When your baby arrives, you may feel overwhelmed. Even routine tasks such as basic infant care can be stressful. But it doesn't take long to develop confidence in providing routine care for your baby.

Bathing

Sponge baths are recommended until the umbilical cord falls off and/or the circumcision site heals. Pay special attention to the creases around the ears, neck, and "private" areas. Clean female babies from front to back. Any mild soap can be used. Do not put a cotton tip applicator into the baby's ear canals.

Once the cord and circumcision are fully healed, the baby may be placed directly in water. A bathroom sink or shallow, plastic, oval-shaped tub is a suitable place for a bath. Only fill the basin with about two inches of water. The water temperature should be watched closely so that it is skin temperature. Make sure your hot water heater is set no higher than 120 degrees Fahrenheit.

Also, be sure that you have all the supplies you need before undressing your baby (washcloth, mild soap such as Dove or baby soap, cup for rinsing, and towel to dry). During the bath, the baby's head should be controlled with one of your hands while the other is free to wash.

Wash your baby's hair when it is bath time. Regular mild soap or baby shampoo is fine and don't be afraid to gently massage his entire scalp, including the soft spot.

When Do Baby's Soft Spots (Fontanels) Close?

The smaller spot at the back usually closes by age 2 to 3 months. The larger spot toward the front often closes around age 18 months. It's normally slightly depressing and pulsates. Soft spots are covered by a thick fibrous layer and are safe to gently touch.

When you rinse the soap from his head, cup your hand across his forehead to keep the soap from his eyes.

If you get some in his eyes, he will fuss, but all you need to do is take the wet washcloth and wipe them with plain water until the soap is gone. If you have forgotten something or need to answer the door or phone, you must take your baby with you. Never leave your infant alone in a bath for a second-he could drown in two inches of water.

Bath time is a special time between parents and newborns. The stimulation of the water and washing is exciting for babies, and you should try to enjoy the experience with your child.

Dry Skin

The newborn infant usually has dry, sometimes scaly skin, occasionally with cracks in the skin around the ankles and wrists. The use of lubricant cream may help when applied once or twice per day, especially after the bath, but this condition should resolve in the first 2-3 weeks.

Circumcision

If your baby has been circumcised, the penis will be red and swollen for the first two to three days. This will heal readily with the application of A&D ointment or Vaseline to the circumcision site at each diaper change. It is a good idea to cleanse the area gently with mild soap and water, rinse well, and pat dry. Vaseline gauze dressing may be used if there is undue redness or swelling. On the second or third day following circumcision, a yellowish membrane usually appears over the areas. This is part of the normal healing process and will disappear in a few days. Some infants are circumcised with a plastic bell. No care is required with this technique. The ring gradually detaches from the penis in 2-5 days. Erections are common in newborns and often occur just before urination.

If you have chosen not to circumcise your son, his penis should simply be cleaned and bathed with soap and water like the rest of the diaper area. Do not try to pull the foreskin back and no cleaning with antiseptic is needed. Just make sure that the hole at the tip is large enough for the urine stream to be normal. If the stream is consistently just a trickle, call your pediatrician.

Umbilical Cord Care

The end of the cord will fall off within the first month of life, usually within a couple of weeks. Until the cord falls off, sponge bathe your baby. Try to keep the diaper below the cord to help keep urine off of it. At each diaper change, use a cotton swab dipped in rubbing alcohol to clean away the wet sticky material that collects at the base of the stump near the skin. You may notice a few drops of blood or a small amount of yellow material coming from the stump after the cord falls off. This is normal. Call our office if it looks red, bleeds, and/or oozes a lot.

Often the ring through which the umbilical cord passed in the baby's abdominal muscles does not close immediately so that some protrusion of the navel may be seen. This is called an umbilical hernia, and even though it is not pleasant to look at, it does not harm the baby and will almost always disappear with time. The use of adhesive tapes, bellybands, and coins is not helpful in making it go away any quicker.

Vaginal Discharge

Baby girls frequently have a whitish, thick, mucousy vaginal discharge which may become blood-tinged, almost like a small menstrual period. This is normal and gradually will disappear without treatment. Clean the vaginal area from front to back.

Diapering

Before you start to change your baby's diaper, make sure you have everything you will need in reach. This includes a clean diaper (and fasteners if using cloth diapers), any ointment you may be used for rash, a warm, wet washcloth for cleaning your baby's bottom or wipes, and a towel (in case he urinates while you are changing him). NEVER leave your baby alone on the changing table, even for a second. He could fall off and seriously hurt himself. There is nothing wrong with disposable diapers; in fact, they probably keep a baby drier than cloth diapers and plastic pants. Change your baby's diapers as soon as possible after wetting. Wash the area with a soft, moist, soapy cloth and rinse; baby wipes are fine. Some babies may be sensitive to wipes. In this case, use plain water with a soft cloth or paper towel.

Plastic or rubber pants or diapers with elastic gathers prevent optimum air circulation that is necessary to prevent diaper rash or treat a rash that has already appeared.

Baby powder is not recommended. If the powder is used, corn starch is as good or better as any. Apply with a cotton ball to prevent the infant from inhaling powder that is freely dusted onto his body. Soaking the diapers in mild bleach may be helpful in ensuring a cleaner diaper, but one must be careful to rinse adequately. To wash the baby's clothes, sheets, and diapers, use a mild or low sudsing soap since a stronger detergent is a frequent cause for rashes. Do not use fabric softener/anti-static patches in the dryer; these often cause rashes.

Mouth Care

The tongue may normally have a white coating on it, and one or two white spots may be seen on the roof of the mouth. However, notify us if white patches appear on the gums or inside the cheeks. The baby's upper lip may develop a normal sucking blister.

Breasts

Some enlargement of the breasts in both male and female infants is not unusual due to the maternal hormones. No treatment is necessary for this and the swelling usually subsides in a few months. If, however, redness and/or tenderness develop, please consult with us. Please do not massage or squeeze the breasts.

Head

After birth, a baby's head is often elongated (the Cleopatra look) or has a bump on the back or side of it. This is due to the pressure on the head during delivery causing some mild bleeding under the skin. The brain is not damaged or injured by this. A baby's skull may flatten on one side if he constantly lies in one position. Try to rotate your baby's position in the crib to lessen the chance of this happening, although as the bones mature, the flattened area will return to normal. There are also two soft spots (fontanelles) on the head. The large one on top usually closes by two years and the small one, in the back of the head, by 2 months. Brush these spots with a soft baby brush (as well as the rest of the head) so your baby will not develop a cradle cap (a yellowish dry scale on the scalp). You can't hurt the baby as there is a tough membrane on the soft spot.

Eyes

Erythromycin ophthalmic ointment is put in the baby's eyes in the delivery room to prevent infection. Some babies may have a small whitish discharge from the eyes. A cotton ball moistened with lukewarm water may be used to gently wipe away any accumulated discharge from the eyes. Sometimes, red marks or lines may be noted on the white of the eye. These are slight hemorrhages caused by the pressure of labor and disappear without any treatment. The color of a baby's eyes may change for as long as 1-2 years after birth. Please notify us if there is a persistent thick yellowish-green discharge.

Pacifiers

If you plan to use a pacifier, it must be given to the baby during the first few days of life before the thumb is discovered. A pacifier is recommended by many dentists because it may help prevent the deformities of the teeth caused by thumb sucking. A good pacifier is the NUK pacifier but it is the most difficult one for the baby to use. Use a one-piece pacifier that will not come apart. The pacifier should be kept clean and it is recommended that its use be discontinued by one year. Pacifier use has been associated with a lower risk for Sudden Infant Death Syndrome.

Fresh Air

Fresh air is fine for a new baby. The infant may go out 1-2 weeks after discharge from the hospital. This will depend on the baby's size and the time of year. Take the baby out on a clear non-windy day and dress him appropriately. Dress your baby the way you would dress for the day with one additional layer. Keep the newborn out of direct sunlight and away from the beach. They burn easily and will not look away from the sun. Check sensitivity to sunblock by applying it to a small exposed area prior to full application. There are insect and tick repellents available that are specifically formulated for children who have low-dose DEET or none at all. New mothers should try to get out and away from the house, alone, at least once a week after the first two weeks.

Environment/Visitors

Try to avoid crowds during the first 6-8 weeks. In the first three or four days, while the baby is getting used to his new surroundings at home, it is better not to have visitors if possible.

A new baby has not had time to build up resistance to infections. Therefore, make sure anyone handling him during the first few weeks washes their hands carefully. If they have a cold or other contagious illness, they should delay their visit. Be particularly careful about visiting children outside the immediate family, because kids can carry strep throat and chickenpox with no outward sign of infection and give these germs to your baby.

Do not smoke or let others smoke inside your house or car. It is a well-established fact that babies who live in homes where parents smoke have twice as many upper and lower respiratory infections like colds, ear infections, bronchitis, pneumonia, and asthma as infants growing up in homes where no parent smokes.

Sleep

Initially, your infant doesn't know the difference between day and night. Her stomach holds only enough to satisfy her for three or four hours, regardless of the time, so there's no escaping round-the-clock waking and feeding for the first few weeks. But even at this age, you can begin to teach her that nighttime is for sleeping and daytime is for play. Do this by keeping nighttime feedings as subdued as possible. Don't turn up the lights or prolong late-night diaper changes. Instead of playing, put her back down after feeding and changing her. This will train her to save her extra sleeping for nighttime.

If your baby is rarely alert, does not wake up on his own for feedings, or seems too tired or uninterested in eating, consult our office. This may be a symptom of a serious illness.

The American Academy of Pediatrics recommends that healthy infants be placed on their backs for sleep. For many years it was recommended that infants be placed on their stomachs for sleep. This was thought to be the best way to avoid aspiration (sucking food into the trachea or windpipe) in case of vomiting or spitting up. Recent information, however, indicates that the back is a safer position, particularly as it relates to Sudden Infant Death Syndrome (SIDS).

This recommendation applies to infants throughout the first year of life. However, the recommendation is particularly important for the first six months, when the incidence of SIDS is the highest.

It is also important to avoid placing your baby down for sleep on soft, porous surfaces such as pillows or quilts Her airway may become blocked if her face becomes burrowed in such surfaces. A firm crib mattress covered by a sheet is the safest bedding.

As she gets older and her stomach grows, your baby will be able to go longer between feedings. In fact, you'll be encouraged to know that more than 90 percent of babies sleep through the night (six to eight hours without waking) by three months. Most infants are able to last this long between feedings when they reach 12-13 pounds, so if yours is a very large baby, she may begin sleeping through the night even earlier than three months. As encouraging as this sounds, don't expect the sleep struggle to end all at once. Most children swing back and forth sleeping beautifully for a few weeks, or even months, then returning abruptly to a late-night wake-up schedule. This may have to do with growth spurts increasing the need for food, or later, it may be related to teething or developmental changes.

Bowel Movements

Many parents (and grandparents) feel that something terrible will happen to the baby if he does not have a bowel movement every day. Normal babies can have only one stool every three to four days (or longer) or a bowel movement with each feeding, especially in the first week of life. It is also important to keep in mind that variation in color and consistency of stools can be completely normal. All babies strain like they need to have a bowel movement and don't pass anything. This is normal. If your baby has hard or "rabbit-pellet" stools, or if you notice large amounts of blood or mucus in the stool, call for advice. Constipation is easily managed. One tablespoon of dark corn syrup can be added to four ounces of formula or breast milk. Give the infant two ounces of this mixture in the morning and two ounces in the afternoon for hard stools. An alternative is to mix equal parts of apple juice (or in more stubborn cases, prune juice) and water, giving two ounces in the morning and two ounces in the evening.