General care guide for your newborn

When your baby comes home, it is normal to have a lot of questions about everyday care. It is an intense time, with many changes, and it does pass. So those first days go as smoothly as they can, our midwife team at Happymami wrote this guide to general newborn care.

The first days at home with your baby

In this first stage, common sense helps. It lets you understand your baby and sort out everyday questions, always with the advice of the health professionals around you. Babies are not all the same. Some are calmer and settle into new situations easily. Others are less regular: less sleep, changing nappies, more fussing, or they cry more readily. Give yourselves time to get to know each other. Little by little you will recognise your baby's rhythm. Like breastfeeding, it is something you learn day by day. The topics below are in alphabetical order, so you can find what you need.

Bath

A bath can be daily from birth, even before the cord stump falls off. We suggest waiting until 24 hours after birth, and never before 6 hours. Choose the calmest moment of the day for both of you, or the time your baby finds most soothing, and make it a gentle time together.

• Have everything you need within reach.
• Do not fill the bath too deep. 10 to 15 cm of water is enough.
• The water should feel pleasant (36–38°C). Check it with your elbow or the back of your hand, so it is not too hot.
• The room should feel pleasant too (22–24°C), with no draughts.

• Electrical appliances near water can cause short circuits and very serious accidents, including electric shock.
• Use a mild soap, and very little of it, and rinse with the same water. For a girl, clean from front to back, between the genitals and the anus, to lower the chance of infection.
• Keep the bath short. A few minutes is enough at the start. You can stay longer as your baby grows.
• Lift your baby out carefully, wrap them in a dry, warm towel, and pat them dry gently.
• Afterwards you can moisturise the skin and give a massage with a cream, lotion or oil suited to their age. That close contact helps them settle for sleep, and it cares for the skin.

Dummy

If you are breastfeeding, we do not recommend a dummy in the first weeks, until feeding is well established. Breast and dummy are sucked in different ways, and that can confuse how your baby latches. It is one reason breastfeeding can falter.

For safety, the dummy should be a single piece. Silicone and latex are both suitable. From 6 months, latex is preferable because it stands up better to chewing.

Do not share spoons or other utensils with your baby, and do not clean the dummy in your own mouth. That passes on germs, including the ones that cause tooth decay.

Safe bed-sharing

A guide to safe bed-sharing. Do not share a bed if:

• You or your partner smoke.
• You have had alcohol.
• You have taken drugs or medicines that make you sleep more heavily than usual.
• You are so tired you do not think you would wake if your baby needed you.
• You have an illness that means you do not wake in response to your baby's needs.

Infant colic

Spells of crying, shorter or longer, that are hard to settle. They happen mostly in the late afternoon or early evening. They often come back every day for a while, in the same way, and they are quite common in the first three months. This is not an illness. It passes within a few weeks. A full guide to infant colic.

Colic massage

• Massage the tummy, from under the ribs down to the pubic bone, with gentle pressure.
• Resting hands: lay your hands on the tummy. Try to relax fully, even if your baby moves or cries.
• Water wheel: paddle one hand after the other over the tummy, as if you were making a hollow in sand. Let your hands follow the shape of the tummy. Repeat 6 times.

• Knees up and down: bend the legs and press them gently towards the tummy. Hold for about five seconds, once. Do not bring the knees together before your baby is crawling.
• Relaxing stroke: run your hands down the legs to the ankles, to ease the tension.
• Sun and moon: picture a clock on the tummy. With your left hand, start on your baby's right side (7 o'clock) and draw a full circle clockwise, without lifting your hand. When that hand passes 12, your right hand joins from 11 o'clock down to 5 o'clock, like a half moon. Repeat 6 times.

• Repeat the knees, as above.
• Relaxing stroke again, down the legs to the ankles.
• Start the whole cycle again, 3 times. Twice a day for 2 weeks. You can carry on if you still need to. It can take several days before your baby responds. Sometimes wind comes out on the first try. Every baby is different.

Position during a colic spell

Lay your baby on their tummy, one palm on the tummy, the head resting in the crook of your elbow, feet hanging, and your other palm on the back.

Cot

If you use a cot, it should meet safety standards. If it is an older cot, check that the gap between the bars is under 5 centimetres. When you put your baby down, do not leave chains, medals, bibs or safety pins with them.

Nappy rash

This is irritation and inflammation from damp, lack of air, and rubbing from the nappy. Besides the sore skin in that area, your baby may cry and seem irritable when you clean them. More on nappy rash.

Prevention

• Keep the area clean and dry.
• Dry the skin gently.
• Choose liquid products, without detergent or perfume, with a neutral or slightly acidic pH.
• Disposable nappies are linked with fewer cases.
• Change nappies often, so the skin spends less time against irritants.
• You can use barrier creams.

Stools

In the first 24 to 48 hours, stools are black and sticky. That is meconium. They then become looser, greenish-black. Those are the transition stools. By the end of the first week they settle: yellow, sometimes greenish, like ointment or semi-liquid, lumpy, with white curds. In breastfed babies they have almost no smell.

• If on day 4 or 5 your baby is still passing meconium or transition stools, and is not gaining weight, the way you breastfeed needs a closer look. How to tell if your baby is getting enough milk.
• How often a baby passes stool varies a lot. It can be once at every feed, or once every two or three days.
• Breastfed babies usually go more often, and the stools are softer, than babies fed by bottle. Later the rhythm is more irregular. If your baby is well, you do not need to do anything just because they have not passed a stool.

Teeth

Start brushing when the first teeth appear, with a small, soft, wet brush, and no toothpaste until your child can spit. Twice a day, and one of those times after the last feed. That includes babies who are still feeding.

Fever

Always measure a fever with a thermometer, not by touch. Your baby has a fever when the temperature is over 38°C in the rectum or over 37.5°C under the arm. Under the arm, up to 39°C is a moderate fever. Over 39°C is a high fever. Do not use braziers or heaters as a heat source, and do not put your baby next to one. The room should be around 20°C. More on fever in babies.

What matters most is the cause. How you respond depends on the temperature, and the paediatrician should assess it.

Up to 38°C. Treatment is not recommended. Do not overuse medicines that bring a fever down, especially if your baby seems well. Offer plenty of fluids and keep them cool, in light clothing. If they stay unwell and the fever continues, see your paediatrician.

From 38°C. Medicine at the dose your paediatrician prescribed can sit alongside plenty of fluids, a cloth on the forehead that is damp and at room temperature (never very cold, and never with ice), and a lukewarm bath for 15 to 20 minutes. If the temperature stays above 39.5°C, another check with the paediatrician can help.

Phimosis

In boys, phimosis is normal at this age and you do not need to do anything. Pulling back the foreskin is not advised in a newborn or in the first months. Your paediatrician will tell you how and when to start.

Vaginal discharge

Girls sometimes have a whitish discharge, or a small amount of vaginal blood. It comes from the mother's hormones during pregnancy, and it goes within a few days, with no treatment.

Wind and burps

During a feed, with a dummy, or while crying, your baby swallows air, and that air can be uncomfortable. These ideas can help. If it keeps going, ask your paediatrician.

• Help the wind out after every feed. Hold your baby upright on your shoulder, or sitting on your legs, for a few minutes.
• Small vomits with the burp are common in the first months. They do not matter if weight gain is fine.
• Do not leave your baby crying for a long time. Crying means swallowing air.
• Try not to start a feed when your baby is very hungry. A frantic feed takes in more air.

• Skip the dummy.
• Do not give herbal teas or medicines without asking a doctor.
• If your milk comes in a stream, let a little flow first so your baby does not have to gulp and swallow more air.
• To ease the discomfort, try bicycle legs and a gentle circular tummy massage, clockwise.

Hiccups and sneezes

Hiccups and sneezes are normal in a newborn. They do not need treatment.

Jaundice

This is a yellow colour in the skin and the eyes. It is common from 48 hours of life, and it often lasts until day 10 or 15. It is temporary and normal, and more common in babies born early. It is worth having the paediatrician follow how it goes. Early breastfeeding, with more frequent feeds, lowers how often jaundice appears and how long it lasts.

When your baby cries

Why is your baby crying? Crying is how babies show what is going on, in the body or in how they feel, so it needs an answer. Quite soon you will read the cry: hunger, cold or heat, tiredness, wind, pain, a dirty nappy, clothes that are too tight, something rubbing, a need to be close to you, or simply a wish to be held.

Holding your baby does not spoil them. It builds trust in you, it settles them, and they learn ways to communicate.

When they cry, it can help to:

• Check whether they want to feed.
• Cradle them, rock them, or walk with them.
• Hold them tummy-down, curled up.
• Hold them gently against you, relaxed, for a few seconds.
• Keep the room quiet.
• Talk softly, or put on pleasant music.
• Rest them high on your chest, on your shoulder, and stroke from the head down to the nappy, over the clothes.
• Give them a bath.

Swollen breasts

This can happen in girls and in boys. It comes from the mother's hormones crossing the placenta. Sometimes a few drops of milk appear. It is temporary and normal. Do not keep touching or squeezing them: they can get infected. See your doctor if they become very large, red and hot, or if there is a discharge.

Wee

After the first wee, your baby can go up to 24 hours without another. After that, the nappies should be wet often, with wee that is clear and has little smell, especially with exclusive breastfeeding. Red or pink marks on the nappy where they have weed are also common. They are not blood. They come from urates, and they usually go between day 3 and day 7.

Sudden infant death

• Put your baby on their back to sleep.
• Do not overdress them, and do not cover the head for sleep. Too many clothes, or a room that is too warm, raises the risk.
• The mattress should be firm. Do not use pillows or soft toys in the cot.
• Keep the air clear. Do not let anyone smoke around your baby.
• Breastfeed. Breast milk is the best food for your baby.
• If your baby is not born yet, go to your check-ups. Tobacco, alcohol or drugs in pregnancy carry many risks, including a higher risk of sudden infant death.

A blocked nose

The nose blocks easily, even when there is not much mucus. Sneezing, which happens often, is how your baby clears the lining of the nose. Do not use cotton buds on the outside of the nose. A sea-water rinse and a nasal aspirator for the mucus help prevent chest infections.

Eyes

The colour is not settled until about 6 months. A squint that comes and goes is also normal: the eyes cross now and then. If you need to clean them, use a damp gauze from the inner corner outwards, and a fresh piece for each eye.

Ears

Clean only the outside of the ear that you can see, with a damp gauze. Earwax is a defence. Do not try to remove it.

Navel

Clean the cord every day, with water and soap, during the bath. Keep it dry and clean so it can heal and infection is less likely. Do not cover it or wrap it in gauze: that holds damp. Belly bands and binders are not advised. They make breathing harder, and they do not heal a hernia. If it smells bad, leaks or bleeds, see your paediatrician. A few drops of blood for some days after it falls off do not matter, if the amount is small.

Do not clean the navel with anything that contains iodine. Use 70% alcohol, two or three times a day, after the bath and at each nappy change, until the cord falls and the navel has healed. When it falls, usually between day 5 and day 15, keep cleaning it until it is fully dry. Infection is uncommon, but the navel is a wound and germs can enter. See someone if it smells bad or the skin around it goes red. More in the cord care guide.

How to clean the cord

1. Wash your hands.
2. Hold a sterile gauze by the four corners, so your fingers do not touch the centre. That centre is what meets the navel.
3. Wet the centre with chlorhexidine.
4. Clean the base with a turning movement around it.
5. With another sterile gauze, clean the far end, the part with the clamp.
6. Do not cover the navel with gauze. Covering it slows the cord coming away. The cord dries on its own.

Nappies

Change the nappy on a wide surface, and do not leave your baby alone. Any movement can mean a fall. Change often, so the skin is less likely to get sore. Washing with water and soap is better than disposable wipes, which are best used as little as possible. Wash from the genitals towards the anus, never the other way, especially for girls, because of the risk of infection. Dry very well, above all in the folds. Leaving the bottom in the air for a while, before a new nappy, helps prevent soreness. Do not use talc. It holds damp, and if your baby breathes it in, it can be toxic.

Going out

Walks matter for your baby's health. Go out every day from the day you leave hospital, unless something means you should not. It settles your baby, and it helps your muscle tone and circulation recover. Choose quiet places, away from noise and fumes. In winter, use the sunny hours. In summer, avoid the middle of the day and direct sun. Sunlight helps the body make vitamin D, so when the weather allows it is good for the face, arms and legs to be in the open air. In summer, a hat or a shade, and sunscreen, protect the head.

Weight

How your baby grows depends on the genes from both parents. There is no single pattern for weight gain. In general, birth weight is back by about day 10 to 15. Weight can change through the day because of a feed, a stool or a wee. For most babies, weighing once a month in the first months is enough. More on weight gain in the first year and how much milk by age.

Skin

Peeling is normal. A little lotion or oil made for babies can help. Jaundice, milia and marks are also common.

Neonatal acne. It shows before 3 months, often between 2 and 4 weeks, and goes between 6 and 8 months. Hormones stimulate the oil glands. It can sit alongside larger breast glands and a flaky vulva, with a mucous discharge and sometimes a little blood as oestrogen drops.

Acrocyanosis. Hands, feet and lips look blue. Crying or cold can deepen it. A gentle massage settles it.

Harlequin colour change. The half of the body your baby is lying on goes red, and the other half looks pale. It is more common in babies born early or small, between day 2 and day 5. It is not serious, and it can last from 30 seconds to 20 minutes.

Newborn redness. The skin looks very red, especially if your baby was born early, and the vessels show because there is little fat under the skin. The colour settles within 24 hours of birth.

Toxic erythema. Red spots, like hives. They do not matter, and they go in the first week.

Lanugo. Fine, pale hair on the shoulders, ears and back. It goes in the first weeks.

Marks. Reddish marks on the nose, eyelids or nape often go by about 6 months. A dark mark low on the back can look like a bruise. The size varies. It is not an illness, and it fades in the first years.

Milia. White spots, alone or in groups, on the forehead, cheeks, nose and chin. They are small oil cysts. They go on their own in a few weeks, often between 4 and 12. Do not squeeze them.

Miliaria. A sweat rash, when a newborn is too hot and damp.

Milk rash. A rash in the first months, mostly on the cheeks. People sometimes call it a milk allergy. That is a folk name, not a diagnosis.

Vernix. The fatty coat on a term baby's skin, mostly in the folds. It dries and comes off within a few hours of birth.

Clothes

Clothes should be comfortable and loose, in cotton or another natural fibre. Avoid anything that sheds fluff. Do not use safety pins, bows, buttons, ribbons or cords, especially around the neck or where they could be dangerous. If you use dresses, avoid very small buttons, or buttons at the front: there is a choking risk. Do not overdress your baby. They do not need more clothes than an adult would. Cold hands and feet are common, because the circulation at the edges is still immature. That does not mean they are cold. Too many clothes is as unhelpful as too few.

Sleep

Do not worry if your baby sleeps a lot. In the first weeks, 12 to 14 hours is normal. Should you wake your baby to feed? For a healthy baby born at term, the Spanish Paediatric Association (AEPED) suggests waking them every 3 or 4 hours until feeds are more vigorous. Waking at night is natural, at least through the first year. The day-night rhythm starts from about 4 months. A breastfed baby may feed 1 to 5 times at night. If they sleep in your bed, you may rest more, and you may not notice every feed, because they fall asleep again. The safest position is on the back. Do not sleep with your baby on a sofa. Do not leave them alone on an adult bed, a waterbed, or a mattress that sinks.

Nails

You can cut the nails at any age. Cut them, but not too short. Toenails go straight across. Fingernails should have no sharp corners, so they do not scratch. Never cut right to the skin, or the nail can grow into the finger. Use small scissors with rounded tips. Hold the hand so you can follow the movements, in a position that is comfortable for you. If scissors do not feel safe, a nail file works.

Travelling

In a car, use every safety measure. Your baby must be properly strapped in. For your peace of mind and their safety, never leave them alone in the car. There is no reason a baby cannot fly. Ear pain on take-off and landing can ease if they suck at the breast or the bottle.

Vomiting

In the first months, small vomits are common. They are normal if weight gain is fine. They settle on their own, so medicine is not needed, and it could do harm.

Shoes

Until your baby walks, they do not need shoes. Depending on the season, cotton socks are enough to keep the feet warm. Shoes should be comfortable and soft. If they will step outside, the sole should be strong enough to protect against anything sharp.

When to see a paediatrician straight away

• Crying. More than usual, in a different way, and the usual things do not settle them, or the cry sounds like a moan.
• Alertness. Very floppy or sleepy, hard to wake, and the skin looks pale yellow.
• Breathing. Breathing is hard work, they grunt at the end of each breath, or they breathe faster than usual.
• Colour. The body goes blue, especially the lips, or turns grey.

• Red spots. New dark-red dots or small marks that were not there before.
• Feeding. They tire or sweat during feeds, or milk comes back in a forceful stream over several feeds.
• Fever. A rectal temperature over 38.5°C, or a low temperature under 36°C.
• Fits. Trembling in the arms, legs and chin is normal, and it stops when you hold them. If your baby goes stiff, the gaze goes blank, or they go floppy, it may be a seizure. Go to the nearest health service.

To close

When your baby comes home, an intense time begins. This guide to everyday newborn care is here so you can live it with more calm. Questions will still come. Lean on the health professional who knows you.