eyes, looks tired and get restless. Many parents want to Agrock the cradle in order to help baby fall asleep. Although it is a good approach to organize appropriate conditions before the baby falls asleep, the baby should not fall asleep on the lap. Falling asleep on the lap may become a pattern and the baby may need a lap in order to fall asleep.

It is commonly recommended that the baby may feel sleepy on the lap of mother or father, but the baby should be placed on the bed in order to enable the baby learn falling asleep alone. In addition, some routines (bath, reading book, music, singing a lullaby etc.) will help the baby falling asleep.

Recently, it is demonstrated that during the sleep, supine position is safer than the prone and sleeping on side. For babies lying supine, the sudden infant death syndrome is less frequent than the babies lying prone or on side. Therefore, supine position is safer for your baby during sleep. In addition, the bed should be solid; no pillow should be placed under the head. No toys should be left in the cradle. Baby should not be worn hat while the baby is sleeping.

Common Problems

Diaper Rash

This is the one of the most common problems of neonatal and infantile periods. The underlying cause of the diaper rash is the irritation of skin. The inappropriate size of diaper (extremely

tight or loose), perineal humidity, recently started foods and fungal and bacterial infections may lead to diaper rash. Poor hygiene, failure to change nappy at short intervals and conditions such as diarrhea will lead to development of bacterial or fungal infection on the rash, resulting with refractory rash.

The correct approach should involve prevention of rash, eliminating underlying causes (if available) and rapidly treating the diaper rash before it is infected.

To avoid development of diaper rash,

I. You should use nappy with appropriate size and you should re-consider the size depending on the age (in weeks) and body weight of the infant

2. The nappy should be changed at 3- to 4- hour internals and whenever the infant spoils the nappy.

3. You should prefer washing perineal region rather than wiping, depending on the conditions of the house.

4. You should wait for several minutes to air dry the skin before the nappy is worn.

5. You should not use soap for washing the skin of the baby.

6. You may use rash creams 3+-4 times a day.

7. You should avoid use of powder and lotion.

If the baby is extremely agitated and crying and you see erythema (redness) on the area covered by nappy, treatment should be started to eliminate rash. First, you should follow all measures taken to prevent the diaper rash and you should consult to your doctor and follow her/his recommendations strictly. Contact of the rash region with air for long time will facilitate healing process.

Oral Thrush

The white and mildly erupted spots develop on interior surface of cheeks, tongue and palate are referred as thrush and the spots are not easily eliminated by wiping them. They should be distinguished from milk residues. The thrush may cause pain, resulting with discomfort, crying and inability to eat. If you are breastfeeding, you should take care of breast cleaning and you should keep all feeding equipment’s clean. If thrush had already developed, oral care should be maintained once or twice a day and you should consult to your physician.

Cradle Cap (Neonatal seborrheic dermatitis)

Cradle cap refers to the yellow- brown layer appearing like crust since fatty substances produced by overactive sebaceous glands cannot be eliminated from the scalp. They do not usually cause pain as long as they are humidified and hair is not forcefully combed. A good care and regular bathing may prevent the cradle cap. If it had already developed, the cradle cap area should be massaged with baby oil or almond oil. You should wait for 30 minutes after the massage. Later, the scalp is gently combed and the crusts are eliminated. The baby should have bath after the scalp is gently combed. This routine is repeated for every bathing session until cradle cap completely disappears.

Nasal congestion

Nasal cavity of newborns is smaller than that of children and adults. At infantile period, any abnormality influencing the nasal cavity will lead to serious problem. If there is no structural problem of nose, the underlying cause of the nasal congestion is deposition of secretions within the nasal cavity. The babies with nasal congestion may not comfortably suck the breast of mother or suck the breast for long time, resulting with poor weight gain. They will continuously cry and they are usually agitated. The nasal congestion may lead to sleep and nutritional disorders, diseases of oral cavity and pharynx and growth problems.

If the baby suffers nasal congestion, it should be eliminated as recommended by your physician 1-2 hours before or after the baby is fed. The room should be appropriately humidified (humidity rate is 30-40 %) and the baby should not be nearby heat sources.

Neonatal Jaundice

Neonatal jaundice may occur in 60 % of term and healthy newborns and up to 80% of preterm infants and it refer to yellowing of skin and sclera (the white portion of the eye) since the level of a particular substance, referred as bilirubin, increases in blood. The severity and duration of neonatal jaundice may vary depending on many factors including but not limited to the time between two births, gestational age of the newborn, nutritional habits, race and genetic structure. The neonatal jaundice is usually characterized as physiological jaundice, pathological jaundice, mother milk jaundice and prolonged jaundice. The yellowing is usually manifested first on face and sclera. It may spread to abdomen and legs when the severity increases. When you are discharged, you should check the color of the skin of your baby under day light every day for the first week and the period should be 2 weeks particularly for premature newborns. If you recognize yellowing on abdomen and/or legs of the baby, you should contact your pediatrician and follow her/his recommendations.

If jaundice is diagnosed during examination or control visit of the newborn, blood is drawn from the heel into capillary tubes and serum bilirubin level is determined. A decision is made whether treatment is required depending on the age of the newborn, body weight, gestational age, physical examination and some other laboratory tests, which can be ordered if required. If bilirubin exceeds a particular range (this level is determined according to the birth weight, age, gestational age and the health state), it is possible that the substance passes into the brain resulting with cerebral damage and therefore, treatment is required.

Treatment of jaundice: the worldwide and locally recognized treatment method is phototherapy. Phototherapy exerts effects on the principle that light with a particular wavelength is applied on the naked body of the baby and the bilirubin is excreted from the body. During the therapy, specific phototherapy spectacles are worn in order to avoid possible hazardous effects of the light on the eyes of the baby. Phototherapy is not associated with permanent or severe side effect.

Neonatal jaundice cannot be completely eliminated; however, early diagnosis and treatment is very important since bilirubin may not reach destructive levels.


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