Newborn Discharge Teaching Outline PDF

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Newborn Discharge Teaching Outline 1. Weight and length a. Typically loses weight (4-10 oz) in first few days b. Regains weight lost by 10-14 days c. Birth weight doubled by 5th month; tripled by a year d. Length doubled by a year 2.

Head size a. Larger than infants body size b. Dramatic brain growth in first year c. Importance of parent-child interaction

3.

Molding a. Elongated shape b. Scalp swelling in the area that was pushed out first during birth c. Swelling should disappear within a few weeks

4.

Fontanels (soft spots) a. Two fontanels b. Top of the head – diamond shaped – closes by 18 months of age c. Back middle of head – triangle shape – closes in 3-6 months of age d. A thick membrane that protects the brain covers this area e. Purpose – to allow for growth/expansion

5.

Eyes (refer to “Newborn Eyes and Ears” handout) a. Red spots – hemorrhages – caused by tiny blood vessels breaking from pressure on the head during birth (resolves within a few days to a week) b. Puffy eyelids – caused by pressure on the face during labor (fades away in a few days) c. Color – most look steel gray or blue (prominent color is evidenced at about 6 months of age)

6.

Ears (refer to hearing screen handout)

7.

Breathing a. Irregular breathing – common the first few weeks of life (alternates short breaths, breath holding for a few seconds, then deep breaths) b. Nose breathers c. 40-60 breaths per minute

8.

Skin (refer to your (Baby’s Skin Rashes” handout) a. Pink color b. Bruising may be seen on the head, face and body from birth (fades within a few days) c. Skin will become dry looking (normal shedding of the top layer of skin after birth) d. No need for oils/lotions/powders e. Milia (tiny white spots on nose and chin caused by blocked oil glands; disappears in the first 203 weeks of life) f. Acrocyanosis (bluish color of hands and feet due to the immature circulation; seen the first couple of days of life) g. Newborn rash (pimple-looking rash scattered all over; normal and disappears on own; do not pop or treat them with oils or creams

9.

Jaundice (refer to “Jaundice in the Newborn” handout) a. Yellow appearance of skin and whites of eyes b. Caused by bilirubin from normal breakdown of red blood cells c. Newborns have more blood and a liver not as efficient to remove the bilirubin d. Extra bilirubin builds up in the blood (not harmful; resolves without medical treatment; lasts up to one week; high levels of blood bilirubin may need specialized treatment) e. Notify your doctor if your baby’s color does not look right.

10. Umbilical Cord a. White, shiny and translucent in color b. Painted with blue antibacterial dye c. Dye helps the cord to begin to dry d. Cord falls off within 1-3 weeks e. Mild bleeding may occur when cord falls off f. If redness, swelling, foul smell, or drainage occur notify pediatrician g. Wipe with alcohol with every diaper change – thoroughly swab the base of cord (refer to Your Baby’s Bath Time” handout) h. Keep cord dry i. Keep diapers below the cord j. No tub baths until the cord falls off and is healed k. Do not pick at it, cut it, or pull it (allow to fall off on its own) 11. Fingernails a. Attached to the skin at the edge of the nail b. It is not recommended to use clippers, as it will nick the fingertip (can use cardboard nail file) c. Peel nail when softened in bath water 12. Reflexes a. Startle or Moro – baby will jump and fling arms outward at loud noises or sudden change in movements b. Suck – baby will suck when something is gently place in to its mouth (refer to “Sucking and Pacifier” handout) c. Grasp – baby will close its hand on an object when stroked against its palm d. Rooting – baby will instinctively turn its head toward something that touches/strokes its mouth or cheek e. Stepping – if held upright with feet touching a slid surface, baby will step as if walking 13. Senses a. Smell – well developed, can differentiate between Mom and Dad within 1-2 weeks; breastfed babies can smell breastmilk from across the room b. Hearing – can tell the difference between Mom and Dad and strangers; will turn head toward sound; will respond to familiar voices/music c. note family history of hearing difficulties d. EOAE Hearing Test (Evoked Otoacoustic Emissions) e. Touch – will pull away from harsh feeling (scratchy, rough, etc.) objects; will comfort to touch or stroking f. Taste – likes sweet over sour, salty or bitter This product was funded by a grant awarded by the U.SDepartment of Labor’s Employment and Training AdministrationThe product was created by the grantee and does not necessarily reflect the official position of the U.SDepartment of LaborThe Department of Labor makes no guarantees, warranties, or assurances of any kind, express or implied, with respect to such information, including any information on linked sites and including, but not limited to, accuracy of the information or its completeness, timeliness, usefulness, adequacy, continued availability, or ownership. Unless otherwise specified, this work by Delaware Technical Community College is licensed under a Creative Commons Attribution 4.0 International License: http://creativecommons.org/licenses/by/4.0/.

14. Vision a. Vision gradually improves throughout infancy and childhood i. sees at a distance of 8-12 inches ii. will focus mainly on bright colors, contrast of dark and light, and a human face iii. 15. Bath Care (refer to “Bath Time” handout) a. Bathe before feeding – jostling may cause feeding to come up b. Bathe your baby once or twice a week only c. Cleanse face and hands daily d. Need to cleanse diaper area after each diaper change e. Wipe girls from front to back f. Sponge bath until umbilical cord falls off and/or circumcision is healed g. Gather all bathing supplies together before beginning bath h. Choose a warm spot free of drafts i. Lay baby in towel j. Water temperature should feel warm to inside of wrist k. Begin bath at head and work downward exposing only the area being bathed l. Cover the body part not being bathed m. Wash the face with a wet wash cloth and no soap n. Wipe the eyes from inner corner out toward ears – o. use different corners of the wash cloth or fresh cotton balls p. Wipe outer part of ears q. NEVER stick anything smaller than your forefinger in or around the baby’s ears r. Wash hair last – wrap baby in towel and place in football hold s. pour clean water over scalp t. wash with small amount of shampoo in scalp u. use a mild shampoo on scalp v. stimulate the entire scalp (even soft spots) w. rinse with warm water x. After cleansing the top part of the baby, dress the part that has been bathed and dried (this will decrease the chance of baby getting cold) y. You may use lotion, however, this is unnecessary z. NEVER leave baby alone in the bathtub to avoid drowning 16. Dressing for the weather/environment a. Can get too hot or cold – an infant working to maintain a normal body temperature will deplete blood sugar levels and need more oxygen, thus increasing their breathing effort b. May require to keep their hat on for at least their first day of life c. Feel the baby’s hands (f too warm, unclothe baby; if too cold, add more layers) d. Choose clothing according to the temperature in your home e. Wash all new clothing with a mild soap before placing on infant (their skin is very sensitive) 17. Diapering a. Change frequently to prevent diaper rash (as soon as possible after baby wets or stools) b. Wash buttocks with warm water c. Soiled diaper – take unsoiled corner of diaper and wipe away excess stool This product was funded by a grant awarded by the U.SDepartment of Labor’s Employment and Training AdministrationThe product was created by the grantee and does not necessarily reflect the official position of the U.SDepartment of LaborThe Department of Labor makes no guarantees, warranties, or assurances of any kind, express or implied, with respect to such information, including any information on linked sites and including, but not limited to, accuracy of the information or its completeness, timeliness, usefulness, adequacy, continued availability, or ownership. Unless otherwise specified, this work by Delaware Technical Community College is licensed under a Creative Commons Attribution 4.0 International License: http://creativecommons.org/licenses/by/4.0/.

d.

Always remember to keep diaper below umbilical cord until it falls off

18. Penis (circumcised/uncircumcised) a. Circumcised i. place gauze with Vaseline on it for 3-5 days or per pediatrician’s instruction – Plastibell falls off by 7th-10th day ii. change with every diaper change iii. cleanse gently with warm, soapy water and rinse iv. hold baby’s feet when changing baby’s diaper as he can kick at his circumcision and cause it to bleed v. report any bleeding, foul odor or excessive redness or swelling to your pediatrician vi. a yellow-white film will develop on the head of the penis; this is the healing process (do not wipe off) vii. circumcision should be healed within 2 weeks b. Uncircumcised i. clean the penis well ii. do not retract the foreskin iii. it will take about 3 years to be able to retract the foreskin iv. teach your son how to clean himself 19. Feeding (refer to “Bottle Feeding Your Baby,” “Preparing Concentrated Liquid Formula,” “Preparing Powder Infant Formula” handouts) a. Formula i. Will be prescribed by pediatrician b. Will want to eat every 2-4 hours until 6-8 weeks of age c. Feed until infant is satisfied – stops sucking, no further hunger cues (lip smacking, rooting, sucking or crying) d. Make sure you have plenty of bottles and nipples and a bottle brush to clean them (thoroughly clean and rinse; sterilize in dishwasher) e. Always check formula container for preparation instructions (ready to feed vsconcentrate; check expiration date) f. Use formula container within 48 hours of opening i. throw out remainder after 48 hours ii. during 48 hours, cover open container and store in refrigerator iii. any formula not finished at feeding should be thrown away (bacteria grows quickly because of sugar in formula and baby’s saliva) g. Temperature of formula is what your baby prefers (never microwave formula – heats unevenly; place filled bottle under running warm tap water to take chill off) h. Nipple hole – check by tilting bottle i. if formula runs out, hole is too big ii. if nothing comes out, the hole is too small iii. formula should drip from tilted bottle with ease i. Never prop bottle and leave for any length of time – infant could choke/baby bottle tooth decay j. Take your time and hold baby close 20. Breastfeeding This product was funded by a grant awarded by the U.SDepartment of Labor’s Employment and Training AdministrationThe product was created by the grantee and does not necessarily reflect the official position of the U.SDepartment of LaborThe Department of Labor makes no guarantees, warranties, or assurances of any kind, express or implied, with respect to such information, including any information on linked sites and including, but not limited to, accuracy of the information or its completeness, timeliness, usefulness, adequacy, continued availability, or ownership. Unless otherwise specified, this work by Delaware Technical Community College is licensed under a Creative Commons Attribution 4.0 International License: http://creativecommons.org/licenses/by/4.0/.

(refer to Breastfeeding Guidelines) 21. Temperature Taking (refer to “Taking Your Baby’s Temperature” handout) a. Take temperature if acting out of the usual or if you think baby is getting sick b. Axillary temperature – taken by placing the thermometer under arm and holding the arm firmly against the body for 3-5 minutes for mercury thermometer, or until it beeps in a digital thermometer c. Make sure the thermometer is against bare skin d. Report any temperature above 99 degrees to doctor e. Do not do rectal temperature unless directed by a physician 22. Sleeping Position/Baby’s Bed (refer to “Back to Sleep” pamphlet) a. Sleep on back is preferred (lowest risk for SIDS); sleeping on side is a reasonable alternative when you are checking on infant frequently b. Should sleep in a crib that meets federal safety standards i. read the tag on the crib or mattress ii. if using an older crib, bars should be less than 2 and 3/8 inches (6 cm) apart iii. mattress should be firm and snuggly fit against the sides of the crib c. Rolled blanket or crib bumper should be used if there is more than 2 finger spaces between the mattress and the side of the crib d. Should not sleep on waterbeds or any soft surfaces such as lamb’s wool, pillows, bean bags, foam pads, or stuffed toys (could block airway) 23. Smoking a. You should not smoke or allow visitors to smoke around your baby b. Designate the house and car as smoke free places c. Babies who are around people who smoke are sick more often d. Chest colds e. Ear infections f. Bronchitis g. Pneumonia h. Eye irritations i. Sneezing j. Coughing k. Wheezing l. Fussiness/crying m. Sickness will linger if your baby is around smoke

24. Comfort Measures a. Hold in your arms and rock in a chair or back and forth b. Wrap in a blanket (swaddle) c. Talk to softly and gently pat back d. Sing quietly or play soft music e. Try burping f. Give a bath This product was funded by a grant awarded by the U.SDepartment of Labor’s Employment and Training AdministrationThe product was created by the grantee and does not necessarily reflect the official position of the U.SDepartment of LaborThe Department of Labor makes no guarantees, warranties, or assurances of any kind, express or implied, with respect to such information, including any information on linked sites and including, but not limited to, accuracy of the information or its completeness, timeliness, usefulness, adequacy, continued availability, or ownership. Unless otherwise specified, this work by Delaware Technical Community College is licensed under a Creative Commons Attribution 4.0 International License: http://creativecommons.org/licenses/by/4.0/.

g. h. i.

If inconsolable and you’re stressed, have someone give you a break NEVER, NEVER, NEVER SHAKE OR JERK A BABY! This can cause permanent brain damage and even death!!! Try to console your baby, but recognize that he may not always be consolable regardless of what you do Many babies have a daily fussy period in the late afternoon or evening.

25. Safety (refer to “Burn Prevention: Infant and toddler”, “Poison Prevention”, and “A Safe World for Your Baby” handouts) 26. When to Call the Doctor (refer to “When Your Baby is Sick” handout) a. Temperature above 99 degrees axillary (under the arm) b. Limp, floppy or sleepy and you can’t wake him c. Irritable – can’t be calmed down d. Problems with feeding such as failure to eat, crying when eating, vomiting associated with feeding e. Constant diarrhea and/or vomiting f. Very jaundiced (pumpkin-colored) g. Drainage, a foul odor, redness or swelling at the cord h. Less than 4 wet diapers a day (after breast milk has come in) i. Has not wet within 24 hours after circumcision j. Unusual or severe rash (other than prickly heat) k. Bleeding at cord or circumcision 27. Well Baby Exams (refer to Health Journal in “Growing Together” packet, “Hepatitis B Vaccine” pamphlet, and “Newborn Screening” pamphlet) a. To monitor growth and development b. Scheduled routine immunizations (to protect against harmful diseases) c. Keep a record of every shot starting with the Hepatitis B Vaccine in the hospital d. Hereditary Metabolic Screening (HMD) – Initial test done prior to discharge from hospital e. Repeat to be done as an outpatient in 2 weeks f. Tests for hypothyroidism, PKU, sickle cell anemia, galactosemia 28. Visitors/Crowds a. Limit the number of persons (especially children) handling infant the first week b. Avoid large crowds initially to allow infant to build up resistance to infection c. Encourage frequent hand washing when handling infant (especially after diaper changes and before bottle feedings)

This product was funded by a grant awarded by the U.SDepartment of Labor’s Employment and Training AdministrationThe product was created by the grantee and does not necessarily reflect the official position of the U.SDepartment of LaborThe Department of Labor makes no guarantees, warranties, or assurances of any kind, express or implied, with respect to such information, including any information on linked sites and including, but not limited to, accuracy of the information or its completeness, timeliness, usefulness, adequacy, continued availability, or ownership. Unless otherwise specified, this work by Delaware Technical Community College is licensed under a Creative Commons Attribution 4.0 International License: http://creativecommons.org/licenses/by/4.0/....