Pullman Regional Hospital

Caring for a new baby can be tough. Below is some detailed information to help you along. If you need further help or have a question for us, feel free to contact one of our qualified nurses at (509) 336-7401.

Bottlefeeding

• Wash your hands and all equipment.
• No need for sterilization if you're using chlorinated water.
• Follow directions carefully when mixing the formula.
• Hold baby close with head slightly elevated and place nipple straight into mouth.
• Be sure that nipple is full of formula.
• Never prop a bottle.
• Alternate arm baby is held in to promote equal eye development.
• Burp baby about every ½ ounce in the first weeks.
• Discard unused portion of bottle.

Breastfeeding

• Wash hands before feeding.
• Feed baby on demand at least 8-12 times per 24 hours, waking him/her, if necessary.
• Start with the breast you finished on last time. Empty the first breast before offering the second. Although it's common for a newborn to only want one breast per feeding in the first few weeks, offer both.
• Make sure the infant takes 1 to 1½ inches (2-3 cm) of the areola into his mouth.
• It usually takes 10-15 minutes of active nursing to empty a breast, BUT it may take as little as six minutes or as long as 30. Use different positions to decrease nipple soreness. There's no need to limit nursing time if nipples are not sore.
• Break suction by inserting finger into infant's mouth before removing baby from breast. Wipe off baby's saliva, express colostrum or breastmilk, rub into nipples, then air dry.
• Burp your baby after emptying each breast, and at the end of the feeding.
• Breast-fed babies need no other food or fluid if they are having 6-8 wet diapers and two or more large, runny, curdy yellow bowel movements daily after four days old. Diapers should be moderately saturated and urine should be clear.
• Call BirthPlace or your physician if baby is not having frequent wet and dirty diapers after day four.
• Refer to ‘Breastfeeding Basics', ‘Troubleshooting Guide' and ‘Is Baby Getting Enough?' info sheets in your post-partum folder.

Bulb Syringe

• Position infant's head down or to side.
• Squeeze bulb before putting into mouth or nostrils.
• Release pressure to draw out mucus.
• Wash bulb syringe with warm soapy water after each use.
• Avoid over-suctioning that can cause increased swelling of nasal passages.

Car Seat

• Rear-facing position in back seat at 45 degree angle until 20 pounds and at least 1 year old.
• No greater that one finger width between shoulder strap and baby's collar bone.
• Chest clip slid to level of armpits.
• Once secured, seat should not be able to move more than 1″ (2 cm) side to side or front to back.
• Head rolls not crash tested with the seat and seats more than 5 years old may be unsafe and should not be used.

Circumcision Care

• Plastibel will fall off usually in 7-10 days.
• Keep Vaseline® gauze on for 24 hours if no plastibel is present unless it falls off. Apply Vaseline® to the penis and/or diaper to prevent the penis from sticking to the diaper.
• Some drainage is normal and baby may be fussy.
• Complications to report to the doctor: watch for bleeding and swelling-infant may be unable to urinate, have a fever, or the area may have a foul discharge.

Cord Care

• Keep edge of diaper turned down exposing cord to the air.
• Wash your hands before cleaning the cord.
• Clean base of cord where cord and skin meet with rubbing alcohol or warm water only if it becomes soiled or smelly until the cord falls off.
• Typically the cord dries and falls off within the first two weeks after birth and it is common to see small smears of dry dark red blood when the cord is about to fall off and for a day or two afterward.
• Call your doctor if there is bright red bleeding making a spot larger than a quarter, if you see any pus or drainage at the base of the cord, or if there is redness on the skin around the cord. Redness or discharge may indicate infection.

Jaundice

Jaundice is a yellowing of the skin and whites of the eyes caused by increased levels of bilirubin in the blood.

• Press a finger on baby's skin in natural light. Look for a yellow color. If your baby is jaundiced from face down to thighs, or if the whites of the eyes are yellow, call your doctor or BirthPlace. A blood test may be ordered to check the level of bilirubin in your baby's blood, and treatment with phototherapy lights may be necessary.
• Wake baby up if necessary and feed at least 12 times per 24 hours. The bilirubin is excreted in baby's bowel movements, so the more the baby "poops", the faster the jaundice resolves.
• Very high bilirubin levels can cause permanent brain damage, so it's extremely important that jaundice not be ignored.

Newborn Screening

• Identifies disorders that, if left untreated, can result in severe illness or mental retardation.
• Checks for Phenylketonuria (PKU), Congenital Hypothyroidism, Congenital Adrenal Hyperplasia, Sickle Cell disease, Biotindase deficiency, Galactosemia, Homocystinuria, Maple Syrup Urine Disease (MSUD, and Medium chain acyl-coA dehydrogenase deficiency (MCADD), and cystic fibrosis.
• State law requires that the PKU test be done prior to discharge from the hospital and needs to be repeated when baby is feeding well, in 7-14 days. (Only exception: religious objection).

Skin Care & Bath

• Dry and peeling is normal for the first two weeks. Ignore it unless cracking is present, then apply Vaseline or A&D ointment to the cracking areas.
• At two or three days baby may appear to be covered with tiny mosquito bites. This is normal newborn rash and may be ignored.
• At approximately 2-4 weeks baby's face may become covered with small red pimples. This is infant acne and may be ignored.
• Babies can be sponge or tub bathed once or twice weekly. Bathe baby starting with no soap on face. Cleanse each eye from inner to outer corner. Work in a downward direction, clean to dirty, and finish with a shampoo and rinse.
• Use only water or non-medicated, unscented soaps. A harsh soap may alter the skin's pH and decrease the skin's ability to provide a barrier against infection.
• Baby powder and baby oil are not recommended. Powder may enter lungs and cause irritation and infection. Baby oil may block pores. Diaper ointments (Vaseline, A&D ointment and Desitin) are fine.

Temperature

• For rectal temperature, lubricate thermometer with a small amount of Vaseline® or water soluble jelly (K-Y®).
• Gently insert ½-¾ inch (1-1½ cm). Hold loosely in place until thermometer beeps.
• Axillary (under the arm) is better if checking temps frequently.
• Normal range: 98-99 degrees (36.7-37.2 degrees C). Rectal temp. is more accurate than axillary above 100 degrees (37.8 degrees C).
• If temp. is low, place a hat on baby, wrap more warmly, and recheck in 20-30 minutes.
• If temp. is high, remove baby's hat or unwrap baby and recheck in 20-30 minutes.
• If baby's rectal temperature remains above 100.4 (38.0) or below 97.4 (36.3) during the first month of life despite the above measures, notify your baby's doctor.

When to Call for Medical Help

• Problems with breathing including blue lips, struggling to breathe, indentations in chest with breaths.
• Change in baby's behavior-floppy and difficult to awaken, or unusually fussy or irritable.
• Baby jaundiced to thighs, sleepy, and not eating well.
• Baby not eating well and too few dirty or wet diapers.
• Rectal temperature too high or too low.
• Problems with cord or circumcision.
• Something doesn't seem right and you are worried about your baby's health or behavior.