Guide for New Parents Your Baby's Care and Feeding Caring for Your Baby at Home Feeding Your Baby For Breastfeeding Mothers For Bottle/Formula-Feeding Mothers For Breastfeeding and Bottle-feeding Mothers Caring for Your Baby at Home Once you bring your baby home, you should limit the number of people that visit. This is a special time for you to bond with your new family. Family and friends can help you by running errands and doing household chores but this is your special time to get to know your new baby. Be sure that visitors and siblings wash their hands before holding your baby. If they have a cold or have been exposed to illness, they should not visit. It is normal for your baby to lose weight in the first few days before starting to gain weight. Most babies regain their birth weight a couple of weeks after he or she was born, then double it by six months and triple it in one year. Sleeping Always place your newborn on his or her back when putting your baby to sleep. The American Academy of Pediatrics states that sleeping on his or her back is the safest position for your newborn to sleep. Sleeping in this position has been proven to lower the risk of Sudden Infant Death Syndrome (SIDS). Do not place pillows, stuffed animals, toys, a heavy comforter, or anything else in the crib with your baby. These items could suffocate or choke your newborn. Using bumper pads in the crib is not recommended. When putting your baby to sleep, it is important that your baby stays warm, but do not overdress him or her. Sleeping patterns may not become well established for some months, which is why it is so important to sleep as much as you can. Nap when your baby naps. You will soon develop a bedtime and nap routine for your baby. Some babies like to be bathed or massaged before bedtime. This may be a perfect time for you or your partner to spend with the baby. “Tummy time” is also important for the development and strengthening of the baby’s shoulders and arms. While your baby is awake and well attended, position the baby on his or her stomach. However, remember to always place your baby on his or her back for sleep. Crying Crying is your baby’s way of communicating with you. For many babies, there is a different cry for “I’m hungry,” “I need my diaper changed,” “Pick me up,” and “I want a hug.” You will soon learn your baby’s cry. You will get to know what position and activities your baby likes for comforting. Babies love it when you speak and sing to them. You will learn to tell when your baby has “had enough.” Getting to know your baby is a very exciting experience. Many parents notice their baby has a fussy period in the evening. This is not uncommon. Some think it is the baby “blowing off steam” (releasing excess energy after experiencing all the excitement of the day). Check to be sure that she or he is not hungry, does not have a wet diaper, and is not in pain. You may find that holding your baby or taking him or her for rides in the car helps to settle the baby. Infant massage can sometimes calm a fussy baby. Bathing You may be nervous or anxious about giving your baby a bath. The first bath may seem intimidating but it could also be full of laughter. As with most anything else, bathing your baby gets easier with practice. Many babies love bath time and it may become a relaxing ritual before bedtime. Be sure the area is free of drafts and choose a time when you are not hurried. Have all your supplies ready ahead of time, such as cotton balls; a soft washcloth; clean, warm water in a tub or sink; mild soap; and a towel. When bathing your baby, you can place him or her in a tub by supporting the baby’s head and bottom. Begin washing your baby from top to bottom. Gently wipe with clean water from the inside to the outside corner of each eye with a clean washcloth or cotton balls. Wipe his or her face with a washcloth. Dampen your baby’s hair/scalp with water and gently rub in baby shampoo. Rinse by pouring water over the baby’s head while avoiding the eyes. Support your baby’s head and neck with your hand under the chin and gently lean him or her forward to wash the back. Rinse with clean water. Wash from top to bottom, bathing the diaper area last. Be sure to clean well between the skin folds. For girls, be sure to wipe from front to back. For circumcised boys, clean the healed penis the same way as the rest of the body. For uncircumcised boys, do not retract the foreskin. Bathe the area and rinse. When finished, lay your baby on a clean towel and quickly dry off before diapering and dressing. NOTE: Never leave your baby unattended during bath time. Diapering Gather your supplies including a clean diaper, baby wipes, a diaper pail and petroleum jelly or diaper rash ointment. Lay your baby on the changing table and unfasten the tabs. Place a cloth under the baby so he or she will not soil the surface. Gently grasp your baby’s ankles and elevate as you take off the diaper. If your baby has a full portion of the diaper to clean the area before you wrap the used diaper into a bundle for disposal. Clean the area with wipes or a damp washcloth. Always wipe from front to back and be sure to clean between the folds of skin. Apply petroleum jelly or diaper rash ointment to your baby’s bottom. To put on a clean diaper, hold your baby’s ankles lifting his or her bottom and slide the back of the clean diaper under your baby’s bottom, lowering the legs. Pull the front of the diaper up between the legs and attach the tabs to each side. Redress your baby and wash your hands. Cutting Your Baby’s Nails Trimming your baby’s nails may seem scary at first. Try filing your baby’s nails with a nail file during the first few weeks when the nails are tiny and soft. After that, you can use nail clippers or roundtipped scissors. This is best accomplished when your baby is soundly sleeping. Taking Your Baby’s Temperature It is not necessary to take your baby’s temperature regularly. If your baby is not acting like himself or herself or feels very warm to touch, you may want to take the temperature before calling your pediatric care provider. The two ways to measure the temperature are axillary (under the arm) and rectally. Measure the temperature using the axillary method first. Place the thermometer under the arm and hold the arm in place. If his or her temperature is higher than 100.3 degrees, your pediatric care provider may want you to take a rectal measurement. Do not use a mercury thermometer to check your baby’s temperature - always use a digital thermometer. To measure a rectal temperature, wash your hands and the thermometer and then dab a little petroleum jelly (Vaseline®) on the end and press the “on” button. Lay your baby on his or her back on a firm surface, lift his or her legs and gently spread the cheeks. Use both hands, one for the thermometer and the other to hold your baby securely. Gently insert the tip about one half inch into the baby’s rectum. Hold it in place until it beeps, then slowly withdraw and read it. Notify your pediatric care provider of a rectal temperature over 100.3 degrees. Warning Signs Please call you pediatric care provider if you notice the following: Your baby seems ill or is not acting like himself or herself; Your baby is not eating well or refuses feedings; Your baby’s rectal temperature is over 100.3 degrees; Your baby has less than six wet diapers in 24 hours; Your baby is still passing meconium at three days of age; Your baby’s skin has a yellow tint, which is moving down from the baby’s face to the legs; Your baby is very sleepy and difficult to wake; Your baby is vomiting repeatedly; Your baby is crying excessively with no known cause; You notice an unusual or severe rash on your baby; Your baby has frequent or excessive loose stools; Your baby has no stool in 24 hours during the first week of life. Feeding Your Baby Feeding your baby will be one of the most satisfying experiences of early parenthood. It is a time to be close, to nurture and communicate with your baby in your own special way. Whether you choose to breastfeed or bottle-feed your baby is your decision. Parents choose each method for different reasons. The method you choose should be one that is right for you and your baby and the one that makes you and your partner comfortable. For Breastfeeding Mothers Breast milk contains all the nutrients needed for your baby’s growth and development and is perfectly matched to meet his or her needs. There are many breastfeeding benefits for your baby. Extensive research has demonstrated that breast milk provides optimal health benefits to both the newborn and the mother. Breastfed babies may also have less risk for developing: diarrhea or constipation; ear infections; asthma; diabetes; leukemia; respiratory infections; allergies. Some breastfeeding benefits for mother include: faster postpartum recovery; cost-efficient; convenient; reduces risk of breast, uterine, and ovarian cancer; quicker weight loss after birth. There are many resources available to you to learn about breastfeeding. Brigham and Women’s Hospital offers breastfeeding classes while you are in the hospital, teaching and assistance from your nurse, and if needed, a lactation consultation. You can also get information from your health care providers. Additional resources can be found at the back of this guide. Preparing to Breastfeed/Feeding Cues: If you are unsure of whether or not your baby is ready to feed, look for signs (cues) that he or she may be hungry. Your baby may open his or her mouth wide like a yawn with tongue down and forward over the bottom gum (rooting). Your baby may start smacking his or her lips and thrust the tongue. Your baby may also bring his or her hands up to the mouth. You may also notice fluttering eyes and rapid eye movement with your baby’s eyes closed. Crying, which is a very late feeding cue, can also be a sign that your baby is hungry. If your baby is crying, it is important to calm the baby before trying to feed him or her. Positioning your baby for feeding: You should be relaxed and comfortable. Support your back, feet and arms. (Your head should be supported in side-lying). Support your baby’s head and body at the level of the breast. Pillows are usually helpful with the “cradle” and “football” positions to support the arm that is holding your baby’s head and body. Turn your baby completely on his or her side with nose, chin, chest, abdomen and knees touching you (cradle and side-lying). Make sure your baby’s head is in a neutral position (hip, shoulder and ear aligned). Keep your baby’s body close to you by placing your hand and arm along your baby’s back for support. Support your breast with cupped hand (“C” hold) with thumb and fingers kept well back from the areola. Latch-on: You will first express drops of colostrum/milk. Your baby then roots and opens his or her mouth wide (like a yawn). Your baby’s tongue should be over the lower gum, cupped around your nipple and areola. Your baby’s lips should be visible and flanged outward. Your baby’s lips should cover 3/4” – 1” of areola (usually most or all of areola). The entire nipple will be deep in your baby’s mouth. You should not hear any clicking or smacking sounds. You will notice your baby’s cheeks are round with no dimpling. You should NOT experience any pain after your baby has latched on, only a sensation of pulling, tugging, and/or pressure. Suck and Swallow: Your baby’s jaw should be moving in rhythmic motion. Your baby sucks slowly and deeply with short pauses. You may feel any of the following normal occurrences in your body: uterine cramping, increased bleeding, thirst, breast ache or tingling, relaxation, sleepiness. During every feeding, you should see and hear your baby swallowing and/or see milk in his or her mouth. A breastfeeding mother should never experience blisters, bruising or cracks on her nipples. The skin should remain intact and the nipples should retain their original shape and color, although they may be elongated. Cracks, blisters or bruising indicates that the baby is not positioned correctly or latched on properly. Please call your pediatric or obstetric care provider for help if you experience any of the above symptoms. Get Your Calcium It is particularly important for you to get 1,200 mg of calcium each day while you are breastfeeding. Your body will route calcium to your milk supply before it will use the calcium to fortify your bones. If you do not consume enough, your baby will still receive calcium through your breast milk, but your body will not. As a result, your bone density may decrease - putting you at increased risk for osteoporosis. Recommended Nutrition Plan for Breastfeeding Mothers You should consume a minimum of 1,800 calories each day while you are breastfeeding. Although you are probably eager to get back to your pre-pregnancy weight, it is crucial that you consume the nutrients you need to sustain yourself and produce milk for your baby. The following nutrition plan will help you achieve this. Foods# of ServingsImportance of FoodProtein meat, chicken, beans (particularly soybeans and tofu), fish, eggs, cheese, nuts, and nut butters (such as peanut butter and almond butter) 3Builds healthy tissue and contributes greatly to your ability to produce milk.Milk and Dairy milk, yogurt, ice cream, cheese 4Helps keep bones and teeth strong; improves strength.Breads and Cereals whole grain/enriched breads, cereal, rice, pasta, tortillas 6-11The carbohydrates and B-vitamins found in these foods are an important source of energy.Vegetables and Fruits green beans, corn, apples, bananas, spinach, carrots, sweet potatoes, winter squash 3-6Provide vitamins and minerals that are important to keeping your body healthy. They are also a great source of fiber, which will help prevent constipation.Foods rich in vitamin C broccoli, tomatoes, peppers, oranges, strawberries, cantaloupe 2-4Boosts immunity and helps your body use iron more efficiently.Fluids water, fruit and vegetable juices, seltzer water 8-12Your body needs plenty of fluids to recover from the pregnancy and optimize milk production. If you are trying to lose weight, make water your drink of choice.Fats and Oils Eat foods that contain mono-unsaturated fats, such as olive oil, canola oil and spreads/dressings made with these oilslimited amountsThese healthful fats add flavor to foods while helping raise the level of good cholesterol (HDL) in your blood.Sweets candy, cookies, soda and sugary drinks, dessertslimited amountsSweet foods and drinks are high in calories, and they have little nutritional value. Top with yogurt and sprinkle cereal and fruit on top. For Bottle/Formula-Feeding Mothers If you have made the decision that bottle-feeding is the best choice for you, there are many things to know about cleaning the utensils and preparing the formula properly. Buy and use the formula before the expiration (“use before”) date that is printed on the can. Do not use damaged or dented cans. Read the directions on the label carefully. Store powdered formula with the cover on in a cool, dry place and use within one month of opening. After feeding the baby a bottle, throw away any formula that is left in the bottle since once it has been in your baby’s mouth, it has come into contact with his or her saliva and bacteria can grow in the formula. If you do not put all the liquid formula in bottles, cover the opened can of liquid formula and store it in the refrigerator for no more than 48 hours. Store unopened cans of formula at room temperature. Step-By-Step Formula Preparation The following steps should be taken to clean yourn equipment and to prepare bottles of formula, either for a 24-hour supply or as single bottles if you prefer. Wash your hands. Wash bottles and nipples with hot, soapy water (using a bottle and nipple brush), rinse well, and air-dry. If you have a dishwasher, you can use it to sanitize the bottles, nipples and utensils. The nipples should be placed on the top rack in the dishwasher so that they do not melt. Do not use the energy saving or no-heat cycle. It is not necessary to sterlize the equipment. Washing the parts as described above is fine. Wash the top of the unopened can of formula and the can opener with hot, soapy water and rinse with hot water. Shake concentrated and ready-to-feed cans well before opening or using. Use a pointed can opener to puncture a complete opening on one side of the can; on the opposite side put a smaller opening in the can to allow air to escape while you pour. Add to the clean bottles either the powdered formula (use the instructions on the can for the amount of powder and the amount of water to use), or equal amounts of concentrated formula and water, or ready-to-feed formula with no added water. Place the nipples on the bottles tip down (handle as little as possible), put the caps on and tightly screw on the rings. Store the bottles in the refrigerator until needed, but not more than 48 hours. Temperature of Formula If you prepare formula for your baby in advance, be sure it is refrigerated. Formula that has been refrigerated does not have to be warmed up for your baby, but most infants prefer it at least at room temperature. Remember that your baby will get used to whichever temperature formula you give him or her and will expect that temperature for all feedings. To warm formula, stand the bottle in a few inches of warm water for a few minutes, gently rotating the bottle occasionally for even warming. Do not leave a bottle to warm at room temperature. It will take too long and may result in the growth of bacteria. NEVER HEAT BOTTLES IN A MICROWAVE OVEN. They can overheat the milk in the center of the bottle. Even if the bottle feels comfortably warm to your touch, the milk in the center can burn your baby’s mouth. The easiest way to test the temperature is to shake a few drops on the inside of your wrist. Feeding Position It is important for your baby to be physically close to you while bottle-feeding since this is a time for interacting and bonding with your baby. Place your baby in a feeding position by cradling him or her in a semi-upright position (the head and shoulders are higher than the waist) while supporting the head. Do not feed your baby when he or she is flat or lying down and never prop a bottle in your baby’s mouth. Babies have a natural instinct, called rooting, to turn toward a touch on their lips or cheek. Touching your baby’s mouth or cheek with the bottle nipple will cause a hungry baby to turn toward the nipple and open his or her mouth. This is the time to put the nipple in the baby’s mouth making sure the nipple is placed on the tongue. To prevent your baby from swallowing air, tilt the bottle so that the formula fills the nipple. Look for bubbles in the bottle as the baby sucks. This will let you know that the baby is able to draw out the formula when sucking. If there are no air bubbles, loosen the cap slightly and try again. Amount of Formula In the beginning, babies take about a half to one ounce of formula at each feeding. Their stomachs are about the size of a walnut and cannot hold more than that. Small babies may want to rest every three to four minutes and may need to take smaller amounts more frequently. The amount of formula your baby takes will increase gradually as the baby grows. You may wish to check with your pediatric care provider for the appropriate amount of formula for your baby. Generally, you should feed your baby every three to four hours during the day or six to eight times in 24 hours. If your baby does not seem to take very much formula and then falls asleep either before or after burping, do not try to feed your baby more. It is best to feed your baby on demand. Do not encourage your baby to finish the bottle if he or she is not interested. If your baby is still sucking enthusiastically when the bottle is empty, offer more formula. (It is wise to prepare several one-ounce bottles for this reason when you prepare your bottles in advance.) You never need to wake a baby at night for a feeding unless your pediatric care provider has told you to do so. It should take your baby about 15-20 minutes to finish a bottle. It may take longer to feed a young or smaller baby who needs rest periods than it will an older, more practiced baby. A strong and vigorous baby will not tire from sucking as quickly as a young, smaller baby. If, on more than one occasion you notice it is taking your baby more than 30 minutes to feed, tell your pediatric care provider. Early in a feeding while the baby is very hungry, he or she will suck much faster than later on when he or she is almost full. As your baby gets older, he or she will want more formula at each feeding. Each week your baby will take about a half to one ounce extra per bottle. At the same time, your baby will gradually decrease the number of feedings in a 24 hour period from six to eight feedings initially to four to six feedings by the end of three months. Be aware of your baby’s intake. Your pediatric care provider will probably ask how much formula your baby takes. You will know that the baby is getting enough to drink if your baby has six to eight wet diapers in 24 hours by the time he or she is six days old and has one to two bowel movements a day. For Breastfeeding and Bottle-feeding Mothers Burping your baby Babies may swallow air during feedings so be sure to burp your bottle-fed baby often - after every half to 3/4 of an ounce of formula in the first few days. If you are breastfeeding, burp your baby before you switch to the second breast and also when your baby is done feeding. If your baby does not burp after a couple of minutes of trying, resume feeding. A few of the best burping positions are: Over the shoulder: Drape your baby over your shoulder and gently pat or rub your baby’s back. On the lap: Sit your baby upright, lean his or her weight forward against the heel of your hand, and gently pat or rub your baby’s back. Lying down: Place baby stomach-down on your lap and gently rub or pat his or her back.