Clothing should be loose fitting and allow for easy movement. Don’t overdress your baby. Dress him as you would yourself. Your baby’s hands and feet may feel cool, but if his body is warm, he is fine. Cotton material is best. Wool may irritate your baby’s skin. Wash new clothing before putting it on your baby for the first time. Dreft detergent is a good choice for washing clothes and diapers. Softeners, tide, and anti-static additives (i.e. Bounce) are best avoided for the first year, as they frequently cause skin irritation.
Your baby’s crib slats should be no more than 2 3/4 inches apart and the surface should be free of splinters and painted with a non-lead based paint. The mattress should be the appropriate size for the crib. Don’t permit hanging toys or window curtains within reach of your baby.
Ideal room temperature for your baby is 65-70 degrees (no different than you probably keep it anyway!). Central or room humidifiers may provide additional humidity during winter.
Skin And Hair Care
Your newborn’s umbilical cord should be kept clean and dry. Cleansing with alcohol 3-4x per day around the base of the cord is sufficient. Once the umbilical cord is off and, if you have a circumcised boy, once the plastic ring is off the circumcision, the baby may be bathed in the tub (or sink). Until then, sponge your baby with warm water only or with a very mild soap such as Dove or Neutrogena for “real messes.” Babies don’t need to be bathed daily, just when dirty. (Once or twice a week is often enough during the winter.) Again, plain water or a very mild soap (Dove or Neutrogena) are all that are needed. Baby oils and lotions can clog your baby’s pores, causing rashes, and should be used with caution, if at all. Hair should be washed with a mild baby shampoo. You may wash around the outside of your baby’s ears with a Q-tip or soft washcloth. Do not insert Q-tips or other objects into your baby’s ear canal.
If your baby has oily, yellowish scales and crusts on his scalp, he probably has “cradle cap,” a common condition in young infants. Applying baby oil to the crusts before shampooing will help soften them so they are more easily removed. Use Selsun Blue or Sebulex shampoo and an old toothbrush to scrub the scales up and clear the problem fairly easily. Use the Selsun Blue daily until the scales have cleared, then once or twice a week to keep the problem from flaring up again.
Diaper rash is a common problem among babies. You can help prevent it by keeping your baby’s diaper area clean and dry. At each diaper change, the area should be cleansed with water and a soft cloth or with diaper wipes that don’t contain alcohol, oils or perfumes. Once a day, wash the diaper area with warm water and soap. Allow your baby’s bottom to air dry before putting diapers back on. Air drying with a hair dryer on a cool setting can be very soothing.
If your baby develops a diaper rash around the rectal area, a barrier cream such as Desitin, Triple Paste or Vaseline should be used. If the area is very red and “scalded” looking, your baby’s stools may be somewhat acidic. Applying Maalox (Yes, like you drink!) and then covering with Vaseline will speed the clearing of the rash. Eucerin cream and even Crisco shortening can also be used for dry skin.
If your baby has recently been on antibiotics, diagnosed with thrush or has developed red bumps over the front of the diaper area, she may have a yeast infection causing the rash. Generic Lotrimin cream used twice daily should clear this. (Lotrimin is now available over-the-counter.) If unsure, call the office during regular hours.
In the summer your baby’s skin will need to be protected when he is outdoors, even from indirect reflected sunlight such as under an umbrella. Babies should be shielded from direct sun exposure when possible. PABA free sunscreen lotions of a 15 rating or greater are recommended routinely for any sun exposure to provide maximum sunburn protection. Skin cancer is on the rise. Studies have shown each case of sunburn increases this risk. Though probably safe for the four month old child, it is not recommended until 6 months of age.
Infants generally travel very well. Plan ahead to allow more frequent stops for feeding and diaper changes. Infants should ALWAYS travel in APPROVED car seats.
For those babies taking airplane rides, the only precaution needed is to have the baby nursing or sucking on the pacifier during landing. This allows for equilibration of ear pressure during changes in altitude. Call ahead and request the bulk head for extra room, and try to keep your child buckled in their car seat while on the plane.
Stork bites – Flat; pink birthmarks may be present at the bridge of your baby’s nose, eyelids or the back of the neck. About half of all newborn babies have some form of these. You may notice the spots becoming more pronounced when the baby is crying and fainter when the baby is quiet. The spots on your baby’s eyelids (sometimes called “angel’s kisses”) will usually fade away in the first 3-4 months of life. Spots on the forehead or nose often take longer to fade and may not entirely fade away. Spots on the neck usually don’t fade but are covered up as the hair grows.
Mongolian spots – These are bluish flat birthmarks seen most commonly in dark skinned babies on the back and buttocks. They may be present on any part of the body and usually appear less noticeable after the first 2-3 years of life.
Milia – These are tiny white bumps seen on the face of about 40% of newborns. They are basically plugged skin pores and usually open up and disappear by 1-2 months of age. No ointments should be applied to them.
Erythema toxicum – Over half of all newborn babies develop red blotches in the first week of life, some with a small white lump in the center. These can literally appear and disappear before your very eyes but they are NOT hives and do NOT mean your baby is allergic to anything in particular.
“Drooling rash ” – A rash may often appear on the chin or cheeks due to excess drooling or contact with stomach contents after a baby spits up. Some of this can be helped by placing a clean towel under your baby’s face during naps.
Most babies develop some degree of jaundice (yellow/orange skin color). This is not present at birth but becomes noticeable at 2-3 days and usually peaks at 5-7 days It is usually seen more with breast-fed babies and may persist to some degree for 2-3 weeks. Notify our office during hours if during the first two weeks of life you notice increasing jaundice or jaundice plus:
- Excessive sleepiness
- Poor feeding
- Less than 1-2 bowel movements a day
- Less than 3-4 wet diapers a day
If your baby has jaundice but is feeding well, urinating and stooling, it is usually not a problem. Call us if you are concerned and we can see your baby and/or obtain a bilirubin level. Treatment is usually simple observation and occasionally phototherapy (usually done at home using a fiber optic light blanket).
Newborns may have up to 10 loose stools per day, especially if breastfeeding, or may not have a stool for a week or more at a time. As long as your baby’s tummy feels soft and the stools aren’t rock hard or so watery they leave large water rings in the diaper, things are probably just fine. Again, many babies grunt and turn red in the face when having a stool. This does not in itself mean your baby is constipated. Small babies should not be given enemas; always call the office during regular hours if you are concerned about your child’s stool pattern.
It is normal for newborn babies to sleep much of the time. They often awaken only for feedings or diaper changes. As your baby gets older, he will sleep less and play more. If you happen to have a “good” baby who wants to sleep all day when first coming home from the hospital, be sure to awaken the baby every 4 hours at least during the day so the baby doesn’t sleep through too many feedings. At night, if the baby wants to sleep for a longer period of time, LET THE BABY SLEEP if your baby is gaining weight appropriately!!
If at all possible, your baby should sleep in his/her own crib and own room. Babies normally are very noisy when they sleep. For your baby’s safety, under no circumstances should you sleep with him/her in your bed.
Babies should sleep on their backs or propped to the side. Crib death (Sudden Infant Death Syndrome) has been shown to occur only half as often when babies are positioned in this way. By 5-6 months, many babies can roll back to front and positioning is no longer an issue. Keep the crib free of pillows or items that could cause suffocation until 12 months of age. Awake “tummy time” is most beneficial for all babies, as long as their heads are free from anything that could block their airway.
Most pediatricians don’t have strong objections to the use of pacifiers in infants who seem to have a strong need to suck. A properly shaped pacifier is less damaging to the developing mouth than sucking on a thumb or finger. Pacifiers should be of a one-piece design to avoid the possibility of an infant swallowing or choking on a part of it. Pacifiers should not be placed on strings tied AROUND a baby’s neck or any string used which is long enough for a baby to strangle. The use of pacifiers should be for sleep (nap/bedtime) use only, not for walking around like the little girl on the “Simpsons”. The time to discontinue the use of the pacifier seems to work at either 4 months or 15 months of age. Do not expect the child to stop. There is evidence that the use of the pacifier does decrease speech in the toddler.
The decision as to whether to have a newborn son circumcised is no longer considered a medical one. While statistically there is a slightly higher chance of urinary tract infection in an uncircumcised male, the chance is still extremely low (1%). Most physicians do not inflict their personal feelings, pro or con, on families but allow the families to make their own decision on this very personal issue.
If you wish your newborn son to be circumcised, this can be performed in the newborn nursery by the OB physician prior to discharge from the hospital. A local anesthetic is injected to numb the area. “Plastibell” circumcisions are most commonly performed in this part of the state. This means there is a plastic ring that remains on the tip of the penis for a few days following the procedure. The area should be cleaned with warm water until the Plastibell detaches. If the ring appears to be slipping down the shaft of the penis, contact the office. Otherwise, the Plastibell should detach on its own within five to seven days after leaving the hospital. It is normal for a moderate amount of yellow mucus to be present when the ring is detaching. If you have concerns about this or feel the area looks red or infected, call the office.
If you do not want your newborn son to be circumcised, no special care of the foreskin is needed. Just clean the tip of the penis. Do NOT try to retract the foreskin forcefully. It will retract naturally as your child gets older (usually by 5-10 years of age).