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Caring
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for Your Ne w b o rn
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Table of Contents
Title
Page
Normal Newborn Features and Behaviors . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Handling and Holding Your Newborn. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Breastfeeding. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Congratulations — you have a new baby! No matter how much
over the past months and years you have anticipated becoming a
parent, nothing can really pre p a re you for how you will feel when
your baby arrives. Caring for a newborn is one of the greatest
challenges a parent or care g i ver faces, because an infant is completely
dependent on loved ones for care and surv i val.
Pumping, Handling and Storing Breast Milk . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Caring for a new baby can be a source of great joy as well as great
s t ress. Regardless of how much you think you have prepared beforehand, it probably will not be enough to prevent you from feeling
ove rwhelmed at first. Do n’t worry, that’s perfectly normal. All pare n t s
must work hard to understand and care for their babies.
Daily Baby Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
The Children’s Hospital of Philadelphia provides this booklet to
help you cope during your first experience at parenting. Inside, you
will find useful information on things like feeding and bathing yo u r
baby, safety tips, sleep problems and child development.
Your most important job right now is to take care of yourself and
your newborn. That will be easier if you have an idea of what to
expect in the first few months of your baby’s life, take an active role
in your infant’s healthcare and development, and build close ties
with a support i ve network made up of your child’s doctor and yo u r
family and friends.
Formula Feeding. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Diapers and Diaper Changing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Bathing Your Ba by . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Sleep and Cry i n g . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Colic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Infant Development and Stimulation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Playing with your Ba by: birth to 4 Months . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Playing with your Ba by: 5 to 8 Months . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Infant Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Secondhand Smoke . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 2
The Children’s Hospital of Philadelphia provides this booklet
to guide you during your first experience at parenting.
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• You might notice tiny white dots (these
a re called milia), on or around the nose.
These are oil glands that eventually will
get smaller; don’t pop them.
• A blotch of color called “stork bites”
and “angel’s kisses” may be seen in
lighter-skinned infants. They will fade
gradually over the first few months.
Normal Newborn Features and Behaviors
Newborns usually don’t look like the plump, cuddly infants you see in magazine ads —
those infants actually are several weeks or months old. In fact, babies often look unattractive
immediately after birth, even to proud parents. They may appear wet, wrinkled and
reddish, and their skin may appear thin, with their veins showing through it.
Here are some of the things you may notice:
Eyes
• You may see blood spots on the white
p a rt of your baby’s eyes. These are from
the pressure of delive ry, and they are
harmless and temporary.
• Eyes may seem to be crossed. This is
normal in newborns. The eyes should
look normal when the baby is about
4 months old.
• Your baby can see clearly only a few
inches in front of him, and his vision
gradually will improve. Hold your baby
close to you so he can see you we l l .
• Your baby may not produce tears right
away.
• Most Caucasian newborns have blue
e yes, and it may take a year for a baby’s
permanent eye color to emerge. Infants
of other races usually have brown e yes at
birth and keep that color throughout
their lives.
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Head
• The pressure from a vaginal delive ry
may make your baby’s head appear
cone-shaped, flattened or lopsided,
and it may cause swelling on the scalp.
This will go away within a few we e k s .
• All babies have two soft spots on their
heads where the skull bones haven’t ye t
g rown together. These should close at
9 to 18 months.
Skin
• Your baby’s skin will look delicate. If he
was born early or right around your due
date, his skin may peel or crack a little
bit because of the exposure to air. This
is normal. He also might have flakes on
his scalp that look like dandru f f. Do n’t
use lotion, oils or Vaseline™ on yo u r
baby’s peeling skin or flaky scalp;
it could make the condition worse.
The peeling should go away soon
without treatment.
• “Newborn rash,” also known as erythema
toxicum, are red raised bumps with a
central tiny white dot. They usually go
away within the first week or so.
• “Mongolian spots” are large, flat, bluish
a reas that look like bruises. These commonly appear on darker-skinned babies
and will fade in time.
Hearing
Most infants have normal hearing, but
they can’t tell where a particular sound
is coming from until about 4 months.
Most Pennsylvania hospitals test newborns’
hearing before they leave the hospital.
Body
• After the umbilical cord is cut, about
a one-inch piece of it remains. This
stump will begin to dry up and turn
black, and it will drop off within one
to two we e k s .
• Both newborn boys’ and girls’ breasts
may be swollen or have a discharge;
this is a result of the large amount of
hormones their mothers produced
during pregnancy. The swelling should
disappear within a few we e k s .
• Your baby may have areas of fine hair
on his body. This is called “lanugo”
and helped protect him while he was
in the womb; it will fall out within a
f ew we e k s .
• Newborns’ genitals often appear reddish
and may seem large, and girls may
h a ve a whitish or bloody discharge.
This, again, is caused by the mother’s
hormones and should stop within a
f ew we e k s .
Nose
Sn e ezing is normal; it is your baby’s way
of clearing dust from the nose.
Mouth
• “Epstein’s pearls” are normal, tiny white
bumps on the roof of your baby’s mouth.
• A sucking callus is the thick skin on
your baby’s upper lip caused from
repeated sucking. It is normal, don’t
peel it off.
• A quivering chin is normal newborn
behavior.
Handling and Holding Your Newborn
Even if you have never before held or handled a baby, you will soon get used to it. Babies
enjoy physical contact, and your baby needs you to hold and soothe him in order to feel
safe and loved.
A newborn can’t hold his head up by himself for several months, so support his head and
remind others who may be holding your baby to do so also.
Your newborn will like to be nestled against your shoulder or chest, where he can hear
your heartbeat. In this position, use one arm to support his buttocks and the other to
support his neck and head. You may also hold your baby in a cradle position in your arms.
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Breastfeeding
Benefits of breastfeeding
Deciding to breastfeed is a wonderf u l
decision for you and your baby. Breast
milk is the healthiest food for babies and
provides all the nutrition your infant
needs. It also promotes bonding betwe e n
mother and infant and protects your baby
against illness. Babies that breastfeed have
f ewer ear infections and get diarrhea less
often — that means fewer trips to the
pediatrician.
Breastfed babies do not have as many
allergies as formula-fed babies, and mothers
who breastfeed are less likely to get breast
and ovarian cancer than those who do not.
Breast milk is different from formula
because it is always changing to meet
the nutritional needs of your child as he
grows. Human milk also provides special
fats that promote brain development. For
all these reasons, the American Academy
of Pediatrics recommends infants be fed
only breast milk for their first 6 months of
life. Babies do not need additional water,
juice or formula. At 6 months, you may
offer your baby solid foods, but it is best
for babies to continue to breastfeed until
they are at least 1 year old.
Getting started
Your baby should be nursing at least eight
times in 24 hours. The key to successful
breastfeeding is the way your baby “latches
onto” the breast. While holding yo u r
breast, stroke the baby’s cheek from nose
to chin to encourage him to open his
mouth wide enough to take both the nipple
and approximately one inch of the areola
into the mouth. Positioned this way, yo u r
baby will get the most milk and you will
be less likely to have sore nipples.
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Positions for breastfeeding
There are different positions you can use
while breastfeeding; choose the one that
makes you and your baby most comfort a b l e .
Hold him or her close to your body. For
most positions, your baby should be on
his side with the entire body facing yo u
and his mouth near your nipple. Your
baby shouldn’t have to turn his head in
order to reach your breast.
Signs of a poor latch
• Your nipples are sore during the whole
feeding or become sore as the feeding
continues.
• When the baby sucks, you hear clicking
or smacking sounds.
• The baby is coming off the breast
repeatedly after only a few sucks.
• The baby’s cheeks are dimpling in with
each suck.
• The baby acts hungry all the time after
nursing.
Do I have enough milk for my baby?
This is probably the greatest concern for
all new breastfeeding mothers. After the
first few days of life, many infants seem to
nurse more often and may be a little fussy.
Many parents think this means their baby
is not getting enough milk. This is a
normal stage of breastfeeding when the
infant’s demand increases the mother’s
milk supply. Howe ve r, sometimes the
baby’s fussing causes mothers to offer
bottles of formula instead. These bottles
cause problems in two ways. They fill
your baby up, delaying his desire to nurse,
which can decrease your milk supply.
Bottle-feeding also causes problems with
breastfeeding because the infant’s sucking
is different for breast and bottle.
Even though you can’t see the amount of
breast milk that goes into your baby, there
are other ways to know if he is getting
enough milk. Your baby is getting a
sufficient supply if he:
• Nurses at least eight times in a 24-hour
period.
• Nurses for 10 minutes or more in a
rhythmic suck/swallow/pause/suck
pattern.
• Is satisfied and not displaying feeding cues
( rooting, sucking on fingers) after a feed.
• Has one wet diaper on the first day of
life, three on days two and three and
m o re wet diapers on days four and five .
By day six, your baby should have at
least six to eight wet diapers a day.
• Is producing ye l l ow, seedy, runny stools
at around day three or four. If yo u r
baby is not passing any stools, call yo u r
pediatrician.
• Is gaining weight. Your baby should be
weighed during the first week of life
and may lose a little weight first —
this is normal. Breastfed babies should
stop losing weight around day four or
f i ve and then begin gaining weight and
return to birth weight by 2 weeks of age.
Normal weight gain after the second
week is about one ounce per day.
• Once your milk comes in, your breasts
will feel softer after a feeding. This
tells you that your baby is getting
enough milk.
Offering your baby an extra feeding from a
bottle after nursing to “see if he is still
hungry” is not a reliable way to tell if he
has had enough. Many babies will still
take a bottle even if they have had enough
f rom the breast.
Feeding frequency
Your baby’s stomach is small and he
digests breast milk easily, so it will leave
the stomach in one to two hours. T h i s
means you should feed your baby often
in the first few weeks, but the time
b e t ween feedings will get longer.
Always feed your baby when he is showing
signs of hunger, even if the baby just ate
an hour ago. This is normal in the first
f ew weeks and before naps. Your baby is
doing well if he nurses eight to 12 times
in a 24-hour period.
Feeding length
Your baby should nurse long enough to
get a good flow of milk and to be full. In
the beginning of the feeding, the milk is
more watery, and as nursing continues,
the fat content increases until your baby
reaches the rich, high-fat hindmilk. It is
best to allow your baby to nurse as long as
he wants (at least 15 minutes) on the first
breast so the baby is reaching the hindmilk,
which is important for his growth. W h e n
your baby has had enough, he will let go
of the breast and seem satisfied. Try burping
your baby, and then offer the second breast.
Your baby’s strongest suck is at the beginning of the feeding. Don’t always start the
feeding on the same breast — switch back
and forth at the start of each feeding.
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Growth spurts
At around 2 weeks, 6 weeks and 3 months,
your baby may go through growth spurt s .
He will want to nurse every 90 minutes
or so for a day or two. Remember, this is
your baby’s way of helping you produce
more milk. Allow your baby to nurse as
often as he wants during this time, and
you will make enough milk for him.
Call your local nursing mothers group or
La Leche League if you experience:
Call your pediatrician or obstetrician if:
Breastfeeding can be a rew a rding experience
for both you and your baby. The staff at
Children’s Hospital is here to make your
breastfeeding experience a positive one.
Lactation specialists and breastfeeding
resource nurses are available to assist both
inpatient and outpatient mothers. They
can also help you if you have difficulty
finding a nursing mothers' group or
La Leche League group. You can reach
the Hospital’s lactation specialists at
215-590-4442.
• You notice a white coating that doesn’t
come off your baby’s tongue and cheek
• You notice your baby has a ye l l ow
coloring to the skin or in the white part
of the eye s
• You have sudden onset of flu-like
symptoms, pain in the breast and
a fever
• Difficulty getting your baby to latch on
• So re or cracked nipples
• Flat or inve rted nipples
• So re breasts or lumps in breast without
fever
Pumping, Handling and Storing Breast Milk
There may be times when you can’t be with your baby to breastfeed, but you still want
him to have breast milk. You can express milk ahead of time with a breast pump. Childre n’s
Hospital’s lactation specialists can help you learn how to use a breast pump properly.
Tips for pumping
• If you are having problems producing
milk, try putting warm washcloths on
your breasts and massaging both breasts
for five minutes before pumping.
• Think about your baby, look at photos
of him, think happy thoughts and relax
(try a warm drink, listening to music,
watching TV or reading). Stress can
interfere with milk production.
• Try not to focus on pumping or on the
amount of milk in the collection bottles.
• Drink plenty of fluids and make sure
you are eating three healthy meals a day.
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• High-calorie, healthy snacks are good
if you can’t fit in scheduled meals. Try
dried fruits, nuts, cheese and crackers,
granola bars, peanut butter and dried
cereal.
• If your supply is low, pumping more
often will help to increase it. You can
pump every two to three hours during
the day and at least once at night. If
your supply is low, you may consider
renting a hospital-grade pump to help
completely empty your breasts and
increase your milk supply.
• It may take several days for your supply
to increase. Do n’t worry; it will happen.
Tips for storing milk
• Use as many bottles as you need, but
s t a rt with clean ones each time yo u
pump.
• Do not add new milk to previously
collected milk, even if there is room in
the bottle. This increases the risk of germs
entering the milk you already pumped.
• Use fresh milk when possible. You may
s t o re fresh milk for as long as five days
in the refrigerator if your baby is at
home. If your baby is in the hospital,
s t o re milk for no longer than 48 hours
in the refrigerator. Breast milk may be
s t o red in the fre ezer for three to six
months.
• Milk that will not be used within 48
hours should be frozen. Thawed milk
must be used within 24 hours.
Pumping at home
If you will be spending a lot of time at
home pumping, you will probably want to
rent an electric pump to keep there. An
electric pump works better than a small
hand or battery-powe red pump. Children’s
Hospital recommends electric pumps for
maintaining your milk supply if your baby
is not breastfeeding yet. If your baby is
breastfeeding and you plan to pump only
occasionally, then one of the hand or
battery-powe red pumps is fine.
To rent a pump, you may call the Hospital’s
Lactation Rental Station at 267-426-5325.
Resources for pumps include:
• Medela® (this is the brand Children’s
Hospital uses, so if you rent this pump
you won’t need to purchase another
pump kit). 800-Tell-You rents Medela
Symphony®, ClassicTM, and Lactina®
hospital-grade breast pumps, as well
as Ba by WeighTM scales.
• Ameda® (The Medela kit will not work
with this pump). 800-323-4060.
These companies will tell you where yo u
can get a pump close to your home.
Rates va ry, so it pays to shop around and
compare prices. Often, your insurance
company will pay for the cost while yo u r
baby is in the hospital. Check with them
first. They may even send one to yo u r
house.
Additional questions or problems
with pumping
You may get help with pumping or
maintaining your milk supply by calling
the lactation specialists at 215-590-4442.
Leave us a message and we will get back
to you as soon as we can. We want to help
you get your baby back to breastfeeding as
soon as possible.
Formula Feeding
Infant formulas meet all your baby’s nutritional needs for the first 4 to 6 months of
life. You don’t need to feed the baby extra
water, juice or cow’s milk. There are two
major types of infant formula: cow milkbased (Similac™ or Enfamil™) and soy-based
formulas (Isomil™ or Prosobee™). Your
doctor or nurse practitioner can help yo u
decide which formula is best for your baby.
Both types contain all the vitamins
n e c e s s a ryfor your baby’s growth.
How to prepare infant formula
Infant formula comes in three forms:
• Ready-to-feed: This is the most convenient but most expensive way to buy
your formula. All you have to do is
open the can and pour it into a bottle
(or attach a nipple if you are using the
kind that comes in a bottle).
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• Concentrated liquid: Mix this formula
with water in a ratio of 1-to-1 (for
example, two ounces of concentrate
and two ounces of water), or you may
mix the entire can of concentrate with
one can of water.
• Do not use a microw a ve to warm formula
— it causes uneven heating and can
burn your baby’s mouth.
• Burp your baby often, after eve ry one to
two ounces.
• Do n’t put your baby to bed with a bottle
— it can cause tooth decay.
• Powd e red formula: This is the cheapest
way to buy your formula. Mix each scoop
of powder with water as directed: one
scoop of powder in two ounces of water.
• Feed your baby only formula, no water.
Do not feed him cereal or other foods
until your pediatrician says it is OK
(usually at 4 to 6 months of age).
Tips
• Wash your hands before preparing
formula.
• It is not necessary to boil the water
before mixing the formula.
• Use cold tap water — there is less risk
of lead poisoning and it usually contains
fluoride for your baby’s teeth. You do
not need to use bottled water.
• Use a clean container with a top to mix
formula, and shake well until all lumps
a re gone. You may also use a blender to
mix formula.
• You should store prepared or opened
formula in the refrigerator until ready
to use. Use prepared formula within 24
hours.
• Warm the bottle of prepared formula in
a pan of warm water.
• If you warm the formula, check the
temperature on your own wrist before
giving it to your baby to avoid burning
his mouth.
Im p o rtant Feeding Information
Do not feed your baby more often than eve ry two to three hours and do not let him sleep
longer than four hours at a time during the day as a young infant. Unless your baby has
special needs, you do not need to awaken him during the night to eat.
Spitting up
• Most babies spit up a small amount
after feedings. This can be very messy,
but your baby will outgrow it by 9
months of age.
• You can reduce the spitting up by
burping your baby often (after eve ry
one to two ounces).
• Avoid swings or bouncing activities after
feedings.
• Try offering smaller feedings, more often.
• Try keeping the baby upright for 30
minutes after each feeding.
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Call your doctor or nurse practitioner if:
• Your baby does not seem to be gaining
we i g h t .
• Your baby seems to be vomiting most
or all of the food after a feeding.
• Your baby is having ve ry watery stools
m o re than eight times a day.
• Your baby is having fewer than six we t
diapers per day.
• Ne ver prop up a bottle while your baby
is feeding: it can cause choking and lead
to ear infections.
• When feeding your baby formula, hold
him in a partially reclining position
with his head higher than his stomach.
Hold the bottle tilted so that the nipple
is always filled with formula and your
baby will not swallow a lot of air.
Schedules
Most formula-fed babies will want to eat
eve ry three to five hours, but feed yo u r
baby when he is hungry. At first, your new
baby may only drink one to two ounces at
each feeding. At most, a baby can usually
drink his weight in pounds divided by two
(for example, a 12-pound baby should not
be drinking more than six ounces at a time).
Diapers and Diaper Changing
At birth and for the first few days of life, babies have greenish-black, thick and sticky
stools. This is called “meconium” and is the material that was in your baby’s bowels before
b i rth. These change to normal stools within 48 hours. Breastfed babies have watery, seedy,
ye l l owstools that may come with eve ry feeding. After the first month, they become less
frequent. Formula-fed babies usually have soft, pasty, ye l l owish-brown stools. All babies
should have six to eight wet diapers per day. The number of stools varies from baby to baby.
Diapering
At first, it may seem a frightening task to
change a diaper — particularly if your
baby is screaming and waving his arms and
legs around while you’re trying to do it.
Don’t worry; with a little practice, yo u
soon will grow used to this routine. You
will need about 10 diapers a day for yo u r
baby. Disposable diapers are more popular
than cloth ones because they are conve n i e n t
and easy to use. However, they can be
expensive to buy. Disposable diapers come
in several sizes; be sure they fit securely, but
not too tightly, around your baby’s thighs.
Be f o re diapering your baby, make sure yo u
have all supplies within reach. Do not leave
your baby alone on the changing table,
even for a moment, and even if he hasn’t
yet begun to roll over by himself.
You will need:
• A clean diaper
• Diaper ointment if the baby has a rash
• A container of warm water
• Cotton balls, a clean washcloth or baby
wipes
• A towel or clean cloth for dry i n g
1. After each bowel movement, or if yo u r
baby’s diaper is wet, lay your baby on
his back on a changing mat (with a
waterproof backing, if possible), or
other flat surface, and remove the dirty
diaper. Remove a boy’s diaper carefully,
because the feeling of the air on his skin
may cause him to urinate suddenly.
Dispose of the dirty diaper in a plastic
bag or diaper pail; diapers are not
flushable.
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2. Wipe and wash the entire diaper area
each time you change your baby.
3. Pat your baby dry using a towel or
washcloth — any moisture that remains
on the skin can cause diaper rash.
Do not use baby powd e r. The dust
can cause breathing problems. If your
baby has a rash, apply ointment.
4. To put on a new diaper, open it up, lift
your baby’s legs up by his feet and slide
the clean diaper under his buttocks.
Release his feet and bring the front of
the diaper up between his legs, smoothing
it over his stomach. Fasten the sticky
tabs, angling them downward so the
top corners of the tabs don’t irritate
your baby’s stomach.
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• Gently clean the diaper area with a warm
washcloth, or allow your child
to soak in a tub of warm water for five to
10 minutes (never leave your child alone
in the tub). This will help your child to be
m o re comfortable and help the area to heal.
• If possible, allow the skin to air-dry
completely by leaving the diaper off for
a period of time.
• Do not use baby wipes or lotion to clean
the area.
• Apply a thick layer of diaper cream, such
as De s i t i n™ or A&D™ ointment,
after you have cleaned the skin.
Choose a convenient time before feeding
time for bathing. Many parents prefer
either the morning or evening. You do not
need to bathe your baby eve ry day — in
fact, frequent bathing can cause ove rdrying
of his skin. Bathing your baby two to thre e
times a week is enough. Wash your baby’s
face eve ry day and clean your baby’s diaper
area with eve ry diaper change.
Gather eve rything you need before yo u
undress the baby :
• Clean bath tub (there are many baby
models from which to choose)
• Mild soap (such as Dove™ unscented)
• Do not use baby powder or cornstarch on
the area.
• Two soft towels (put one in the tub to
prevent the baby from slipping)
5. Always wash your hands well after
changing a diaper.
• Avoid using rubber diaper pants.
• Diaper and undershirt
Call your doctor or nurse practitioner if:
• Soft washcloth
Diaper Rash
Diaper rash appears as a flat, pink or
bright red rash on the diapered area.
For treatment:
• Your baby’s stools contain blood and/or
mucous.
• Blanket
• Change your child’s diaper often.
• Make sure the diapers aren’t too tight.
• T h e re are any blisters in the diaper area.
• T h e re is any bleeding from the diaper area.
• The rash doesn’t start to get better after
48 hours.
Bathing Your Baby
Bath time can be enjoyable for both you and your infant. It is a time when you can talk to
and play with him. Also, it gives you a chance to watch his behavior and examine his skin.
Newborns do not need a full bath at first.
Do not use soap on your baby’s face.
Using cotton balls squeezed in warm
water, wipe your newborn’s eyes from the
nose outward, using a separate cotton ball
for each eye to pre vent infection. Wash
the outside of the nose and the ears with a
damp cloth. Do not use cotton swabs to
clean inside your baby’s ears or nose. Wipe
into the creases in his neck and armpits,
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and clean his hands and feet. Clean the
diaper area according to the “Diapers and
Diaper Changing” section, above.
The most important rule about bathing
your baby is never leave him alone in the
tub or turn your back, even for a
moment, and never let go of your baby
while he is in the water. If you need to
l e a ve, put the baby back in his crib.
• Padded surface on which to lay the baby
1. Always wash your hands before handling
your infant. Bathe him in a warm
room, away from drafts. Your baby’s
skin is sensitive, so make sure the bath
water is warm, but not hot. Check the
temperature by using your elbow or the
inner side of your wrists.
2. Do not use soap on your baby’s face.
Clean around his eyes with cotton balls,
a different one for each eye to prevent
infection. Wipe with plain water from
the inner corner (nearest the nose) to
the outer corner. Wash the outside of
the nose and the ears with a damp
cloth. Do not use cotton swabs to clean
inside your baby’s ears or nose.
3. It is not necessary to clean inside yo u r
baby’s mouth. The tongue, gums and
cheeks should be smooth, clean and
pink, and the baby’s breath should
smell good.
4. To wash your baby’s hair, use baby
shampoo or lather from soap. Hold the
baby securely, supporting both the neck
and the back. Rub your baby’s head
gently, in a circular motion, from front
to back. Rinse well and pat dry. Be
c a reful not to get soap in the baby’s
e yes. Washing your baby’s hair prevents
cradle cap, a scaly rash on the scalps of
healthy babies.
5. When bathing the body, wash in the
folds and creases of the neck, arms,
thighs and buttocks. Dry these skin
folds carefully.
6. When bathing a girl, open the labial
lips (folds in the genital area) and wipe
f ront to back to prevent infections.
Do n’t try to remove the sticky white
substance in the folds all at once – it
will work its way out gradually. This is
vernix, the material that covered yo u r
baby in the womb.
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When bathing a boy, wash the diaper
a rea well. Gently wash the skin folds
a round the scrotum. For boys with an
uncircumcised penis: never pull the
f o reskin back. This can cause severe
s welling and may block urine flow. Penis
g rowth over the first several years will
gradually stretch the foreskin. If the baby
has been circumcised, follow the directions from your doctor.
Rinse the diaper area and dry well
(see “Diapers and Diaper Changing.”)
Bath tips
• Gi ve your baby a sponge bath until his
umbilical cord stump falls off. The nave l ,
or belly button, needs time to heal.
• It is safe to wash over the soft spots on
your baby’s head.
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• You do not need to use oil, Vaseline™
or lotion on the baby’s skin or hair.
• Do not use baby powd e r. The dust can
cause breathing problems for you and
your baby.
Call your doctor or nurse practitioner if:
• You notice a rash anywhere on your
baby’s body.
• You notice any changes in skin color or
texture.
• You see any drainage from eyes, ears or
nose.
• You notice that the navel is not healing,
t h e re is more drainage or the color is
different.
Daily Baby Care
Nail care
To pre vent your baby from scratching
himself, keep his nails short and clean.
Cut nails straight across; do not round
them. Use an emery board to file the nails.
You may find it easier to cut the nails
while the baby is sleeping.
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When dressing the baby, use yourself as a
guide. If you are warm, your baby will be
warm. If you need a swe a t e r, your baby
needs a swe a t e r. Do n’t overdress your baby.
Dress warmly to go out in cold weather,
but unbundle your baby as soon as you
go inside.
Walks and crowds
Avoid going for walks outside during
temperature extremes (below freezing or
above 85 degrees Fa h renheit). Avoid
direct sunlight — babies under 6 months
of age can’t wear sunblock. Walks outside
in open spaces and nice weather are fine.
The more people to whom the baby is
exposed, the more likely he will get sick, so
a void anyone with re s p i r a t o ryproblems, g a strointestinal symptoms or a rash. Ha ve visitors wash their hands with soap before they
touch the baby, and wash your own hands
before touching your baby.
Sleep and Crying
• You see white patches or color changes
inside the mouth.
• Do not use bubble bath. It can be
irritating to both girls and boys, and it
may also cause urinary tract infections
in girls.
Umbilical cord care
Keep the cord dry — don’t give your baby
a tub bath until it has fallen off. Keep the
diaper away from the cord. Watch for signs
of infection: a foul odor, pus discharge or
red skin around the cord. Call your doctor
or nurse practitioner if the cord isn’t dry i n g
up. Infection of the cord is an emergency.
Dressing
New clothing should be washed in a mild
detergent before wearing the first time,
and buy only baby clothing that’s flameretardant.
Genital care
For girls, wipe front to back to prevent
infections.
For boys with an uncircumcised penis,
n e ver pull the foreskin back. This can
cause severe swelling and may obstruct
urine flow. Penis growth over the first seve r a l
years will gradually stretch the foreskin.
If your baby is circumcised, you will
receive a separate sheet about his care.
Sleep
Each infant has his own sleep pattern. It is
normal for infants to sleep 12 to 20 hours
a day in one- to three-hour stretches, waking
for feedings and diaper changes. Be sure to
play and talk with your baby when he is
a l e rt. He will not know the difference
b e t ween night and day at first, but most
babies sleep through the night by 4
months.
About 20 to 30 percent of infants and
young children have a hard time falling
asleep or wake up at night. In most cases,
sleep problems are not a part of a larger
medical problem. The ways in which
infants learn to fall asleep can start a
pattern for the next few years. While there
is no magic cure for sleep problems, most
will go away if parents are able to stick
with a program over time.
Newborn to 6 months
• Babies should always sleep on their
backs.
• Babies at this age rarely sleep through
the night without waking.
• Babies need to be fed throughout the
day and night.
• Feeding a baby cereal will not make
him sleep through the night.
7 Months to 1 Year
Babies at this age may still wake at night.
Usually, they do not need a nighttime
feeding. Babies do need a routine pattern
of getting ready for bedtime each night.
Here are some tips for getting your baby
to sleep:
• Try to put your baby to bed at the same
time each night.
• If possible, your baby should sleep in
the same place each night.
• Keep the room quiet and dark.
• Rock, hold, read to or feed your baby to
help him get ready for sleep.
• Put your baby down to sleep while he is
still awake.
• Cribs should be empty of toys.
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Swaddling
Swaddling, or wrapping your baby snugly in a blanket, is a soothing technique that may
help him sleep. The goal is to keep your baby warm and give him a sense of security.
This may resemble how babies felt when they we re in the womb. Here is how to swaddle
a baby:
• Use a large blanket or sheet. Spread it
out and fold one corner over slightly.
• Bring the bottom corner up and ove r
his feet.
• Lay the baby face-up on the blanket
with his neck at the folded corner.
• Finally, bring the left corner downward
and across your baby’s body and tuck it
s e c u rely underneath him, leaving only
his head exposed. Make sure the material
isn’t too tight against the neck.
• Bring the right corner downward and
a c ross your baby’s body and tuck it
snugly underneath him.
If your baby wakes up at night, check to
make sure he is not in pain or whether he
needs to be changed. To help him learn it
is time for sleep, avoid cuddling or playing
with him if he wakes during the night.
If your baby has napped for three hours
during the day, gently awaken and play
with or feed him. This will help decrease
the amount of time he is awake at night.
Crying
Newborns may cry for as much as three
to four hours each day; it is the only way
they can tell you they need something.
Crying does not always mean your baby
is hungry (Cold? Hot? Wet? Tired? Soiled
diaper? Need to be cuddled?) The crying
may be difficult to understand at first, but
you will become better able to tell with
time. You can’t “spoil” a newborn.
Responding to his needs helps your baby
to feel safe and secure.
Babies who fuss a lot may be thought of
in two groups. The first group consists of
babies who are very sensitive to the world
around them. Sudden movement upsets
16
them, and even their own re f l e xes can cause
them to cry. These infants need to be handled gently and quietly, avoiding bright
lights, loud noises and bouncing. They
respond well to being wrapped snugly in a
blanket to reduce their own movements.
Babies in the second group like bouncing
and other large body movements. These
infants are soothed by music, motion and
body contact. As you learn more about
your baby, you will figure out which
activities your baby likes.
Try not to be upset when your baby cries.
Fussy babies are not angry with you or
rejecting you. You may need to take a
break from the baby. Ha ve a family
member come ove r, even for an hour,
so you may get out briefly.
Call your doctor or nurse practitioner if:
• The baby cries for an extended period
of time.
• The baby has a fever or looks sick.
• The baby doesn’t calm down when fed
or changed.
Colic
Many doctors define colic as long periods
of screaming without a clear cause. It’s
common for infants to suffer from colic –
about one in 10 babies has it. The good
n ews for sleepless parents is that most
doctors consider colic a normal part of an
infant’s development, and it generally
stops by 3 months of age.
Colic usually begins when babies are less
than 2 weeks old. Symptoms include crying
if an infant isn’t hungry or sick and doesn’t
h a ve a fever. Fits of crying last for one to
two hours or more, though a colicky baby
acts fine between bouts and when one
holds him.
To treat your colicky baby:
• Cuddle and rock him when he cries.
• Offer him your little finger to suck.
• Place him in a pouch or front-held
carrying pack.
• Place him in a windup swing or vibrating
chair.
• Take him for a stroller ride.
• Avoid excessive bouncing.
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If none of the above works after 30 minutes:
• Wrap your baby and place him in a
crib, and minimize noise and activity
while he is trying to fall asleep.
• If your baby cries for more than 15
minutes in the crib, pick him up and
try the soothing activities again.
• If your baby is tired but not cry i n g ,
place him in a crib, and he will
e ventually fall asleep.
Caring for a baby with colic is hard work
and tiring. Be sure to ask a family member
or a friend for help with other children
and chores while you are tending to a
colicky baby.
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• Your baby cries constantly for more
than three hours.
Playing with Your Baby: birth to 4 months old
• You are afraid you might hurt your baby.
• You have shaken your baby.
• You can’t find a way to soothe your baby.
Call your doctor or nurse practitioner
during regular office hours if:
• The excessive crying began after 1 month
of age.
• The excessive crying continues after 3
months of age.
• Your baby is not gaining weight and may
be hungry.
Call your doctor or nurse practitioner
immediately if:
Your baby needs your love and help to
grow and develop. Here are some activities
you can do with your baby from birth to
about 4 months old:
Sh ow your baby different objects or toy s .
Let your baby look at and touch:
• Cuddle your baby and talk to him. Even
though he can’t understand the words
yet, the beginnings of language are
being formed now.
• A colorful board book: Name the
objects in the picture book while showing
the pictures.
• Let your baby look at black-and-white
and brightly colored objects/toys.
• Change his position: on his back, in an
infant seat, on his belly (except for
sleep), in your arms.
• Call your baby’s name and tell him yo u
a re coming whenever you approach him.
• Your baby’s cry sounds as if he is in
pain, rather than merely fussing.
Infant Development and Stimulation
• Talk to your baby as you feed, dress, or
change him. Use a soft, calming, friendly
voice. Tell your baby what you are doing.
• Sing, whistle or hum to your baby.
• Repeat the sounds your baby makes.
From birth, a newborn can interact with people and things. Cuddle your baby. Sing and
talk to him. Even though your baby cannot understand words yet, the development of
language begins now. Touch, sound and sight are a new b o r n’s most important senses.
Touch
This is the most important stimulation
for a newborn. Good ways to touch yo u r
baby include breastfeeding, holding,
rocking, massaging and bathing.
Sight
Newborns can focus their vision only a
f ew inches in front of them. They close
their eyes in bright light. They prefer to
look at patterns more than at solids, and
they enjoy looking at things that move
more than things that are still. Bright,
bold colors are easier for them to see than
pastel colors.
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• Pick up your baby gently and slowly.
Hold your baby close to your body and
cuddle him.
Sound
Infants are soothed by slow, gentle, rhythmic
sounds. Loud and sudden noises start l e
them. Most babies love the sound of
talking and singing. Music, music boxes,
voices, mother’s heartbeat, clocks and
rattles are all pleasant sounds for babies.
• While your baby is awake, place him
tummy-down so he can play and learn.
Reflexes
There are many normal reflexes in
n ewborns, including blinking, sneezing,
coughing, hiccuping, startling, grasping
and rooting (turning his head toward yo u
if you brush his cheek).
• Against your chest with his head over
your left or right shoulder
• A mirror: Say “Who is that?” and point
to your baby’s image and say his name.
• A colorful stuffed animal: Name the
type of animal and the colors on
the animal.
• A colorful picture: Talk about the picture.
• A soft toy such as a squeeze toy or rattle.
• Your face.
Gently shake a brightly colored baby rattle
near your baby. If he looks tow a rd the
rattle or reaches for the rattle, give him a
smile and kiss.
Hold your baby’s hand and help him
touch different textures, like a soft blanket,
your face, your hair or a rattle. Help him
hold and gently shake the rattle.
Hold your baby in different positions
while supporting your baby’s head:
• In front facing you
• In front facing outward
Gently stroke your baby’s head, arm or
back, or hold your baby’s hand while you
cuddle.
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Playing with Your Baby:
5 to 8 months old
• Once the baby can pull himself up,
keep the crib mattress at the lowest
l e vel and the crib rails all the way up
to pre vent falls.
• If you must smoke, don’t do it in the
same room as the baby. Never smoke
while holding the baby (See “Secondhand
Smoke” section).
In addition to the activities above, here
are some you can do with your 5- to
8-month-old:
• Ne ver turn your back or leave while
your baby is on a changing table or bed,
e ven if the baby is in an infant seat and
e ven if he hasn’t yet begun to roll over
by himself.
• Make sure your baby can’t get anything
pulled tightly around his neck. Do not
hang a pacifier on a string or ribbon
a round his neck. Watch out for hanging
cords or ropes, such as those from window blinds and curtains.
• Laugh when your baby laughs; smile
when your baby smiles.
• Keep all plastic bags away from your
baby — if he puts it on his head, he
could suffocate. Plastic that makes a
loud rustling sound, such as dry - c l e a n i n g
bags, often attracts babies.
• Make interesting noises to encourage yo u r
baby to make sounds and imitate you.
• Show your baby new and differe n t safe
toys. Play simple movement games with
him using your and his hands,
fingers or toes (Itsy-Bitsy Spider, Peeka - B o o, the Wheels on the Bus, This Little
Pi g gy Went to Ma rket, Pat-a-Ca k e).
• Place a toy or rattle out of your baby’s
reach so he can try to reach or grasp for
it. Hide a toy behind you or under your
hands with part of it showing. Attract
your baby’s attention to it and encourage
him to pull it out.
• Help your baby notice the different
things a toy can do by putting his hand
on it and helping him touch, shake or
mouth it.
• Let your baby listen to different sounds,
including:
• Quiet sounds, such as the ticking of a
clock or whispering
• Water running in the sink
• A light switch turning on and off
• A door opening and closing
• The wind or rain
Place your baby in different sitting positions
and support him. Encourage your baby to
look upw a rd by lifting a toy over his head.
• To prevent choking, never leave small
objects (such as coins, Lego™ pieces
and buttons) within your baby’s reach.
Babies have a natural impulse to put
things in their mouths.
• When your baby is old enough for solid
foods, never feed him hard items such
as carrots, apples, hot dogs, hard candy
or grapes. Always supervise your child
eating and drinking, and cut food into
tiny pieces. Never give peanuts to a
child under 4, because he can choke on
them or inhale them into his lungs. Be
extra careful when you are at parties or
visiting other people’s homes.
• Place childproof covers on all electrical
outlets.
Infant Safety
Nearly 300 children under the age of 4 die eve ry month in the United States, and injuries
are the most common cause of death in children ages 1 to 4. Often, these deaths are from
accidents that could have been pre vented. Following the tips below is a good way to start
a lifetime of safety.
• Place your baby on his back to go to
sleep.
• Do not place pillows, comforters or
stuffed toys in the crib with your baby ;
they can cause suffocation.
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• Make sure there are no more than 2 3/8
inches (the size of a soda can) betwe e n
the slats of your baby’s crib. A crib
shouldn’t have any missing, loose or
b roken hardware.
• Set the temperature on your hot water
heater below 120 degrees to prevent
scalds.
• Ne ver carry your baby at the same time
you are carrying hot foods or liquids.
• Stay away from crowds (malls, restaurants)
during your baby’s first 2 months when
he is most sensitive to germs.
• Bew a re of open-we a ve sweaters and
blankets in which your baby could get
his finger caught.
• Make sure smoke detectors and fire
extinguishers work on every floor in
your house. Plan escape routes in case
of fire.
• Keep poison control, police, fire and
ambulance numbers by your phone.
• Do not warm baby food or formula in
the microwave.
• When riding in a car, your infant must
ride in a rear-facing car seat. Read and
f o l l owthe instructions that come with
the car safety seat and the section in the
owner’s manual of your car on how to
install and use the car seat correctly.
Ne ver put an infant in the front seat
of a car that has a passenger-side air
bag, or in any front seat.
• Use gates on stairways and close doors
to rooms where your baby might get
hurt.
• Put window guards on all windows
above the first floor.
• Do not use a baby walker.
• Take classes in baby first aid and CPR.
• Wash your hands before touching your
baby and have visitors do the same.
People who are sick shouldn’t hold or
touch the baby.
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Secondhand Smoke
What is it?
Secondhand smoke is the smoke released
from a burning cigarette and that a smoker
exhales. It has more than 4,000 chemicals
in it, including nicotine. Some of these
chemicals cause cancer.
What can I do?
• Talk with others in your home about
making your home a smoke-free
environment.
Why is it bad for children?
Infants and children breathe in secondhand smoke whenever someone smokes
around them. The level of nicotine in an
infant’s blood may be as high — or higher
— than in the blood of the smoker. If yo u
smoke around your child, it is as if he is
smoking too!
• Smoke lingers in clothing. Change yo u r
outer clothes after smoking.
Children who breathe in secondhand
smoke are not as healthy nor as strong as
children in smoke-free homes.
Secondhand smoke can contribute to
many childhood illnesses, including:
• Asthma
• Ear infections and hearing problems
• If you must smoke, do it only outside
and away from your children.
• Wash your hands after smoking and
before touching your infant.
• If your child is 1 month to 2 years old,
call Philadelphia Fresh at 215-746-7158.
It is a free program at the University of
Pennsylvania that gives advice and
information about how to limit yo u r
child’s exposure to tobacco smoke.
• The best, safest option for you and
your child is for you to quit smoking.
Millions of people have done it. Talk to
your doctor or nurse practitioner, or call
the free 24-hour Pennsylvania Qu i t l i n e
for help at 877-724-1090.
• Upper-re s p i r a t o ryinfections
• Respiratory problems, such as bronchitis
and pneumonia
• SIDS (Sudden Infant Death Sy n d rome)
• Colic
Secondhand smoke can cause problems
for children later in life, including:
• He a rt disease
• Lung cancer and other cancers,
including leukemia and lymphoma
• Cataracts (eye disease)
• Becoming smokers themselves
22
DEDICATION
We dedicate this booklet to the memory of
Liz Lopez, R.N., B.S.N.,
who worked for Children's Hospital for 17 years
in the Newborn/Infant Center, Connelly Resource
Center for Families and Lactation Program.
The patients and families she served as well as
her colleagues benefited from her compassion,
Includes information from:
Pasquariello, Jr., M.D., Patrick S., Sr. Ed.
The Children’s Hospital of Philadelphia Book
of Pregnancy and Child Ca re. New Yo rk:
John Wiley & Sons, Inc., 1999.
©The Children’s Hospital of Philadelphia 2005
her devotion and her generous spirit.
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