Two medications are given to all babies shortly after birth.
Vitamin K injection
Babies are not born with enough vitamin K. Vitamin K is needed to prevent bleeding problems. All babies receive an injection of vitamin K shortly after birth. The injection is given in the baby‚Äôs thigh. You can breastfeed or hold your baby while it is given.
Antibiotic eye ointment
In Ontario, all babies currently receive antibiotic eye ointment in each eye after birth. This is done to prevent an eye infection that can lead to blindness. This infection is caused by gonorrhea or Chlamydia. The Canadian Paediatric Society has issued a position statement that may change this practice in the future.
Babies are screened for several conditions after 24 hours of life.
When your baby is approximately 24 hours old, a small blood sample is taken to screen for some serious diseases. You will be contacted by your health care provider in the unlikely event that the screen is positive for any of the diseases. A positive result does not mean your baby definitely has a specific disease. It means that more testing is needed. Serious health problems can be prevented or reduced if treatment is started early.
Your baby may be tested for jaundice with a blood test or a monitor placed on the forehead. Jaundice is the buildup of bilirubin that happens when extra red blood cells are broken down after birth. It can make your baby‚Äôs skin and eyes look yellow. Breastfeeding your baby often can help prevent a buildup of bilirubin. Extremely high levels of bilirubin can affect a baby‚Äôs brain. If your baby‚Äôs bilirubin level is high, your baby may need to be placed under phototherapy lights that help break down the bilirubin.
The Ontario Infant Hearing Program provides free screening of all newborns for hearing problems. Ask your health care provider where and when the hearing test will occur. Early detection and treatment of hearing problems is important to help ensure that your baby will develop speech, language, and social skills.
Change your baby whenever his or her diaper is wet or soiled.
Your baby may need a diaper change eight to 10 times a day, no matter if you are using cloth or disposable diapers. A good time to check the diaper is before and after feedings. It makes the baby alert for feedings and ensures that your baby is comfortable. To change your baby‚Äôs diaper:
- Wash your hands before and after changing the diaper.
- Keep one hand on your baby at all times. Never leave your baby unattended.
- Wipe from front to back using a clean, wet, and warm washcloth or unscented baby wipe.
- For baby girls: Gently clean between the outer folds of the labia. There is no need to clean inside the vagina.
- For baby boys: Be sure to clean underneath the scrotum where stool can collect in the skin folds. You do not need to pull the foreskin back when cleaning the penis.
- Allow the diaper area to air dry. Using baby powder to keep the diaper area dry is not safe for newborns as it can get into their lungs.
Contact your health care provider if your baby has a diaper rash that does not go away in a few days. Your baby may have a yeast infection or other condition and may need a medicated cream prescribed by your health care provider.
Talk to your health care provider if you are thinking about circumcision for your baby boy.
Circumcision of baby boys is a surgical procedure that removes the layer of skin called the foreskin that covers the head of the penis. It is usually done during the first few days after birth. Circumcision is not a medically necessary procedure and routine circumcision is currently not recommended by the Canadian Paediatric Society. Some parents choose to have it done for cultural, religious, or social reasons. If you are considering a circumcision for your baby boy, discuss this with your health care provider. Circumcision is not covered under the Ontario Health Insurance Plan so you will need to pay for the procedure. Ask your health care provider about how to care for your baby after the procedure.
Bathe your baby every few days. Wipe your baby‚Äôs hands, face, neck, and diaper area every day.
Babies do not need to be bathed every day. Bathing too often can cause your baby‚Äôs skin to dry out. Bathe your baby every two to three days or as needed. Your baby can have a full bath even if the cord stump has not fallen off; just pat it dry after the bath. Some bathing tips to keep in mind:
- If you give your baby a bath right after feeding, your baby may spit up.
- Choose an area that is safe and easy to bathe your baby (baby bathtub, sink, or basin).
- Bath water should be warm, not hot. Test the temperature with your wrist or elbow.
- Stay with your baby. Always keep at least one hand on your baby at all times.
- Wash your baby‚Äôs eyes and face first with warm water, no soap.
- Never put your baby‚Äôs face under the water.
- Use mild soap to wash your baby‚Äôs body, from cleanest to dirtiest, cleaning the diaper area last.
- After bathing, gently dry your baby with a towel making sure to dry the skin folds.
You will also need to:
- Trim your baby‚Äôs nails once they grow beyond the skin. The nails can be cut with blunt scissors when your baby is sleeping or after feeding when his or her hands might be still.
- Clean your baby‚Äôs gums twice a day. Gently wipe your baby‚Äôs gums from back to front with a soft, clean, damp cloth or a piece of gauze (wrapped around your finger) to remove any leftover milk.
Your baby will go through many changes in the first week after birth.
These are some of the things that you can watch for as you get to know your baby.
- Your baby may have swollen genitals at birth due to your hormones in their body.
- Breasts in both baby girls and boys may be larger than normal and may leak a small amount of milk. Newborn girls can also have a small amount of bleeding or white discharge from their vagina. All of these are normal and will disappear in a few days.
- The stump of your baby‚Äôs umbilical cord will dry up and fall off by itself one to three weeks after birth. Keep the cord stump clean and dry to prevent infection. You do not need to put anything on it to keep it clean. Fold the diaper below the cord stump to keep it dry until it falls off. If the skin around the cord stump becomes red or swollen, smells bad, or has pus coming from it, the cord stump may be infected. Call your health care provider if that happens.
- You may notice tiny hairs on your baby or a white cream (vernix) on your baby‚Äôs skin. These protected your baby while in the womb. You do not need to remove the vernix.
- Your baby may get a scaly or flaky scalp known as cradle cap. It usually does not need to be treated, but you can ask your health care provider.
- You may notice dark spots on the buttocks of your baby or a rash on your baby. These skin changes are normal and will go away with time. Talk with your health care provider if you are concerned about your baby‚Äôs skin.
- Your baby‚Äôs stool will change from black or dark-green meconium to brown, green, or yellow by the fourth day. After that, it should be soft, seedy, and yellow.
Dress your baby according to the temperature.
It is important not to overheat your baby. Your baby generally will be comfortable with the same layers of clothing that you are wearing. Babies lose a lot of heat through their heads. Depending on the season, a hat may be worn when outdoors. However, your baby should not wear a hat while sleeping as it could slip down over the face and mouth. See the Newborn Safety file for information about keeping your baby safe while sleeping.
Have your baby vaccinated as recommended by your health care provider to protect your baby‚Äôs health.
Vaccines cause the body to produce antibodies that will protect your baby from diseases and even death. Your baby needs to be vaccinated at several times to be fully protected. You can breastfeed your baby while the injection is given to minimize pain. Your baby‚Äôs first vaccine is given at 2 months of age. See the immunization schedule for more information on when you will need to book vaccination appointments with your health care provider. The vaccines used in Canada are safe and do not cause autism.
Babies can get sick quickly. If you are concerned about your baby, take your baby to see a health care provider.
If your baby seems sick, check his or her temperature. The best way to check your baby‚Äôs temperature is by gently placing a clean thermometer in the opening of their bum. The next best way to check a baby‚Äôs temperature is underneath their armpit. If your baby has a temperature greater than 38.0¬į C (100.4¬į F) when taken in the bum, this is a fever. If your baby has a temperature greater than 37.3¬į C (99.1¬į F) underneath the armpit, this a fever. Take your baby to see a health care provider right away if your baby:
- Has a fever.
- Appears jaundiced or yellow in colour.
- Has a rash, especially in and around the diaper area that does not go away.
- Feeds poorly or will not feed.
- Has a dry mouth, lips, or tongue.
- Normally has regular bowel movements but suddenly stops.
- Is passing less urine or has dark yellow urine.
- Vomits more than twice in one day.
- Has diarrhea.
- Has black or bloody stool that is not meconium.
- Has grey or chalk-coloured stool.
- Has a cough that won‚Äôt go away.
- Is hard to wake or seems very weak.
- Has lips or ear lobes that are blue or grey.
- Has difficulty breathing or breathes very quickly.
- Is shaking and not responding to you (having a seizure).
- Shows any other signs that he or she may be sick.
Learn the cues that mean your baby is tired.
If a baby becomes overtired, he or she can have difficulty falling asleep. Cues that show your baby is tired can include:
- Quietness or a loss of interest.
- Crying or fussiness.
- Rubbing of the eyes.
To help your baby sleep well, it can be helpful if you:
- Create a bedtime routine.
- Avoid stimulating your baby too much before going to sleep.
- Place your baby to sleep in his or her crib, cradle, or bassinet in a room that is dimly lit.
Change your baby‚Äôs position to prevent your baby from developing a flat head.
Your baby spends a lot of time on his or her back as this is the safest way to put your baby to sleep. To prevent a flat head from forming, you can:
- Switch the end of the crib where you place your baby‚Äôs head each day. Your baby will naturally look towards the door.
- Alternate the location of a mobile for your baby to look at when in the crib.
- Avoid having your baby in a car seat or stroller for long periods of time when possible.
- Have supervised tummy time when your baby is awake Do this for 10 to 15 minutes three times a day. It helps if you get on the floor face-to-face with your baby and use this as play time.
Healthy babies cry as a way to express their needs and communicate.
Your baby will cry to let you know when he needs something. Sometimes your baby might cry for no reason at all. Crying is normal newborn behaviour. To soothe your baby, try:
- Feeding your baby.
- Changing your baby‚Äôs diaper if wet or soiled.
- Burping your baby.
- Changing your baby‚Äôs position or giving your baby a gentle rub on the back.
- Cuddling and comforting your baby by holding your baby skin-to-skin.
- Checking that your baby isn‚Äôt under-dressed or over-dressed.
- Talking and singing to your baby or playing soothing background music for your baby.
- Gently rocking your baby, using a baby swing, or going for a car ride.
- Taking your baby for a walk in a stroller.
- Giving your baby a warm bath and massage.
Never shake or hit your baby. See the Newborn Safety file for information on coping with a crying baby.
You are your baby‚Äôs most important connection to the world.
Healthy emotional bonding and attachment establish positive relationships. Attachment develops as you respond sensitively and consistently to your baby‚Äôs needs. Babies need to know they can rely on you to respond to their needs.
- Nurture, comfort, and respond to your baby. Show your baby that he or she can trust you for care and comfort.
- Skin-to-skin contact (placing your baby, wearing only a diaper, chest-to-chest against your body and then covering you both with a light blanket) is a great way to establish an emotional bond between you and your baby. It can help with breastfeeding as well. Parents can place their baby skin-to-skin right after birth.
- Building a secure and trusting relationship with your baby will promote healthy brain development.
- Plan daily face-to-face time with your baby to cuddle and tummy time to play and engage with your baby.
- Be sure to spend lots of time with your baby. Talk soothingly, sing songs, and look into your baby‚Äôs eyes.
- Listen to your baby and watch for cues to understand your baby‚Äôs behaviour.
Learn more about how to care for your newborn.
You can find out more about newborn care from the following resources. More suggestions can be found in the Resources and Links section.
About Newborn Care
The World Health Organization defines the newborn period as the first 28 days of life; this is also called the neonatal period. The newborn period is a critical time for a child. It is when a child is at highest risk of death. To ensure that a newborn both survives and thrives during this period as well as thrives later in life, she needs adequate care.1,2 Right after birth, a newborn needs to receive certain treatments and assessments. A newborn depends on her parents for a variety of care needs such as:
- Diaper changes.
- A safe place to sleep.
- Illness prevention.
- Emotional support.
Globally, newborn (i.e., neonatal) deaths account for 45 percent of all deaths among children under 5 years of age. Of these deaths, 36 percent occur within the first 24 hours of life and 73 percent occur during the first week of life. The infant mortality rate refers to the number of infants who die during the first year per 1000 live births.
In 2011 in Canada, this rate was 4.8 percent and in Ontario 4.6 percent. In Canada and Ontario, this rate has been decreasing slightly each year. In 2007 in Canada, the infant mortality rate was 5.3 percent and in Ontario 5.2 percent.3
Who is at Risk?
Parents may have difficulty caring for their newborn if they:4,5,6,7,8,9,10,11,12
- Lack adequate supplies and/or knowledge needed to care for a newborn.
- Do not have a strong support system.
- Experience conflicts in their marital or partner relationship.
- Are of low socioeconomic status.
- Experienced difficult events during pregnancy or the postpartum period.
- Have a history of mental health challenges.
- Experience postpartum depression.
- Gave birth to a child with health concerns.
Medications after Birth
The Canadian Paediatric Society (CPS) recommends that vitamin K is given as an intramuscular injection to all newborns within the first six hours of life following stabilization and after the mother and/or family has had time to interact with the baby. This treatment is recommended because all babies are born with a deficiency of vitamin K. Breastfeeding during, and holding the baby skin-to skin for at least 15 minutes before any painful procedure supports the baby‚Äôs ability to cope with pain.
Vitamin K is needed for blood to be able to clot. If a newborn does not receive a vitamin K injection at birth, he is at risk of external and internal bleeding, otherwise known as hemorrhagic disease of the newborn (HDNB).13,14
Although it is not recommended, some parents may choose to give oral Vitamin K. This dose will need to be repeated at two to four weeks and six to eight weeks of age for it be effective. Parents should be cautioned that with an oral dose of vitamin K, their newborn is at an increased risk of developing late HDNB.13
If a woman is infected with Neisseria gonorrhoeae, at the time of birth, the bacteria can be transferred to the baby and lead to an eye infection called neonatal gonococcal ophthalmia which can cause blindness. Since the late 1800s, all babies have been given a prophylactic antibiotic treatment in their eyes after birth. Initially, this treatment was silver nitrate drops; today, erythromycin ointment is used. A strip of the ointment is placed in each eye after birth. The ointment can cause some mild eye irritation and is perceived by some to interfere with mother-infant bonding. It is effective in preventing infection caused by Neisseria gonorrhoeae but not Chlamydia trachomatis. Treatment is mandatory in Ontario, but as neonatal gonococcal ophthalmia is rare in Canada today, whether or not it needs to be mandatory is being questioned.15,16
Potential future practice
Instead of administering erythromycin ointment to all newborns, the Canadian Paediatric Society suggests that a more effective way of preventing neonatal gonococcal ophthalmia may involve screening all pregnant women for Neisseria gonorrhoeae and Chlamydia trachomatis infection at their first prenatal visit, and then treating those found to be infected. Testing would be repeated after the treatment, and again in the third trimester to ensure that the treatment was successful. Their partners would also be treated. Women whose test results are negative but who are at risk of acquiring an infection in pregnancy still would be screened again in the third trimester to ensure that they did not later acquire the infection.
If a woman is not screened during pregnancy, she would be screened at birth and any infant born (either vaginally or by caesarean birth) to a woman with an untreated Neisseria gonorrhoeae infection would be treated with an injection of the antibiotic ceftriaxone. An infant born to a woman with an untreated Chlamydia trachomatis infection would be closely monitored and be given treatment if there were any signs of infection. At home, the mother would need to watch her infant for any eye discharge and/or general unwellness and then contact her health care provider immediately.15 Women should be encouraged to discuss with their health care provider the right course of treatment for themselves and their baby concerning infection with Neisseria gonorrhoeae and Chlamydia trachomatis during pregnancy.
Ontario has one of the most comprehensive newborn screening programs in Canada. Its primary goal is the early identification and treatment of infants with serious health problems. Newborn screening is strongly recommended for all newborns but is not mandatory.17 For the newborn screen, a sample of blood is taken from a newborn‚Äôs heel after the first 24 hours of birth. This wait of a full 24 hours after birth must occur before the sample of blood can be taken as not all diseases are reliably detected until this time.
If mother and baby are discharged before this time, they will need to return to the birth setting for follow up. The screen should occur between 24 hours and seven days after birth. The ideal time for the screen to be completed is between 48 hours and 72 hours after birth.
From the blood sample taken, five drops of blood are placed on a card with the newborn‚Äôs identification information. This card is then sent from the birth setting to the Newborn Screening Ontario (NSO) headquarters. The parent(s) should be given the reference number on the top right hand corner of the card. At the NSO headquarters, the blood is tested for different serious diseases that are not usually apparent at birth, such as cystic fibrosis, congenital hypothyroidism, and phenylketonuria (PKU). For a complete and current list of the diseases screened, see the Newborn Screening Ontario disease fact sheets. Bedside screening is also done for Critical Congenital Heart Disease (CCHD).
About 200 infants in Ontario each year will be found to have one of the conditions screened for; this is equivalent to approximately one in 800 infants. Many of the diseases screened for, if identified early, can be treated with dietary modifications or medications. Untreated infants can develop mental disabilities, serious health problems, or die.17 Parents should be reminded that a positive screen does not necessarily mean that a baby is affected with a disease. If there is a positive screen, further diagnostic testing will be done to confirm or rule out a disease. A negative screen also does not always rule out a disease. If an infant experiences symptoms of a disease, an appropriate diagnostic evaluation should be arranged immediately.17
Sometimes the initial sample taken will need to be repeated because the initial sample was of poor quality. The birth setting or midwife that took the initial sample is responsible for ensuring the repeat sample is done. If there is a delay in obtaining a sample, this can lead to delayed diagnosis and potential serious health problems.17
All newborns are born with an excess supply of red blood cells. When red blood cells break down, the by-product is called bilirubin. If the liver cannot process the excess bilirubin quickly enough or if not enough bilirubin is excreted through a newborn‚Äôs urine and stool, it can build up in a newborn‚Äôs body and be deposited in the skin. When this occurs, the newborn‚Äôs skin and the whites of the eyes can appear yellow. This condition is known as jaundice or hyperbilirubinemia. It is not uncommon for newborns to develop this one to four days after birth. If it occurs, more frequent feedings can increase the amount of bilirubin being excreted in the urine and stool. Increased feedings can also increase energy levels needed for the liver to process the bilirubin.18,19
It is recommended that all newborns be screened for the amount of bilirubin in their body in the first 24 to 72 hours of life. To screen for the amount of bilirubin in a newborn‚Äôs body, a sample of blood is taken from their foot and analyzed in a laboratory or a monitor may be placed on the baby‚Äôs forehead. The bilirubin level corresponds to the age of the newborn. A higher bilirubin level is more serious earlier than later. A low-intermediate level may not require anything more than more frequent feedings but a repeat sample after discharge is often needed with an intermediate level to ensure that the level has not increased after discharge. A high-intermediate level of bilirubin (severe jaundice) can cause a baby to be very tired, irritable, and feed poorly. A high level of bilirubin can affect a newborn‚Äôs brain cells, cause seizures, deafness, cerebral palsy, or serious developmental delay. Thus, high-intermediate and high levels often warrant treatment to decrease the bilirubin level in the newborn‚Äôs body.18,19
If a high bilirubin level is detected, one way to bring levels down is with phototherapy. For phototherapy treatment, a baby‚Äôs eyes are protected with special eye patches while the skin is exposed to ultraviolet light. The light makes the bilirubin water soluble so that that the baby can more easily excrete it through urine and stool.
Phototherapy is usually done in a hospital but sometimes newborns can be treated at home if equipment and a home phototherapy program is available. With phototherapy treatment, the newborn should be exposed to the light as frequently as possible and be given extra fluids, such as through more frequent breastfeeding.18,19 As jaundice can both cause poor feeding and effect how well the infant feeds, careful assessment of feeding is important.
Although using ultraviolent light is used as a treatment modality for hyperbilirubinemia, parents should be cautioned against exposing their newborn to sunlight (directly or indirectly) as this could be harmful.19
Jaundice can be more serious for newborns who:18,19
- Were born before 37 weeks‚Äô gestation.
- Weighed less than 2500 g (5 lb 8 oz) at birth.
- Have bruising or swelling from the birth.
- Have a blood group that is incompatible with their mothers‚Äô blood group.
- Have a sibling that had severe jaundice at birth.
- Developed jaundice during the first 24 hours.
- Are not feeding effectively.
After discharge, newborns may still be at risk of developing hyperbilirubinemia. Parents should contact their health care provider if their newborn:18,19
- Appears jaundiced or the jaundice is getting worse (arms and legs appear yellow).
- Refuses to eat.
- Has lost weight.
- Is sleeping more than usual or is hard to wake.
The Canadian Paediatric Society recommends hearing screening for all newborns. Hearing loss is the most common congenital condition in Canada. It is estimated that about three in 1000 babies have serious hearing loss and that three in 1000 babies are born profoundly deaf. Most hearing-impaired children are healthy and born to hearing parents. With universal hearing screening, diagnosis and intervention can occur early and this can lead to better language development, literacy, and brain development. There is no harm associated with hearing screening.20,21
The most common method to test for hearing in a newborn is with an otoacoustic emission (OAE) test. For this test, a health care provider or other specialist will put a small microphone in the newborn‚Äôs ear which sends a sound. An echo comes back and is sent to a portable computer that can indicate whether the newborn heard the sound. The test usually takes 10 to 15 minutes. It can be done in the hospital, public health units, and some Ontario Early Years Centres.20,21
If a hospital is not equipped to do the test or if one or both ears requires a repeat test, this can be done at a public health unit and some Ontario Early Years Centres. As newborns often have some mucus still in their ears after birth or may move during the test, a referral for additional testing is not uncommon. If hearing loss is identified, digital hearing aids and cochlear implants can now allow even profoundly deaf children to hear and to speak. Newborns can be fitted with hearing aids as well.20,21
Pregnancy hormones may cause a newborn girl‚Äôs genitals to look swollen and there may be a small amount of bleeding or white discharge from the vagina in the first week. Breasts, in both newborn girls and boys, may be larger than normal and may leak a small amount of milk. Newborn boys may have a larger, reddened scrotum. These changes are normal and disappear in a few days.22
Circumcision of newborn boys is a surgical procedure to remove the layer of skin called the foreskin that covers the head (i.e., glans) and part of the shaft of the penis. It is usually done during the first few days after birth. Circumcision is not a medically-necessary procedure but some parents choose to have it done for cultural, religious, or social reasons.23,24 When considering circumcision for a newborn boy, parents should discuss it with their health care provider. It should also be noted that because circumcision is not a medically-necessary service, it is not covered under the Ontario Health Insurance Plan (OHIP). Parents need to pay out-of-pocket for the procedure. Risks associated with a circumcision are rare but can include:23,24
- Pain, although pain medication is given to the newborn during the procedure.
- Complications from the pain medication.
- Surgical errors, such as too much skin being removed.
Circumcision does lower the risk of urinary tract infections, especially in the first year of life. In Africa and other high-risk settings, circumcision can reduce the risk of acquiring HIV.23 If a newborn boy undergoes a circumcision, he should not be fed for an hour before to prevent regurgitation during the procedure and have already had one documented void.
For the procedure, the boy will be given a local anesthetic to numb the area as well as glucose water or other pain medication.22,24 It generally takes seven to ten days for the penis to heal after a circumcision. The area should be kept clean and dry to prevent infection. A sponge bath can be given until the penis is healed. If there is a bandage, it can be beneficial to apply petroleum jelly (e.g., Vaseline¬ģ) on the head of the penis to keep the bandage from sticking to it.23,25 This can also be continued after the bandage is removed. Some studies have shown that applying petroleum jelly can reduce bleeding and infection at the site and decrease healing time.25
Please note that petroleum jelly is flammable so if used it should not be around a source of fire. After a circumcision, parent(s) should be advised to contact their health care provider if they notice:23
- Bleeding at the site.
- Increased redness or swelling at the site.
- A fever.
- That the newborn seems unwell or sick.
- That the newborn does not void for several hours.
The amount of soiled and wet diapers changes as a baby matures. The general expectation is that a baby will have:
- On the first day, at least one wet diaper and at least one or two soiled diapers with black or dark-green stool.
- On the second day, at least two wet diapers and at least one or two soiled diapers with black or dark-green stool.
- On the third day, at least three wet diapers and at least three soiled diapers with brown, green, or yellow stool.
- On the fourth day, at least four wet diapers and at least three soiled diapers with brown, green, or yellow stool.
- On the fifth day through to three weeks, at least six heavy, wet diapers with yellow or clear urine and at least three soiled diapers with large, soft, yellow-coloured stool.
The chart below can be used to help families understand the relationship between a baby‚Äôs intake, soiled diapers and weight gain.
As newborns go through many diaper changes, plenty of clean diapers on hand are needed. After about a month, the number of wet and soiled diapers will decrease, especially the number of soiled diapers. It is helpful for to parents keep track of what is normal for their baby so that they know if there has been a significant change.26 Parents should contact their health care provider if they notice:26
- No wet or dirty diaper within a 24-hour period, based on chart guidelines.
- A sudden decrease in the number of wet or dirty diapers.
- Hard or pellet-like stool and the baby appears to have trouble passing stool.
- Blood in the diaper.
- Grey or chalk-coloured stool.
- Diarrhea or very watery stool.
Initially, changing a diaper can seem complicated for new parents; thus some practice is often needed.27 Practicing diaper changes can be done in prenatal education classes or at home with the use of a doll before the baby is born. The following steps are recommended when changing a diaper:23,27,28,29
- Place supplies for changing diapers as well as setting up a change station in a few different areas of the home can be helpful so that the supplies are easily accessible when needed.
- The person changing the diaper should always wash their hands before changing the diaper.
- The following supplies need to be gathered:
- A clean diaper (and fastener if applicable).
- A clean, wet, warm washcloth, unscented diaper wipes, or cotton balls for newborns with sensitive skin.
- A dry washcloth for patting the baby dry after cleaning.
- Optional supplies: A spare diaper to place over a newborn‚Äôs boy‚Äôs penis, unscented lotion or cream if the baby is developing a diaper rash, and sanitizing wipes to clean the change table/area after use.
- Keep one hand on the baby at all times while a baby is on a change table. It can be helpful to give the baby something to focus on such as an unbreakable mirror or a colourful picture while being changed so that he is less likely to squirm or wiggle.
- Once ready with the supplies to change a diaper, the wet or soiled diaper can be unfastened by releasing the hook and loop fasteners (e.g., Velcro¬ģ), adhesive straps, or other type of fastener found on either side of the diaper. To remove the diaper, grasp both of the baby‚Äôs legs at the ankles with one hand. The other hand can be used to remove the diaper, fold it closed, and set it aside, out of the baby‚Äôs reach. If marks are found around the baby‚Äôs legs or waist, the diaper was put on too tight the last time. Diaper size depends on the weight of the baby.
- Clean the baby completely.
- For girls: Wiping should occur from front to back. Wiping in the other direction can cause bacteria from the anus to spread and cause a urinary tract infection. The folds of the outer layers of the labia should be gently cleaned. There is no need to clean inside the vagina.
- For boys: A clean diaper can be placed over the penis while changing the diaper. Exposure to the air often causes baby boys to urinate. Wiping should occur from front to back. If the boy is uncircumcised, one should not pull the foreskin back when cleaning the penis. The foreskin may not be retractable until puberty (when the foreskin is retractable, the boy should be taught to wash underneath it each day). Once clean, the penis can be placed in a downward position before fastening the clean diaper to help prevent leaks at the waistline. The scrotum can be then be cleaned gently. If stool gets on the cloth, one should not use it to go back up and touch the penis; a new cloth should be used.
- After the cleaning, the baby should be patted dry (not rubbed dry) with a clean, dry cloth. Leaving the baby wet can cause bacteria to accumulate and a diaper rash to form.
- Health care providers should be consulted if a diaper rash develops, and to determine whether cream is needed. The cream should be unscented, be removed from the container with a tissue or a tongue depressor to avoid contamination, and be applied with clean fingers to the buttocks or reddened areas. Baby powder should never be used as it could get into the baby‚Äôs lungs and cause respiratory distress.
- Both of the baby‚Äôs legs should be lifted at the ankles with one hand, and the other hand can be used to place a new diaper underneath the baby. The diaper should be pulled up between the baby‚Äôs legs, making sure it‚Äôs on straight, so it will wrap evenly around the baby‚Äôs hips. The front part of the diaper is then raised up between the baby‚Äôs legs, and onto his stomach. The back part with the fastener tabs should be about level with the baby‚Äôs belly button. The hook and loop (e.g., Velcro¬ģ) or adhesive tab/fastener is then placed over the front of the diaper. Parents should be careful not to let the adhesive tab from disposable diapers stick to the baby‚Äôs skin. If oversized safety pins with plastic heads are used with cloth diapers, a hand should be placed between the pin and the baby‚Äôs skin to prevent pricking.
- If the newborn‚Äôs umbilical cord stump has not fallen off yet, the waistline of the diaper should be folded down to keep the area dry.
- Once the baby is removed from the change area, the area should be cleaned and disinfected using a sanitizing wipe or disinfectant spray and allowed to air dry.
- Stool should be emptied in the toilet. If disposable diapers are used, they should be wrapped and put into a secure, foot-activated, plastic-lined, and covered garbage container. The garbage should be regularly emptied to prevent the growth of bacteria and reduce smells. If cloth diapers are used, they should be put into bag or bucket with a lid until laundry is done. Cloth diapers should not be rinsed in the toilet or sink as this will spread germs to the toilet, sink, floor, or other surfaces.
- The person who changed the diapers, should always wash their hands well after changing the diaper to prevent the spread of germs.
Disposable versus cloth diapers
There are different kinds of diapers available. Parents may choose to use single-use disposable diapers that they can throw out in the garbage or city compost (if available) after use or use cloth diapers that can be washed and re-used. There are also many different kinds of disposable and cloth diapers. Disposable diapers come in a variety of sizes, materials, and designs depending on the manufacturer. Cloth diapers can be all-in-ones (which include the cover), pre-folded, fitted, or flat. Cloth diapers can have hook and loop (e.g., Velcro¬ģ) fasteners, snaps, or other fasteners.
Cloth diapers can be less expensive than disposable diapers in the long run if parents do the laundry themselves. However, if a diaper service is hired to pick up the dirty diapers and drop off clean ones, this can be more expensive.
Cloth diapers should always be washed separately from other laundry using hot water and a mild detergent. Fabric softeners and dryer sheets should be avoided. New cloth diapers and covers need to be laundered at least once before being used.27 Parents should be encouraged to check out the different diapers available before their baby is born and think about what they may like to use. Some parents may choose to use a combination of different types of diapers or change what they use as the child grows. There is no right or wrong choice when it comes to choosing a diaper.
Diaper rash, or diaper dermatitis, occurs when a newborn‚Äôs skin becomes irritated, red, and sore. It can happen if the baby has sensitive skin or when urine or stool in the diaper touches the skin for too long. The best way to prevent a diaper rash is to change the baby‚Äôs diaper often, especially if the baby has diarrhea. If the baby has diarrhea, an unscented barrier cream to protect the skin can be used. To prevent cross-contaminations, cream should not be shared between other children and a finger that has touched the affected skin should not be put back into the cream container. One way to prevent and reduce diaper rash is to let the skin air dry before applying any creams and the diaper. This can be done by placing the baby on a clean diaper on his tummy while supervised for a minute before applying a clean diaper. Diapers also should have a snug fit so that they do not rub.29,30
Candida is a yeast-like fungus that exists naturally in the intestines. If it overgrows in the mouth, it can cause an infection called thrush. If it overgrows in the deepest part of the skin in the groin area and the buttocks, it can cause a diaper rash. This type of diaper rash is usually very red with raised red spots and defined edges. An antifungal cream prescribed by a health care provider is needed to treat a diaper rash caused by Candida. Before the cream is applied, the diaper area needs to be washed with mild soap and warm water, rinsed, and patted dry.29,30 If a baby has thrush, the mother also needs to be treated, often with a topical cream, so that the infection does not pass back and forth between them. A health care provider should be contacted if a diaper rash is:29
- Very red.
- Has raised spots.
- Is blistered or has discharge.
- Gets worse when treated.
A baby does not need to have a full bath every day as this could make a baby‚Äôs skin dry. However each day, a baby‚Äôs face, neck, hands, and diaper area should be washed with warm water.27,30 The following steps and guidelines are recommended for bathing a baby:27,30
- All supplies that are needed for the bath and for changing the baby after the bath should be collected and set out. Supplies generally include:
- A baby bathtub, basin, or clean sink.
- Several washcloths.
- Two soft towels.
- Mild, unscented soap.
- A clean diaper and diaper supplies.
- A change of clothes for the baby.
- A blanket.
- The basin should be filled with a few inches of warm water, not hot water. The water should be tested before the baby is put into the water and feel comfortable to the touch on the inside of the wrist or elbow.
- Jewellery or anything that could scratch the baby should be removed.
- The room should be warm as babies lose heat quickly. If the room is chilly, the baby‚Äôs face, neck, and hands can be cleaned first. Soap is not needed on these areas, as the baby may ingest it.
- When cleaning the eyes, an area of a wet, warm cloth can be wrapped around one‚Äôs finger for each eye and the eye can then be wiped from the inner-most area next to the nose outward. Alternatively, you can use a fresh new wet cotton ball for each eye. If any drainage, pus, or redness is noted in the eyes, parents should contact their health care provider as this may indicate an eye infection needing treatment.
- When cleaning the ears, a wet, warm cloth wrapped around a finger can be used to clean in and behind them. Cotton swabs (e.g., Q-tips¬ģ) should never be used as this can cause inner ear damage. Mucus and ear wax will work itself out in time and some ear wax is actually good.
- When cleaning the head of a newborn, it is important to be gentle. The head of a baby has two soft spots where the bones of the head have not yet fused together. A larger soft spot is located at the top of the head, and a smaller soft spot is located at the base of the head. These soft spots will gradually close over by six months. Pressing on these spots should be avoided. A mild soap can be used on the head and hair. Dry the head afterward as it can lose heat quickly. Some parents and health care providers like to clean the head before submerging the baby in the bathtub. The baby can be held over the bathtub in a football hold, while wrapped in a towel or a blanket, to clean the head.
- When a baby is put into the basin or tub, she should be held securely at all times until she is older and able to hold her head up and keep her back straight. A baby‚Äôs face should never be allowed to be submerged underneath the water. Health Canada recommends that baby bath seats not be used as they can give parents a false sense of security.
- A few clean cloths should be used to clean a baby‚Äôs body from clean to dirty in the bathtub. A mild, unscented soap can be used over the body with good rinsing afterward. When cleaning the genital areas, the genital area should be cleaned from the front to back to avoid spreading bacteria from the anus.
- The bath does not typically take very long. Keeping a baby for an extended amount of time in the water should be avoided to prevent her body temperature from dropping.
- A towel should be ready to place the baby on after the bath, and another towel should be ready to completely dry the baby, drying all the creases and skin folds. Leaving wet spots can cause bacteria to accumulate.
- After the bath and when the baby is dry, a clean diaper should be placed on the baby. The baby can be placed skin-to-skin, be breastfeed, or dressed and wrapped (in a blanket) to ensure warmth and comfort. Feeding after the bath rather than before can prevent a baby from spitting up in the bath.
- After each bath, the bath should be cleaned thoroughly.
Bath time can be fun for both a baby and the parents; bath time is a great time to bond.27
After the umbilical cord is cut at birth, an umbilical cord stump with a plastic clamp remains at the site of the newborn‚Äôs belly button. This stump will usually fall off by itself 7 to 21 days after the birth, with the average time being 10 to 14 days. There is no need to use any drying agents such as alcohol swabs on the stump. The cord stump simply needs to be kept clean and dry.
It is okay to submerge the stump during baths. After baths, it just needs to be dried well with a towel to prevent infection. To keep the cord stump dry and to prevent the cord clamp from rubbing against the newborn‚Äôs stomach, a newborn‚Äôs diaper should be folded down so that the cord stump is exposed.30,31 Parents should watch for signs of umbilical cord stump infection and contact their health care provider if they notice any of the signs of infection. Signs of umbilical cord stump infection include:30,31
- Redness or swelling at the site.
- Drainage or pus from the site.
- Odours or foul smells from the site.
- Fever of 38.0¬į C (100.4¬į F) or higher.
- Bleeding at the site.
Newborns commonly experience a variety of skin changes that may seem unusual to parents. Such skin conditions generally disappear on their own as a newborn‚Äôs skin adjusts to the environment and do not require any treatment.22,27,30
Most babies are born with a white substance, known as vernix, covering their skin. In utero, vernix served to protect the baby. It is harmless and can gradually be washed or wiped off. There is no need to scrub the vernix off as it can act as a natural moisturizer. As the vernix washes away, it can cause the skin to peel; this too is normal. Moisturizing cream is not needed during this time as it can interfere with the natural peeling process.22,30
Tiny hairs or fuzz can cover a newborn‚Äôs body; these hairs are called lanugo. In utero, lanugo served to protect the skin as development occurred. If a newborn was born before the due date, lanugo might be especially apparent. It eventually disappears by the first month.22
Mongolian spots (dermal melanocytosis)
It is not uncommon for newborns to have brown, grey, or blue-black spots that look like bruises on their lower back and buttocks at birth. They are called Mongolian spots. They tend to fade somewhat by 2 years of age and fade completely by 5 years of age. They are very common in newborns of Aboriginal, African, Asian, Hispanic and biracial descent.22,30
A red, pimply rash resembling acne may appear on a newborn‚Äôs face at around two to three weeks of age. Tiny whiteheads on a newborn are called milia. Such skin conditions are normal in newborns and generally disappear after a few weeks.22,30
A red splotchy rash with yellow or white bumps can appear on different parts of newborn‚Äôs body in the first few days or weeks of life. This is known as erythema toxicum.The splotches can appear for a few hours or can last for eight to 10 days. The rash gradually disappears without treatment.22,30
Eczema is a skin condition characterized by a dry, thickened, scaly skin rash with tiny red bumps that can blister, ooze, or become infected if scratched. Eczema can appear on nearly any part of a newborn‚Äôs body. It often occurs more in newborns with a family history of allergies or eczema. Applying a non-scented moisturizer to the skin and dressing the newborn in loose cotton fabrics can help. If eczema persists, a health care provider may prescribe medication.30
Some newborns develop greasy skin with white or yellow flakes or scales on the scalp; this is referred to as cradle cap. Redness can appear around the scales as well. Cradle cap is not harmful, and it usually goes away on its own in a few months. Shampooing more often with a mild baby shampoo, rubbing a small amount of unscented oil (such as mineral oil), and combing out the flakes after can help. Shampooing too often, however, can also cause a dry scalp.27,30 While most of the skin conditions discussed here are normal and will likely disappear on their own, if parents notice any irregular skin condition and are concerned, they should contact their health care provider as treatment may be needed.
Once a newborn‚Äôs nails grow beyond the skin, blunt scissors can be used to cut the nails. They should not be cut so close to the skin as to cause bleeding. The best time to trim a baby‚Äôs nails is when he sleeping or after feeding when his hands may be still.30
It can help to have the baby curl his finger around the parents so that that can hold on and the nails easily cut.
If parents are unsure about how to cut their newborn nails, they can contact their health care provider or public health unit.
It is recommended that from birth to 1 year of age, parents wipe their baby‚Äôs gums with a soft, clean, damp cloth twice a day. Bacteria and plaque can begin to grow in a child‚Äôs mouth before teeth emerge.
Children should never be given a bottle of formula or juice without supervision or in the crib; this is to prevent tooth decay.27,32 At birth, it is not uncommon for a newborn to have small, white or yellow nodules present in their gums that look like teeth. These are referred to as Epstein pearls or Bohn nodules. These nodules are not actually teeth but are harmless cysts that generally disappear in a few weeks.22,33
A newborn can lose a lot of heat quickly. Thus, it is important to keep a newborn warm. Generally, a baby will be comfortable with the same layers of clothing as an adult. Using layered clothing will allow parents to add or remove clothing as required, depending on whether the baby feels warm or cold to the touch. As babies can lose a lot of heat from their head, a hat should be worn on their head when outside in cooler weather. However, it is also important that a newborn not become overheated. If a newborn‚Äôs feet and hands are warm, what he is wearing is usually fine.34
While sleeping, a hat should not be worn on a newborn as it could slip down over their face. When putting a newborn to sleep, all that he generally needs is light sleeping clothing. Hats, extra clothes, or blankets could cause suffocation.35
For more information about keeping a newborn safe while sleeping, see the Newborn Safety file. When dressing a newborn, it is important to ensure that any belts, ties, or sashes are stitched firmly to the clothing to prevent strangulation and, to prevent choking, ensure that there are no loose buttons or other small parts.36
Routine Health Care
The Government of Canada and the Canadian Paediatric Society state that immunization is the best way to protect a child‚Äôs health.37,38 A hundred years ago, infectious diseases were the leading cause of death worldwide. However, because of immunization, infectious diseases now cause less than five percent of all deaths in Canada. Today, it is rare for a Canadian child to develop a serious infectious disease such as polio, diphtheria, tetanus, mumps, measles, pertussis, or rubella due to immunization.27
During the last few weeks of pregnancy, women pass their immunity to their developing fetus through the placenta so that the newborn is protected against infectious diseases at the time of birth; this immunity begins to fade in the first few weeks after birth. Breastfeeding provides some general immunity for a newborn, such as immunity to the common cold, but breastfeeding does not provide protection against illnesses such as diphtheria and pertussis.27
Vaccines are made of weakened or dead versions of viruses or bacteria. They stimulate the body to produce antibodies that protect them from contracting the disease that the virus or bacteria causes. Vaccinations are usually given as injections also known as needles or shots. Sometimes they can be given as a liquid that the child can swallow.27 When a baby receives an injection, this is painful. To lessen the pain, a baby can be:38
- Placed skin-to-skin, ideally for at least 15 minutes before the procedure.
- Given a topical anesthetic an hour before. For this, parents should confirm with their health care provider where the injection will be given, (i.e., arm or leg). A pharmacist can help select the cream.
- Given a toy for distraction.
If the baby cries or is fussy after the injection, pain medication such as acetaminophen may be recommended by the health care provider.38 With any vaccination, redness, swelling, or pain at the site may occur; this is normal. A fever can also occur. If a baby develops severe swelling of the mouth or breathing problems after a vaccination, a health care provider should be contacted. If a baby is sick with a fever when a vaccination is scheduled, it may need to be rescheduled for when the baby is better able to tolerate possible side effects.38,39
Babies need to receive vaccinations at several distinct time periods in their life as well as receive some vaccinations more than once to ensure full protection. Vaccinations work best when they are given on time. They should begin at 2 months of age.
For more information about the time periods when vaccinations are needed, see the Publicly Funded Immunization Schedule for Ontario. This schedule is designed to protect children before they are exposed to preventable diseases. Some of the vaccinations given protect against several diseases at once.37,38,39
It is important for parents to keep track of their children‚Äôs immunizations. An immunization card or booklet can be helpful and be requested at the first vaccination appointment and brought to all of the following appointments to be updated. This record can be requested by daycares and/or schools and can also be beneficial if the child ever travels outside of Canada.37¬† There is also an app that parents can download to keep track of their entire family‚Äôs vaccination history.
Some children cannot receive certain vaccines due to allergies or other medical conditions. These children are at risk of contracting diseases; this is why it is encouraged that children who do not have contraindications have up-to-date vaccinations.37 This allows the community to achieve a higher level of what is known as herd immunity.
Vaccines are very safe. In Canada, vaccines are made according to the highest standards and are continually monitored to make sure they are safe and effective.27,38 There is no evidence that vaccines can lead to the development of disorders such as autism.40,41,42
Following discharge from the birth setting, a newborn will need to see a health care provider again in 48 to 72 hours (two to three days).43 If the health care provider is a midwife, she will do a home visit within this time frame. If parents have any concerns before this visit, they should contact their health care provider sooner. At the first visit, the health care provider will:43
- Weigh the baby.
- Check how feedings are going.
- Check for signs of jaundice.
- Do a physical health exam.
- Complete any screening tests not yet done.
- Ask how the family is adjusting to life with a newborn.
- Answer any questions that the parent(s) may have.
- Set up future appointments.
As a part of the Government of Ontario‚Äôs Healthy Babies Healthy Children program, in the first 48 hours after discharge from a birth setting, a public health nurse may call new parents to offer support and information and to discuss how they are doing. Alternatively, new parents can call their local public health unit during working hours if they do not receive a phone call. The nurse or a home visitor may also be able to do a home visit if parents wish.44,45
When a child has an infection, either bacterial or viral, she may develop a fever. If a child under 6 months of age develops a fever, they should always be taken to see a health care provider for immediate assessment especially if the child if not drinking well.46,47 The Canadian Paediatric Society recommends that a rectal temperature is taken for children from birth to 2 years of age. The second best choice is to take an axillary (i.e., armpit) temperature.46,47
Products for taking a temperature by sweeping a thermometer across a child‚Äôs forehead, forehead strips, pacifier thermometers, and tympanic (i.e., ear) thermometers are not accurate or reliable.46,47
In all cases, a digital thermometer is best to use. It is made of unbreakable plastic, it is easy to use, and it measures temperature quickly. A mercury thermometer should not be used in case it breaks and exposes someone to this toxic substance.46,47 To take a rectal temperature:46
- A digital rectal thermometer should be used.
- The thermometer needs to be cleaned first using cool water and soap and then rinsed.
- The tip can be lubricated with petroleum jelly (e.g., Vaseline¬ģ).
- The baby can be placed supine with the knees bent.
- The thermometer should be gently inserted about 2.5 cm (1 inch) into the rectum for one minute until it beeps.
- The temperature can be read once it is removed.
- The thermometer should be cleaned with water and soap and rinsed after it is used.
To take an axillary (i.e., armpit) temperature:46
- A digital rectal or digital oral thermometer can be used.
- The thermometer needs to be cleaned first using cool water and soap and then rinsed.
- The tip of the thermometer should be placed in the center of the baby‚Äôs armpit. The baby‚Äôs arm should then be tucked snugly against her body for one minute until the thermometer beeps.
- The temperature can be read once it is removed.
- The thermometer should be cleaned with water and soap and rinsed after it is used.
- If an axillary temperature does not show a fever but the child feels warm and seems unwell, a rectal temperature should be taken as it is more accurate than an axillary temperature.
Normal temperature ranges
Normal temperature ranges vary and depend on the method used to take the temperature. The following table provided by the Canadian Paediatric Society outlines normal temperature ranges by the method used to assess the temperature.46Source: Caring for Kids
It is important to note that the temperature is not always an indicator of the seriousness of an illness. How the child is behaving is a more indicative sign. A child with a severe infection may not have a fever.46 If a child has a fever:46
- A health care provider should be contacted if the child is under 6 month of age and/or if the fever has lasted longer than 72 hours.
- Extra blankets and clothing should be removed so that heat can leave child‚Äôs body. Not all of the child‚Äôs clothes should be taken off because this may cause the child to become cold and shiver, which creates more body heat.
- The amount of fluids that a baby receives should be increased by breastfeeding more often. The child does not need water.
- Medication is not always needed to treat a fever. Medication is more suited to treat aches and pains although it can be recommended if a child has a fever.
Ear infections, or otitis media, are caused when viruses and bacteria get into the middle ear. They are most common in children between 6 months and 3 years of age, but some measures can be taken, during infancy, to minimize their occurrence.49 Ear infections can be prevented in children by:49,50
- Ensuring good hand hygiene.
- Avoiding bottle feeding babies while they are in a lying down position.
- Minimizing pacifier use.
- Ensuring babies are not exposed to second-hand or third-hand smoke.
A young child may have an ear infection if they:49
- Have an unexplained fever.
- Tug or pull at their ears.
- Are fussy or irritable.
- Have trouble sleeping.
- Have trouble hearing quiet sounds.
If parents notice any of these symptoms, they should take their baby to a health care provider. Health care providers diagnose ear infections by looking at the tympanic membrane (i.e., ear drum) with a light called an otoscope. A health care provider may prescribe antibiotics to treat the ear infection if needed.49,51
A newborn is vulnerable and can become quite sick quickly. If parents are concerned about anything related to their newborn‚Äôs health, they should not hesitate to contact a health care provider. Some reasons parents may need to contact a health care provider include if the newborn:33-40,30,46,48,52,53
- Has a fever.
- Appears jaundiced or yellow in colour.
- Has a rash that is new or concerning.
- Will not feed or feeds poorly.
- Has a dry mouth, lips, or tongue.
- Has not urinated or had a bowel movement in the last 24 hours or if there is a sudden decrease in the number of wet and soiled diapers.
- Vomits more than twice in one day.
- Has diarrhea or watery stool.
- Has black or bloody stools. A baby‚Äôs stool after birth is normally dark but should become lighter in the first few days after birth and remain a lighter, yellow colour.
- Has grey or chalk-coloured stool.
- Is wheezing or has a persistent cough.
- Is excessively cranky, fussy, or irritable.
- Has any other signs of illness that are concerning.
Parents should be encouraged to seek immediate medical attention if their baby:
- Is excessively sleepy, lethargic, or does not respond.
- Has difficulty breathing or is breathing rapidly.
- Has lips or ear lobes that are blue or grey.
- Is having a seizure.
Sleep is very important to a child‚Äôs overall health. During the first two months, an infant typically needs 16 to 18 hours of sleep in a 24-hour period. Sleep periods can range from 30 minutes to¬† three to four hours long. It is normal and healthy for a baby to wake up to feed during the night.49-56,54,55 As babies get older, they will generally stay awake longer during the day and sleep for a longer period of time at night.49-56,54
It can be helpful for parents to learn a baby‚Äôs signs of tiredness so that they can put their baby to bed when tired. When babies becomes overtired, they can have difficulty falling asleep. Signs of tiredness can include:49,54,56
- Quietness or the loss of interest in stimulating activities.
- Crying or fussiness.
- Rubbing of the eyes.
To help a baby fall asleep, parents can:49,56,54,55,56
- Create a routine before bed that includes reading a story or listening to soothing music together.
- Create a soothing sleep environment that is dimly lit, quiet, and a comfortable temperature.
- Avoid stimulating the baby too much before sleep or during nighttime diaper changes.
- Always place the baby in a bassinette or crib to sleep so that this is associated with the place to sleep.
Babies should always be put on their back to sleep in a bassinette or crib with a firm, flat surface to decrease the risk of Sudden Infant Death Syndrome (SIDS). Items such as pillows, stuffed animals, and fluffy blankets should not be put in the crib as these present suffocation risks.49,56,54 See the file on Newborn Safety for information on safe sleeping.
Preventing a flat head
Babies always need to be placed on their back for sleep to decrease the risk of SIDS. As babies have very soft heads that can be affected by pressure, strategies are needed to prevent them from developing a flat head otherwise known as positional plagiocephaly.57,58[ To prevent a flat head from forming, parents can:57,58
- Alternate the position that a baby sleeps in the crib each day, one day putting the baby‚Äôs head at the headboard and the next day putting the baby‚Äôs head at the footboard. This alternating of positions will cause the baby‚Äôs head to turn in different directions thus alternating the points where the pressure is applied.
- Alternate the place of a mobile for a baby to look at when in the crib.
- Use a soft, upright baby carrier as an alternative to using a stroller.
- Have supervised tummy time for 10 to 15 minutes, three times a day, when the baby is awake. Tummy time involves having the baby play in a prone positions, while being held or closely supervised. Tummy time can also be beneficial in the development of the baby‚Äôs upper body muscles.
Some flattening will naturally resolve on its own, and a flat head does not affect brain development. Parents who notice a flat head developing on their baby should talk with their health care provider as they also may have suggestions for interventions.57,58
Healthy babies cry as a way to express their needs and communicate.59,60 Babies can cry because they:59,60
- Are hungry.
- Are tired.
- Need a diaper change.
- Have gas pains.
- Are too hot or too cold.
- Are uncomfortable.
- Want to be held.
- Are sick or hurt.
It is important to respond to a baby when she is crying; this shows the baby that she is safe and loved. A baby needs this for healthy development. A baby cannot be spoiled.56,59
It is also important for parents to know that sometimes a baby will cry for no reason at all. Crying episodes can peak during the first few months of life. In the past, when a baby cried long and hard for no reason, the baby was said to have colic. However, this is actually not a condition. Crying long and hard for no reason is normal newborn behaviour, and it won‚Äôt last forever. Crying episodes can still be frustrating for parents or caregivers.59,60
To soothe a baby, parents, or other caregivers can try:60
- Feeding the baby if hungry.
- Changing the baby‚Äôs diaper if wet or soiled.
- Burping the baby.
- Changing the baby‚Äôs position or giving the baby a gentle rub on the back.
- Holding the baby or placing the baby skin-to-skin.
- Checking the temperature of the room to make sure that it isn‚Äôt too hot or too cold and making sure that that the baby is not under-dressed or over-dressed.
- Talking and singing to the baby or playing soothing music.
- Turning down the lights and making the environment quiet. Too much stimulation can upset a baby.
- Gently rocking the baby in a rocking chair. Many babies are soothed by motion.
- Taking the baby for a walk in a stroller.
- Going for a car ride.
- Giving the baby a warm bath and massage.
Whatever is done, it should be gentle and soothing. If a parent or caregiver is feeling frustrated, they should put the baby down in a safe place such as a bassinette or crib, and take time to calm down.60,61,62 If a parent or caregiver is feeling frustrated, to calm down it can be beneficial if they:61,62
- Do something that they enjoy such as watch television, surf the internet, make a snack, exercise, or read a book.
- Call a friend or a relative for help and support.
- Call a health care provider.
See the file on Transition to Parenthood for more information on support for new parents.
Abusive Head Trauma (AHT)
Abusive Head Trauma, including Shaken Baby Syndrome (SBS), is a medical condition that refers to injuries that occur when a baby or a young child is shaken by a person who is bigger and stronger than them. AHT injuries can involve intracranial hemorrhage; retinal hemorrhage; brain damage; blindness; seizures; skull, rib, or long bone fractures,; paralysis; and death. AHT can easily occur if a baby or young child is shaken as they have relatively large heads and weak neck muscles.
No child, at any age, should ever be shaken.61,62,63,64 For more information about Abusive Head Trauma, see the Newborn Safety file.
Attachment refers to the deep and lasting emotional connection that children form with those that care for them. This is much different from bonding that occurs initially at birth when a newborn is placed with the parents and interacts with them for the first time. Bonding begins in pregnancy. Attachment takes place as a child grows and develops. When parents respond to their newborn‚Äôs cries; hold and rock their newborn; and fulfill their newborn‚Äôs needs, this builds trust and feelings of love and security ‚Äď the tenants of attachment.
Attachment is important for a child‚Äôs social, emotional, and cognitive development. It affects how a child will interact with people later in life as well as how they will be able to manage difficult situations.65,66,67 According to the Canadian Paediatric Society, signs that a secure attachment is forming are as follows:67
- By 4 weeks of age, the baby will respond to a caregiver‚Äôs smile with a facial expression or movement.
- By 3 months of age, the baby will smile back at the caregiver.
- By 4 to 6 months of age, the baby will turn to the caregiver and expect him or her to respond when he is upset.
- By 7 or 8 months of age, the baby will have a special response when he sees the primary caregiver.
If a baby does not respond to the primary caregiver, make eye contact, or show interest in people, a health care provider should be consulted.67
Newborns learn by listening to voices, watching faces, and reading body language. A child‚Äôs interest and curiosity are the motivators that create new connections to learn new skills. Each new skill builds on a skill already learned. When parents are engaged in the growth and development of their child, this can lead to a healthy brain.68,69 To assist with a baby‚Äôs development, parents can:68,69
- Talk, read, and sing with their baby. Watching a television show, even if touted as educational, is a passive activity. Babies need to interact with people and explore the world. Screen time is not recommended for children under 2 years of age.
- Play simple games such as peek-a-boo with a 5-month-old.
- Develop daily routines that their baby can count on.
- Talk to their baby as they go through their daily routines.
- Tell their baby what is going on, point out interesting things, and help her develop all of the five senses (i.e., sight, hearing, touch, smell, and taste).
- Develop community connections. Many communities have centres that serve young families (e.g., Ontario Early Years Centres). These centres are a good place to meet other parents and have professionals answer questions.
Parents can use what is referred to as the Nipissing District Developmental Screen (ndds)to determine if their child is performing tasks that most children their age are able to do. Many Ontario Early Years Centres have this tool available.
Referrals may be warranted if parents are:
- Anxious or fearful about caring for their newborn.
- Require more information about newborn care.
- Expecting a baby with known health issues/conditions.
Parents who require more information and/or support about newborn care can be referred to the following sources:
- Their health care provider (obstetrician, family physician, Nurse Practitioner, midwife, or paediatrician).
- In-person prenatal education classes, if not already enrolled.
- Their local public health unit.
- Ontario Early Years Centres (OEYC).
Resources & Links
- Ontario Ministry of Health and Long-Term Care
- Perinatal Services BC
- Registered Nurses‚Äô Association of Ontario (RNAO)
- Breastfeeding Committee for Canada (BCC)
- Canadian Paediatric Society (CPS)
- Practice Point: Positional plagiocephaly (2011, reaffirmed 2014)
- Position Statement: Guidelines for detection, management and prevention of hyperbilirubinemia in term and late preterm newborn infants. (2007, reaffirmed 2011)
- Position Statement: Newborn male circumcision (2015)
- Position Statement: Preventing ophthalmia neonatorum (2015)
- Position Statement: Recommendations for the use of pacifiers (2003, reaffirmed 2014)
- Position Statement: Routine administration of vitamin K to newborns (1997, reaffirmed 2014)
- Position Statement: Temperature measurement in paediatrics (2000, updated 2015)
- Position Statement: Universal newborn hearing screening (2011, reaffirmed 2014)
- Newborn Screening Ontario (NSO)
- Ontario Ministry of Health and Long-Term Care
- Provincial Council for Maternal and Child Health
- Canadian Paediatric Society (CPS)
- Health Canada
- Hearing Foundation of Canada
- The Hospital for Sick Children (SickKids)
- Newborn Screening Ontario (NSO)
- Ontario Early Years Centres (OEYC)
- Ontario Ministry of Children and Youth Services
- Ottawa Public Health – Here Comes Baby Video Series
- Public Health Agency of Canada (PHAC)
- Ontario Early Years Centres (OEYC) 1-866-821-7770
- Public Health Units (Service Ontario) 1-866-532-3161
- Telehealth Ontario 1-866-797-0000
Prenatal Education Provider Tools
- Best Start Resource Centre (BSRC)
Client Resources and Handouts
- Best Start Resource Centre (BSRC)
- Baby Friendly Initiative of Ontario (BFI Ontario)
- Children’s Hospital of Eastern Ontario (CHEO)
- Newborn Screening Ontario (NSO)
- Nipissing District Developmental Screen (ndds)
- Provincial Council for Maternal and Child Health (PCMCH)
- Publicly Funded Immunization Schedule for Ontario
- Moore, L. D. (Ed.). (2015). Your child‚Äôs best shot: A parent‚Äôs guide to vaccination (4th ed.). Ottawa, ON: Canadian Paediatric Society.
- Sacks, D. (2009) The Canadian paediatric society guide to caring for your child from birth to age five. Ottawa, ON: Canadian Paediatric Society.
- Best Start Resource Centre (BSRC)
- Healthy Baby Healthy Brain (2012)
- Government of Ontario
- Vaccines and immunization (2015)
- Children’s Hospital of Eastern Ontario
- World Health Organization. (2015). Infant, newborn. Retrieved from http://www.who.int/topics/infant_newborn/en/
- World Health Organization. (2015). Neonatal mortality. Retrieved from http://www.who.int/gho/child_health/mortality/neonatal_text/en/
- Statistics Canada. (2013). Infant mortality rate, by province and territory (both sexes). Retrieved from http://www.statcan.gc.ca/tables-tableaux/sum-som/l01/cst01/health21a-eng.htm
- Nomaguchi, K.M. & Milkie, M.A. (2003). Costs and rewards of children: The effects of becoming a parent on adults’ lives. Journal of Marriage and Family, 65(2), 356-374. doi:10.1111/j.1741-3737.2003.00356.x
- Kingston, D., Heaman, M., Fell, D., Dzakpasu, S., & Chalmers, B. (2012). Factors associated with perceived stress and stressful life events in pregnant women: Findings from the Canadian maternity experiences survey. Maternal and Child Health Journal, 16(1), 158-168. doi:10.1007/s10995-010-0732-2
- Wendland, J., Brisson, J., Medeiros, M., Camon‚ÄźS√©n√©chal, L., Aidane, E., David, M., . . . Rabain, D. (2014). Mothers with borderline personality disorder: Transition to parenthood, parent‚Äďinfant interaction, and preventive/therapeutic approach. Clinical Psychology: Science and Practice, 21(2), 139-153. doi:10.1111/cpsp.12066
- Browne, D.T. & Jenkins, J.M. (2012). Health across early childhood and socioeconomic status: Examining the moderating effects of differential parenting. Social Science & Medicine, 74(10), 1622-1629. doi:10.1016/j.socscimed.2012.01.017
- Larson, C.P. (2007). Poverty during pregnancy: Its effects on child health outcomes. Paediatrics & Child Health, 12(8), 673-677. Retrieved from http://www.pulsus.com/
- Kan, M.L., Feinberg, E., & Solmeyer, A.R. (2012). Intimate partner violence and coparenting across the transition to parenthood. Journal of Family Issues, 33(2), 115-135. doi:10.1177/0192513X11412037
- Ryan, K., Smith, L., & Alexander, J. (2013). When baby’s chronic illness and disability interfere with breastfeeding: Women’s emotional adjustment. Midwifery, 29(7), 794-800. doi: 10.1016/j.midw.2012.07.011
- Lindo, J.M. (2011). Parental job loss and infant health. Journal of Health Economics, 30(5), 869-879. doi:10.1016/j.jhealeco.2011.06.008
- Yopp, J.M., & Rosenstein, D.L. (2012). Single fatherhood due to cancer. Psycho‚ÄźOncology, 21(12), 1362-1366. doi:10.1002/pon.2033
- McMillan, D.D. (1997, reaffirmed 2014). Routine administration of vitamin K to newborns. Paediatrics & Child Health, 2(6), 429-434. Retrieved from http://www.cps.ca/en/documents/position/administration-vitamin-K-newborns
- Kries, R. (1992). Vitamin K prophylaxis: A useful public health measure? Paediatric and Perinatal Epidemiology, 6(1), 7-13. doi:10.1111/j.1365-3016.1992.tb00736.x
- Moore, D.L. & MacDonald, N.E. (2015). Preventing ophthalmia neonatorum. Paediatrics & Child Health, 20(2), 93-96. Retrieved from http://www.cps.ca/en/documents/position/ophthalmia-neonatorum
- Association of Ontario (2012). AOM Position Statement: Informed Choice and Neonatal Eye Prophylaxis. Retrieved from https://www.ontariomidwives.ca/
- Newborn Screening Ontario. (2015). Newborn screening manual: A guide for newborn care providers. Retrieved from http://www.newbornscreening.on.ca/data/1/rec_docs/853_CHO0095-NSM-Pages-Jan2015-WEB.pdf
- Barrington, K. & Sankaran, K. (2007, reviewed 2011). Guidelines for detection, management and prevention of hyperbilirubinemia in term and late preterm newborn infants (35 or more weeks’ gestation). Paediatrics & Child Health, 12(Supplement B), 1B-12B. Retrieved from http://www.cps.ca/en/documents/position/hyperbilirubinemia-newborn
- Caring for Kids, Canadian Paediatric Society. (2012). Jaundice in newborns. Retrieved from http://www.caringforkids.cps.ca/handouts/jaundice_in_newborns
- Patel, H. & Feldman, M. (2011). Universal newborn hearing screening. Paediatrics & Child Health, 16(5), 301. Retrieved from http://www.cps.ca/en/documents/position/universal-hearing-screening-newborns
- Caring for Kids, Canadian Paediatric Society. (2012). Your baby‚Äôs hearing. Retrieved from http://www.caringforkids.cps.ca/handouts/your_babys_hearing
- Perry, S.E., Hockenberry, M.J., Lowdermilk, D.L., & Wilson, D. (2013). Maternal child nursing care in Canada. C. Sams & L. Keenan-Lindsay (Eds.). Toronto, ON: Elsevier Canada.
- Caring for Kids, Canadian Paediatric Society. (2004). Circumcision of baby boys: Information for parents. Retrieved from http://www.caringforkids.cps.ca/handouts/circumcision
- Coylar, M.R. (2015). Chapter 25: Circumcision and dorsal penile nerve block. In Advanced practice nursing procedures (pp. 252-258). Philadelphia, PA: F.A. Davis Company.
- Al-Abdi, S.Y. (2013). Petroleum jelly for prevention of post-circumcision meatal stenosis. Journal of Clinical Neonatology, 2(3), 113-114. doi:10.4103/2249-4847.119988
- Caring for Kids, Canadian Paediatric Society. (2013). How many diapers will be baby go through? Retrieved from http://www.caringforkids.cps.ca/handouts/how_many_diapers_will_my_baby_go_through
- Canadian Public Health Association. (2009). Caring for you and your baby. Ottawa, ON: Author. Retrieved from http://you-and-your-baby.cpha.ca/_pdf/cyayb_e_final_web.pdf
- Canadian Paediatric Society. (2008). 10 steps for diaper changes. Retrieved from https://www.caringforkids.cps.ca/uploads/wellbeings/diaper.pdf
- Caring for Kids, Canadian Paediatric Society. (2013). Diaper rash. Retrieved from http://www.caringforkids.cps.ca/handouts/diaper_rash
- Caring for Kids, Canadian Paediatric Society. (2012). Your baby‚Äôs skin. Retrieved from http://www.caringforkids.cps.ca/handouts/your-babys-skin
- British Columbia Reproductive Care Program. (2001). Newborn guideline 10: Care of the umbilical cord. Retrieved from http://www.perinatalservicesbc.ca/Documents/Guidelines-Standards/Newborn/CordCareGuideline.pdf
- Caring for Kids, Canadian Paediatric Society. (2013). Healthy teeth for children. Retrieved from http://www.caringforkids.cps.ca/handouts/healthy_teeth_for_children
- Moda, A. (2011). Gingival cyst of newborn. International Journal of Clinical Pediatric Dentistry, 4(1), 83-84. Retrieved from http://www.ijcpd.com/
- Schuurmans, N., Senikas V., & Lalonde, A. B. (2009). Healthy beginnings: Giving your baby the best start, from preconception to birth. Location: John Wiley & Sons Canada.
- Caring for Kids, Canadian Paediatric Society. (2010). Safe sleep for babies. Retrieved from http://www.caringforkids.cps.ca/handouts/safe_sleep_for_babies
- Health Canada. (2012). Is your child safe? Sleep time. Retrieved from http://www.hc-sc.gc.ca/cps-spc/pubs/cons/child-enfant/sleep-coucher-eng.php#a62
- Government of Canada. (2015). Immunize your child. http://www.healthycanadians.gc.ca/healthy-living-vie-saine/immunization-immunisation/children-enfants/immunize-immuniser-eng.php
- Caring for Kids, Canadian Paediatric Society. (2014). Vaccination and your child. Retrieved from http://www.caringforkids.cps.ca/handouts/vaccination_and_your_child
- Caring for Kids, Canadian Paediatric Society. (2010). 5-in-1 or 6-in-1 Retrieved from http://www.caringforkids.cps.ca/handouts/5-in-1-or-6-in-1-vaccine
- Immunize Canada. (2013). Autism. Retrieved from http://immunize.ca/en/publications-resources/questions/autism.aspx
- DeStefano, F., Price, C.S., & Weintraub, E.S. (2013). Increasing exposure to antibody-stimulating proteins and polysaccharides in vaccines is not associated with risk of autism. The Journal of Pediatrics, 163(2), 561-567. doi:10.1016/j.jpeds.2013.02.001
- Taylor, L.E., Swerdfeger, A.L., & Eslick, G.D. (2014). Vaccines are not associated with autism: An evidence-based meta-analysis of case-control and cohort studies. Vaccine 32(29), 3623-3629. doi:10.1016/j.vaccine.2014.04.085
- Caring for Kids, Canadian Paediatric Society. (2014). Your newborn: Bringing baby home from the hospital. Retrieved from http://www.caringforkids.cps.ca/handouts/bringing_baby_home
- Ontario Ministry of Health and Long-Term Care. (2003). Ministry reports: Healthy babies healthy children report card. Retrieved from http://www.health.gov.on.ca/en/common/ministry/publications/reports/healthy_babies_report/hbabies_report.aspx
- Ontario Ministry of Health and Long-Term Care. (2001, last modified 2012). Postpartum implementation guidelines for the healthy babies, healthy children program. Retrieved from http://www.health.gov.on.ca/english/providers/pub/child/hbabies/postpartum.html
- Caring for Kids, Canadian Paediatric Society. (2009). Fever and temperature taking. Retrieved from http://www.caringforkids.cps.ca/handouts/fever_and_temperature_taking
- Leduc, D. G., & Woods, S. (2000). Temperature measurement in paediatrics. Paediatrics & Child Health, 5(5), 273-276. Retrieved from http://www.cps.ca/en/documents/position/temperature-measurement
- Caring for Kids, Canadian Paediatric Society. (2011). Using over-the-counter drugs to treat cold symptoms. http://www.caringforkids.cps.ca/handouts/over_the_counter_drugs
- Caring for Kids, Canadian Paediatric Society. (2009). Ear infections. Retrieved from http://www.caringforkids.cps.ca/handouts/ear_infections
- Ponti, M. (2003, eaffirmed 2014). Recommendations for the use of pacifiers. Paediatrics & Child Health, 8(8), 515-519. Retrieved from http://www.cps.ca/en/documents/position/pacifiers
- Lieberthal, A.S., Carroll, A.E., Chonmaitree, T., Ganiats, T.G., Hoberman, A., Jackson, M.A., . . . Tunkel, D.E. (2013). The diagnosis and management of acute otitis media. Pediatrics, 131(3), e964-e999. doi:10.1542/peds.2012-3488
- Best Start Resource Centre. (2012). A healthy start for me and baby: Ontario‚Äôs easy-to-read book about pregnancy and birth. Retrieved from http://www.beststart.org/resources/rep_health/pdf/low_lit_book_fnl_LR.pdf
- Caring for Kids, Canadian Paediatric Society. (2013). Common infections and your child. http://www.caringforkids.cps.ca/handouts/common_infections_and_your_child
- Caring for Kids, Canadian Paediatric Society. (2012). Healthy sleep for your baby and child. Retrieved http://www.caringforkids.cps.ca/handouts/healthy_sleep_for_your_baby_and_child
- Centre of Excellence for Early Childhood Development and the Strategic Knowledge Cluster on Early Child Development. (2014). Eyes on sleeping behaviour: Good sleep, for good growth. Retrieved from http://www.child-encyclopedia.com/Pages/PDF/eyes-on-sleeping-behaviour.pdf
- Best Start Resource Centre. (2014). Sleep well, sleep safe: A booklet for parents of infants from 0-12 months and for all who care for infants. Toronto, ON: Author. Retrieved from http://www.beststart.org/resources/hlthy_chld_dev/pdf/BSRC_Sleep_Well_resource_FNL_LR.pdf
- Caring for Kids, Canadian Paediatric Society. (2011). Preventing flat heads in babies who sleep on their backs. Retrieved from http://www.caringforkids.cps.ca/handouts/preventing_flat_heads
- Cummings, C. (2011). Positional plagiocephaly. Paediatrics & Child Health, 16(8), 493-494. Retrieved from http://www.cps.ca/documents/position/positional-plagiocephaly
- Registered Nurses‚Äô Association of Ontario. (2014). Working with families to promote safe sleep for infants 0-12 months of age. Retrieved from http://rnao.ca/bpg/guidelines/safe-sleep-practices-infants
- Caring for Kids, Canadian Paediatric Society. (2014). Colic and crying. Retrieved from http://www.caringforkids.cps.ca/handouts/colic_and_crying
- Canadian Paediatric Society. (2014). Never shake a baby. Retrieved from http://www.caringforkids.cps.ca/handouts/never_shake_a_baby
- Canadian Paediatric Society. (reaffirmed 2005). Joint statement on shaken baby syndrome. Ottawa, ON: Author.
- Public Health Agency of Canada. (2011). Shaken baby syndrome. Retrieved from http://www.phac-aspc.gc.ca/hp-ps/dca-dea/cht-sse/shaken-secoue/index-eng.php
- Canadian Paediatric Society. (2007). Multidisciplinary guidelines on the identification, investigation, and management of abusive head trauma. Ottawa, ON: Author. Retrieved from http://www.cps.ca/documents/AHT.pdf
- Benoit, D. (2004). Infant-parent attachment: Definition, types, antecedents, measurement and outcome. Paediatrics & Child Health, 9(8), 541-545. Retrieved from http://www.pulsus.com
- Public Health Agency of Canada. (2011). Attachment: Connecting to your child. Retrieved from http://www.phac-aspc.gc.ca/hp-ps/dca-dea/cht-sse/attachment-attachement/index-eng.php
- Caring for Kids, Canadian Paediatric Society. (2014). Attachment: A connection for life. Retrieved from http://www.caringforkids.cps.ca/handouts/attachment
- Caring for Kids, Canadian Paediatric Society. (2014). Your baby‚Äôs brain: How parents can support healthy development. Retrieved from http://www.caringforkids.cps.ca/handouts/your_babys_brain
- Caring for Kids, Canadian Paediatric Society. (2014). Read, speak, sing to your baby: How parents can promote literacy from birth. Retrieved from http://www.caringforkids.cps.ca/handouts/read_speak_sing_to_your_baby