Class 3 - Newborn Care 101

Sleep Safety for SIDS Prevention

Sleep safety is about creating a sleep environment for your baby which reduces the risk of sudden infant death syndrome (SIDS). SIDS is exactly what it sounds like. It can occur without warning, at any age in the first year of life, and results in death. It only happens during sleep, but that includes daytime naps as well as overnight sleep.

There are many leading theories about why SIDS occurs, but unfortunately we do not know for sure. Thankfully, a great deal of research has been done to determine how to prevent prevent it from happening. If you follow these recommendations closely, you can safely remove this terrifying possibility from your mind altogether.

The ABCs of Safe Sleep

  • The ABCs should be followed for both daytime naps and overnight sleep.
  • The ABCs should be followed for the entire first year of life.
  • After 12 months of life, most experts believe these restrictions can be lifted.

A - Alone

  • Your child should be completely alone in the sleep environment.
    • Items such as teething necklaces, pillows, toys, stuffed animals, loose bedding (blankets, quilts, comforters, loose sheets), crib liners (even if advertised as “breathable”), wedges to keep your baby is a particular position, and bumper pads should never be present in the sleep environment.
    • This also includes caregivers. Co-sleeping (when both caregiver and baby are sleeping in the same place together, such as your bed, the couch, a recliner, etc) increases the risk of SIDS, separately from events where a child is accidentally suffocated or injured by a sleeping adult.
    • Put your baby in the same room as you, but not the same bed.
      • Sleeping in the same room as your baby is recommended for the first 6 months, as this has been shown to reduce the risk of SIDS. 
  • Only two items are safe for your baby to have during sleep:
    • Pacifier
      • The pacifier should not have anything attached to it (stuffed animals, strings/ropes). The pacifier should be inspected regularly for signs of wear and tear, and discharged if these are present.
    • Swaddle
      • A swaddle should be tight, and positioned low enough to see the top of the chest and shoulders.

B - Back

  • Always place your baby on their back for sleep.
  • If your baby has rolled from her back to her side or stomach on her own, she is safe to be left in that position, and does not need to be replaced on her back again.
  • Stop swaddling once your baby is 4 months old, or as soon as she can roll from her back to her belly on her own.

C - Crib

The sleep surface must be two things:  Firm and Flat

Firm

  • Cribs, bassinets, portable cribs, or play yards are safe, provided they meet the current safety standards.
  • Cover the mattress with a tight-fitting sheet.
  • Measure the dimensions of this sheet to be sure it is the same size as the mattress.
  • Never put rolled blankets or pillows between the mattress and the sheet.

Flat

  • Never put your baby to sleep at an inclined position.
  • Swings, rockers, bouncers, floor chairs, sleepers, car seats, and cushions/pillows increase the risk of SIDS and are not safe for sleep.
  • If your baby falls asleep in any of these items, he should be moved to a safe sleep environment as soon as possible.
  • Sleeping in a car seat is safe for short periods of time while in a moving car. The exact amount of time has not been thoroughly studied, unfortunately. Nevertheless, it is always safer for your baby to be in a carseat while the car is moving.

Additional Prevention Strategies

Don't Overheat During Sleep

  • Overheating increases the risk for SIDS.
  • Set the thermostat between 68-72ºF.
  • Dress your baby is the same number of layers of clothing as you need to feel comfortable at that temperature.

Pacifiers

  • Pacifiers have been show to reduce the risk of SIDS.
  • We recommend introducing the pacifier after 2 weeks of life, once breast feeding has been established.
  • If your baby is crying, offer more food before the pacifier. In the first 4 months, a crying baby is always hungry until proven otherwise.

Breastfeed Your Baby

  • Breastfeeding has been shown to reduce the risk of SIDS.
  • If, for whatever reason, breastfeeding doesn't work out for your baby this time around, please don't worry. The prevention strategies outlined above will keep your baby safe from SIDS.

Swaddling Your Baby

  • To be clear, swaddling is not necessary, but many parents find it can help soothe baby, and improve sleep.
    • It can also help during breastfeeding, to keep baby's hands out of the way during latching.
  • Many parents struggle to swaddle the baby tightly, which allows her to wiggle her hands free.
  • To ensure the swaddle does not create loose fabric around the face and mouth, it should be low enough to see the tops of the shoulders and the top of the chest.

Feeding Your Baby

  • For complete details, please read our guide to bringing in your breast milk on time, and our Breastfeeding 101 class outline.
  • Main takeaways:
    • A fussy, crying baby is always hungry until proven otherwise.
      • This is true no matter how recently or how much you fed your baby last time.
      • Try not to let yourself imagine other "reasons" your baby could be crying (gas, indigestion, mom's diet, etc).
    • You can't overfeed a baby.
      • Unless the pediatrician tells you differently, there is not a "goal amount" your baby should eat per feed or per day.
    • Feed on both breasts every time
    • On each breast, try to feed for at least 10 minutes and no more than 30 minutes.

Daily Care

Umbilical Stump Care

  • The umbilical cord is cut shortly after delivery, and a small amount of the cord remains attached to the baby. This is called the umbilical stump.
    • The stump gradually dries out and begins to look like a scab attached to the belly button.
    • The stump falls off on it's own, usually between 7-14 days of life.
    • Your baby can't feel the stump because there are no nerve endings in this area.
  • Do not wash, clean, or treat the umbilical stump in any way.
  • The cord will likely bleed for a day or two before and after it falls off.
    • You will likely find blood on the diaper or the clothing overlying the stump.
    • This can be ignored.
  • The cord may develop an odor before it falls off.
    • This can also be ignored.

Circumcision and Circumcision Care

  • In 2012, the American Academy of Pediatrics updated their policy statement on circumcision to reflect the following:
    • There are risks and benefits to circumcision and to not circumcising your baby.
    • In the developed world, these risks and benefits for both options are low.
      • As a result, this decision should be left to the caregivers, "in the context of their own religious, ethical, and cultural beliefs and practices."
  • If the decision is made to circumcise, this is usually performed in the delivery hospital before you take your baby home.
  • Circumcision Care
    • The circumcision should be completely healed within 10 days of the procedure.
    • Until that time, petroleum jelly should be applied to fresh gauze pads, and used to cover the penis after each diaper change.

Bathing

  • Bathe your baby every 2-3 days.
  • Use a warm, wet washcloth to bathe baby until the umbilical cord falls off and the circumcision (if present) has healed. 
  • After this happens (around 10-14 days of life), use a normal baby bath and gentle baby cleanser every 2-3 days.

Nail Care

  • Nail care is usually not needed, but may become necessary if your baby is accidentally scratching his face.
    • Of course, these scratches will heal without scarring on their own.
  • If this happens, nails should be filed, not clipped.
    • This is to avoid accidentally clipping your baby's skin.

Lotions for Baby Skin

  • Baby lotions are safe to use from the start, but not necessary.
  • In the first two months of life, flaking skin is not actually dry.
    • Your baby is shedding layers of skin she no longer needs, and this can be ignored.

Diaper Changes 

  • Until Mom's mature breast milk comes in (around day 3-5 of baby's life), the poop will be black and sticky (meconium).
    • The meconium is sticky, and requires more attention to completely clean from the skin.
    • Baby wipes are safe to use from the first day of life.
    • Be sure to check all the nooks and crannies.
      • Groins and fat rolls, under the scrotum, around the anus
      • Clean poop from the vagina only where you can see, but no further.
    • Putting diaper rash cream on the bottom before a rash has never been scientifically proven to prevent diaper rashes from happening.
      • That being said, the studies aren't perfect, and it won't hurt your baby.
      • If you choose to do so, use healthy amounts of cream after the diaper changes.
  • After the meconium goes away, the poop is easier to clean.
    • Be sure to check everywhere for poop
    • Continue to use diaper wipes and cream with diaper changes.
  • We have a comprehensive discussion about poop (and pee) in Class 4 - When to Worry About Your Baby.

Developmental Progress

  • There are four major areas of development we think about in pediatrics:
    • Gross Motor - whole body movements, such as rolling over, sitting, crawling, and walking.
    • Fine Motor - finger and hand skills such as transferring objects between hands, and picking up small objects with the thumb and index finger.
    • Expressive Language - sounds and words produced by your baby.
    • Receptive Language - ability to understand what is said to your baby.
  • In the first six months of life, babies only need two activities for their development:
    • Hearing words from people they care about.
      • The more words a baby hears from people they care about, the better their language development will be.
    • Tummy time (all the time!)
      • Tummy time is the foundation for gross and fine motor development in the first year of life.
      • When
        • Whenever she is awake and quiet.
        • These periods happen more often starting at 2 weeks of life.
      • How long
        • Leave your baby in tummy time until she begins to cry.
        • We want your baby to "feel the burn" from the exercise!
      • Technique
        • Place your baby in the push up position on a hard, flat surface.
          • Many parents make the mistake of choosing a surface that is too soft, which prevents baby from generating the force needed to hold their head and chest off the mat.
        • Keep your baby's head facing forward.
          • When she moves her face to one side of the other, move it back to center position.

Planning for Help

Grandparents

  • Grandparents are often thrilled at the prospect of helping their son or daughter care for their own new baby.
    • After all, this is an exciting life event for them as well!
  • When accepting these offers for overnight help in your home, you should consider having conversations with your folks to set expectations about how they can be most helpful to you.
    • Unlike other visits, the grandparents are not guests.
    • They were invited to make your life easier during a difficult time.
    • It’s important that you tell them how they can accomplish this.
  • We strongly recommend any caregivers staying overnight have received the tdap booster (if it's been longer than 10 years since their most recent booster), and annual flu vaccine.
  • As a result of COVID, we recommend overnight caregivers maintain 10-14 days of thoughtful and thorough quarantine prior to taking care of the baby.
  • All caregivers MUST maintain their quarantine practices after the baby is born as well, for as long as they are in close contact with parents and baby.

Lactation Support Services

  • Researching your lactation support options ahead of time is an excellent way to help you meet your breastfeeding goals.
  • It’s very possible you won’t need any help outside of the first few days after delivery, but it's good to have a plan in case you need it.
  • We wrote a blog post about lactation support services in Austin to help you get started if you’re in the area,                    

Postpartum Depression (PPD) Resources

  • Like all mental illness, PPD is not discussed as openly as it should be.
  • As a result, PPD is underreported by parents, and under-diagnosed by providers.
  • Like all mental illness, it is not discussed as openly as it should be.
    • One recent study suggested only 15% of Mom's with PPD receive treatment or any kind.
  • Regardless of Mom's personal history of depression or anxiety, it is important that all caregivers:

Introducing Pets to Baby

  • There's isn't much in the way of scientific research on this topic.
  • This is the general consensus:
    • In the days before and the weeks after bringing baby home, put swaddling blankets or clothing worn by baby in the hospital where the animals sleep and elsewhere around the house. Most family pets recognize other animals by scent, so this method serves as an effective introduction.
    • From there, watch all interactions closely for signs of aggression, not just the early intros.
    • Dogs and cats will recognize very quickly that this new human is extremely important to Mom and Dad, and should therefore be extremely important to them as well.