Care Of The Newborn

Patient Education

Introduction

Appropriate care of the newborn baby first few days after birth, especially in the first week, is important to ensure good weight gain and to prevent complications during this critical period. Rooming-in of the mother and the infant, early initiation of breastfeeding, skin-to-skin contact and maintaining temperature in the thermoneutral zone ensure optimal transition and promote bonding between the mother and the baby. The baby is generally kept in the hospital for the first 2-3 days after birth during which the parents are taught the essentials of newborn care including feeding, umbilical cord care, skincare and monitoring of feeding, urination and bowel habits.

Feeding the Newborn

How frequently should the newborn be fed?

The neonate should be breastfed on demand, usually every 2-3 hourly. The newborn will feed on the breast around 8-12 times in a day, each feed lasting around 10-15 minutes. The interval between two feeds should not be more than 4-5 hours in the first 2-3 weeks of life. A rigid feeding schedule is not required, as a routine will be established naturally with time.

Can solids be started at 4 months of age?

It is recommended to continue exclusive breastfeeding until 6 months of age. Weaning is recommended after completion of 6 months. Breast milk has all the nutrients needed to maintain the optimum growth of a newborn for the first 6 months. The antibodies in breastmilk protect the baby from respiratory infections and diarrheal illnesses. Research has proven that exclusively breastfed infants are less likely to develop allergies, asthma, high cholesterol and diabetes. The mothers are also benefitted due to the lesser risk of breast and ovarian cancers. Nursing helps to burn calories that help to shed the extra weight gained during pregnancy.

Can honey be given to the infant in the first 6 months of life?

Honey should not be given to an infant in the first year because it can occasionally contain a spore of a harmful bacterium called Clostridium botulinum which can cause a dangerous type of food poisoning called botulism in babies. This will manifest with symptoms like lack of appetite, constipation and listlessness. Other liquids like glucose water and water should not be given to newborns before 6 months of age.¹

Skin and Umbilical Cord Care

Can a bath be given to the newborn immediately after birth?

The bath is usually delayed for 12-24 hours after birth. The full-term baby’s skin has a natural moisturizer and cleanser called vernix caseosa that also protects against infections. A bath given immediately after birth may remove this natural infection barrier, may predispose to hypothermia and interfere with breastfeeding and mother-infant bonding. Rubbing with a clean, warm towel is recommended at birth to remove amniotic fluid, blood and meconium.

Should an antibiotic powder be applied on the umbilical cord area in the first week of life?

There is no need to apply antibiotic powder, gentian violet or other chemicals over the umbilical stump area. However, it is important to keep the cord clean and dry by keeping it exposed to air or loosely covered with a clean cloth. Cord care is very important to prevent colonization with bacteria like staphylococcus aureus and gram-negative bacilli that may then lead to an infection of the umbilical cord called omphalitis. Application of traditional substances like ash, herbal products, human milk or cow dung may significantly increase the chances of omphalitis and dangerous infections like neonatal tetanus.^2,3

Does a diaper increase the chance of a diaper rash in the newborn and should diaper use be avoided?

Occlusion of the skin pores caused by the diaper and wetness may predispose to breakdown of skin in the area leading to a diaper rash. However, measures like frequent diaper changes, removal before the absorbing capacity is saturated, removing after every bowel movement and gentle cleaning of the diaper area with a clean, wet cloth or gentle wipes may reduce the chance f developing diaper rash. Other factors like bacterial or yeast infection or sensitivity to detergents may also cause a diaper rash. Hence, absorbent diapers can be used provided the above-mentioned points are kept in mind.

Is there a need to panic if the baby develops a reddish skin rash on the third day of life without any other symptoms?

The reddish skin rash is a benign, self-limited rash seen in normal, healthy newborns called ‘Erythema toxicum neonatorum’. This may be related to increased levels of immunological factors and eosinophils in the newborn skin, the cause of which is not known. This rash is usually seen in the first 2 days after birth and may be seen up to 4-5 days in full-term infants. The rash presents with macules and papules on the trunk, face buttocks, arms and thighs. No treatment is required as they fade by themselves.^3,4