General care guide for your newborn

With your baby's arrival at home, it is normal to have lots of questions about the daily care your baby will need. It is a very intense stage with many changes, but it will pass. And to help you settle in as well as possible, our team of midwives at Happymami have prepared this post especially for you. With this general newborn care guide.

A guide to the first days at home with your baby

In this first stage of baby care, common sense matters, because it will help you understand your baby in the best way and find solutions to everyday problems, always relying on the recommendations of the healthcare professionals around you. Remember that not all babies are the same: some are calmer and adapt to new situations easily. Others, however, have more irregular habits: fewer hours of sleep, variable stools, more restlessness or crying easily. You need to give yourselves time to get to know each other and, little by little, to recognise your baby's rhythm. Just like breastfeeding, it is something you will learn together day by day. (Remember that it is arranged in alphabetical order so that you can find the answer to your question more easily).

Bathing

Your baby's bath can be daily from birth, even if the umbilical cord stump has not fallen off yet. It is recommended from 24 hours after birth and never before 6 hours. Choose the calmest time of day for both of you, or the time when your baby finds it most relaxing, and turn it into a tender game between the parents and the baby. Find out more about how to bath your baby.

• Have everything you might need within reach.
• Do not fill the bath too much; 10 or 15 cm of water is enough.
• The water temperature should be pleasant (36-38ºC). Make sure it is not too hot by dipping your elbow or the back of your hand in it.
• The room temperature should also be pleasant (22-24º), avoiding draughts.
• Electrical appliances near water can cause short circuits and very serious accidents, such as electrocution.
• Use mild soaps in very small amounts, and rinse with the same water. If it is a girl, clean the area between the genitals and the anus (from front to back) to prevent possible infections.
• The bath should not last too long. At first a few minutes are enough, and as your baby grows you can make this moment longer.
• Lift your baby out of the water carefully, wrap them in a dry, warm towel and pat them dry gently.
• After the bath we can take the opportunity to moisturise their skin well while giving them a massage with a moisturising cream or lotion or oils suitable for their age. This massage allows close contact between the parents and the baby, relaxes them for sleep and nourishes their skin

Dummy

If you are breastfeeding, using one is not advised during the first weeks, until breastfeeding is well established. The differences between the two types of sucking can confuse the baby about how to feed at the breast. This is one of the causes of breastfeeding failure.

For safety, the dummy should be made in one piece. As for the material, both silicone and latex dummies are suitable, although from 6 months latex ones are preferable because they are more resistant to biting.

Finally, avoid sharing utensils such as cutlery with babies, or cleaning your child's dummy in your own mouth. This way we will prevent the transmission of germs, including those that cause tooth decay.

Safe co-sleeping

Guide to safe co-sleeping. Avoid co-sleeping if:

• You or your partner smoke.
• You have drunk alcohol.
• You have taken drugs or medicines that make you sleep more heavily than usual.
• You are tired and think you will not wake up if your baby needs you.
• You have an illness that stops you waking up in response to your baby's needs.

Infant colic

Episodes of crying, of varying length and hard to soothe, that happen mainly in the afternoon or early evening. They tend to repeat every day for a while, in the same conditions, and are quite common during the first three months of life. It is not an illness but a situation that will go away in a few weeks. Complete guide to infant colic.

• Massage for colic:
  • We massage the baby's tummy (from below the ribs to the pubis) with gentle pressure
  • Resting hands: We place our hands on the baby's tummy. Try to relax completely even if your baby moves or cries.
  • Water wheel: We make paddling movements on the baby's tummy, one hand after the other, as if you were digging a hole in the sand. Your hands should mould to your little one's tummy. Repeat 6 times.
  • Knees up and down: Bend the baby's legs and then press them gently towards the tummy, hold this position for about five seconds, once (we should not press the knees together before the baby crawls).
  • Relaxation touch: We run our hands down their legs to the ankles to release tension and help them relax.
  • Sun-moon: We imagine a clock on the baby's tummy. The adult's left hand starts on the right side of the child's tummy (7 o'clock) and draws a full circle clockwise without lifting the hand. When the adult's left hand passes 12 o'clock, the right hand joins in at 11 o'clock and moves to 5 o'clock, like a half moon. Repeat 6 times.
  • Repeat knees up and down (same as step 3)
  • Relaxation touch again: We run our hands down their legs to the ankles to release tension and help them relax.
  • Start the whole cycle again (steps 1 to 7) 3 times. Twice a day for 2 weeks (we can consider continuing if necessary). It may take several days before your baby responds well; sometimes the baby starts to pass wind on the first attempt. Every child is different.
• Position during a colic episode:
  • The baby lies face down, with the palm of our hand on the baby's tummy, their head resting on the inside of our elbow with their feet hanging, and our other hand resting palm down on the child's back.

Cot

If you use a cot, make sure it meets safety standards. If it is an old one, check that the gap between the bars is less than 5 centimetres. When you put your baby down, do not put chains, medals, bibs or safety pins on them, for their safety.

Irritant nappy dermatitis

This is an irritant and inflammatory process caused by moisture, lack of air and the friction of the nappy itself. Besides the lesion in the nappy area, the baby may cry and be irritable when being cleaned. Full information on irritant nappy dermatitis.

• Prevention:
  • Keep good hygiene in the area, which should stay clean and dry.
  • Dry the skin gently
  • It is advisable for the products you use to be liquid, free of detergents and perfumes, and with a neutral or slightly acidic pH
  • Disposable nappies are associated with a lower incidence
  • Change nappies often to reduce your baby's skin exposure to irritants
  • You can use what are known as “barrier“ creams

Stools

During the first 24 to 48 hours of the baby's life, poos are black and sticky (this is called meconium). Then they become runnier and less sticky, greenish-black in colour (these are called transitional stools). By the end of the first week of life the definitive stools appear: yellow (sometimes greenish), with a consistency similar to ointment or semi-liquid, lumpy with white curds, and in breastfed babies practically odourless.

• If a baby is still passing meconium or transitional stools on day 4 or 5 and is not gaining weight, the breastfeeding technique needs to be “checked”. (How to tell if your baby is getting enough milk?)
• The number of stools per day varies a lot. It can range from one with every feed to one every two or three days in newborns.
• Generally, breastfed babies poo more times a day and softer stools than bottle-fed babies. Later the rhythm is more irregular, and if the baby is well, there is no need to do anything even if they do not poo.

Teeth

You should start brushing when the first teeth appear, with a small, soft, wet brush, without toothpaste until the child can spit. Twice a day, one of them after the last feed (also in breastfed babies).

Fever

It is important to always measure fever with a thermometer and not by touch. We consider that your baby has a fever when their body temperature is above 38 ºC rectally or 37.5 ºC in the armpit. Measured in the armpit, a fever of up to 39 ºC is considered moderate, and above 39 ºC we speak of a high fever.

• Avoid using braziers or heaters as a heat source, because of the danger they pose, and of course do not put the baby next to a heat source
• The room should be at a temperature of around 20º
• To treat a fever the most important thing is to treat its cause; the treatment of the fever itself will depend on your baby's temperature range. Bear in mind that it is the paediatrician who should assess it.
  • Low-grade fever (up to 38 ºC): treatment is not recommended.
    • We should not overuse medicines that lower fever (antipyretics), especially if your baby is well.
    • What you should do is offer plenty of fluids and keep them cool with light clothing.
    • If the discomfort does not stop and the fever continues, you should see your paediatrician so that they can assess your baby.
  • Fever (from 38 ºC):
    • Treatment with antipyretics at the doses prescribed by the paediatrician can be complemented with plenty of fluids, damp cloths on the forehead (at room temperature, never too cold or with ice), and baths in lukewarm water for 15 or 20 minutes.
    • If the temperature stays above 39.5 ºC, it may be advisable for the paediatrician to assess your baby again.

Phimosis:

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

Vaginal discharge

Girls sometimes have a whitish discharge or a small amount of vaginal bleeding. It is due to maternal hormones passed on during pregnancy and will go away in a few days without any treatment.

Wind and burping

When the baby feeds, sucks a dummy or cries, they swallow air that can cause discomfort. The following tips can help you prevent and relieve it, but if it is very persistent do not hesitate to consult the paediatrician.

• Help them bring up wind after each feed. To do this, hold them upright against your shoulder or sitting on your lap for a few minutes to encourage burping.
• Along with burping, regurgitation (small amounts of sick) is common during the first months of life. It does not matter if it does not affect weight gain.
• Do not let them cry for long periods (crying makes them swallow air).
• Try not to let them get too hungry before feeds (they will feed eagerly and swallow a lot of air).
• Avoid the dummy.
• Do not give them herbal teas or medicines without consulting the doctor.
• If your milk comes out very fast (in a spray), let it flow a little first so that your baby does not have to swallow quickly, which would make them swallow much more air.
• To ease their discomfort, try bicycle-style leg exercises and gentle, circular tummy massages in a clockwise direction.

Hiccups, sneezing

Hiccups and sneezing are normal in newborns and do not need any treatment.

Jaundice

This is the yellowish colouring of the skin and eyes that often appears in many newborns from 48 hours of life, and usually lasts until 10 or 15 days of life. It is a temporary and normal process, more common in premature babies. It is always advisable for the paediatrician to monitor how it evolves. Early breastfeeding with more frequent feeds in the newborn reduces the incidence and duration of jaundice.

Baby crying:

Why is your baby crying? Crying is the way babies show what is happening to them, whether physical or emotional, and so it needs a response. Soon you will be able to understand what your baby is asking for when they cry and tell whether it is hunger, cold or heat, tiredness, wind, pain, discomfort from a dirty nappy, clothes that are too tight, something rubbing against them, the need for physical contact with mum or, simply, because they need a cuddle. Holding your baby in your arms does not spoil them; on the contrary, it increases their trust in their parents, relaxes them and helps them learn ways of communicating.

When your baby cries, these can help to soothe them:

• Check whether they want to feed.
• Rock them, cradle them or walk with them.
• Hold them face down in the fetal position.
• Pick them up and hold them gently against you, in a relaxed way, for a few seconds
• Create a calm, quiet environment.
• Talk to them lovingly and play pleasant music.
• Place your baby high on your chest, on your shoulder, and give them
  a massage from the head down to the nappy, over their clothes.
• Bath them.

Swollen breasts:

This can happen in both girls and boys and is due to maternal hormones passing through the placenta. Sometimes a few drops of milk may come out. It is temporary and normal. Do not touch or squeeze them, because they can become infected. See your doctor if they become very large, turn red and hot, or have any discharge.

Urination

After the first wee the baby can go up to 24 hours without weeing. After that the baby should wet nappies often with clear, odourless urine (especially if exclusively breastfed).

It is also common to see red/pink stains in the nappy where the baby has weed, but they do not matter and are due to the normal elimination of urates, not blood. They usually disappear between 3 and 7 days of life.

Sudden infant death syndrome

The recommendations for preventing sudden infant death syndrome are:

• Put your baby to sleep on their back.
• Do not wrap them up too warmly or cover their head for sleep. Too many clothes (overwrapping) or too much heat in the room increases the risk.
• The mattress the baby sleeps on should be firm; avoid using pillows or soft toys in the cot.
• Keep the environment clean and do not allow smoking around them.
• Keep the environment clean and do not allow smoking around them.
• Breastfeed. Breastfeeding is the best food for the child.
• And if your baby has not been born yet, go to your regular check-ups with your doctor and remember that using tobacco, alcohol or drugs during pregnancy carries many risks for the baby, including a higher risk of sudden infant death syndrome.

Blocked nose

The nose gets blocked easily, even if there is not much mucus. Sneezing, which happens quite often, is the way the baby clears their mucous membranes. To clean the outside of the nose, do not use cotton buds. Nasal washing with seawater is recommended, and removing secretions with a nasal aspirator. This will help prevent respiratory infections.

Eyes

They do not acquire their definitive colour until 6 months. Intermittent squinting (the eyes cross from time to time) is also normal. If necessary, clean the eyes with damp gauze from the inner corner outwards, using a separate piece of gauze for each eye.

Ears

With the ears, clean only the outer part that you can see, with damp gauze. The wax the ear produces acts as a defence and we should not try to remove it.

Umbilical cord

The umbilical cord is cleaned daily with soap and water during the bath. To help it heal and prevent infections, try to keep it dry and clean at all times. Do not cover or wrap it in gauze, as this encourages moisture. Not recommended: belly bands or umbilical binders (they make breathing harder and do not cure hernias). If it smells bad, has any discharge or bleeds, you should consult the paediatrician.

A few drops of blood may appear on the navel for a few days after the cord has come off. If the amount of blood is small, this does not matter. The navel should not be disinfected with products containing iodine, but with 70º alcohol applied 2 or 3 times a day after the bath and at every nappy change, until the cord falls off and the navel heals.

When the cord stump falls off (at around 5 to 15 days), keep cleaning it very well until it is completely dry. Infection of the navel is uncommon but, like any other wound, the navel can be an entry point for infections. We should consult if there is a bad smell or reddening of the skin around the navel. More information in the umbilical cord care guide.

Procedure for umbilical cord care

• Wash your hands.
• Hold a sterile gauze by its 4 corners, so that your fingers do not touch the central part of the gauze (which is the part that will touch the navel).
• Soak the central part of the gauze with chlorhexidine.
• Clean the base of the navel with a circular movement around it.
• With another sterile gauze, clean the distal part of the cord, where the clamp is.
• Do not cover the navel with gauze, to help it come off. The umbilical cord goes through a drying process.

Nappies

Nappy changes should be done on a large surface, without leaving the baby alone, because any movement they make could lead to a fall. Change them as often as possible to avoid skin irritation. It is better to wash them with soap and water, using disposable wipes as little as possible.

Wash from the genital area towards the anus and never the other way round (especially in girls), because of the risk of infection. Dry them very well, especially in the skin folds. To avoid irritation, it helps to leave their bottom uncovered for a while before putting on a new nappy. Do not use talcum powder, because it retains moisture and, if the baby breathes it in, it can be toxic.

Going out with your baby

Walks with your baby are very important for their health. You should take them out every day from the time you leave hospital, as long as there is no problem that prevents it. It is relaxing for the baby and helps the mother recover muscle tone and circulation.

Try to walk in quiet places, away from noise and fumes, making the most of the sunny hours in winter and avoiding the middle of the day and direct sun exposure in summer. Sunlight helps activate vitamin D (which prevents rickets), so if the weather allows it is good for their face, arms and legs to be in the open air. In summer it is advisable to protect their head with a cap or parasol and use sun cream.

Weight

Your baby's growth is shaped by the genes inherited from the parents. There is no single, rigid pattern of weight gain in babies. As a general rule, babies regain their birth weight at around 10 to 15 days of life. A baby's weight can vary throughout the day because of everyday events such as feeding, pooing or weeing. For most babies, weighing them once a month during the first months is enough. Find out about the amount of milk in the bottle by age.

Skin

Peeling is normal and common, but you can apply a little lotion or oil made specifically to moisturise your baby. It is also normal for jaundice, milia, erythema toxicum, birthmarks, etc. to appear. Below we list the most common skin changes in newborns:

• Neonatal acne: It appears before 3 months of age, between 2 and 4 weeks of life, and goes away between 6 and 8 months of life. It is due to hormonal stimulation of the sebaceous glands. It is associated with enlarged mammary glands, with desquamative vulvovaginitis with mucoid discharge, and sometimes bleeding due to oestrogen withdrawal.
• Acrocyanosis: This is the bluish colouring of the hands, feet and lips, which can intensify with crying or with cold. It resolves with a gentle massage.
• Harlequin colour change: It is characterised by red colouring on half of the body, on the side the baby is lying on, in contrast with the paleness of the other half. It is more common in preterm or low-birth-weight newborns, between the 2nd and 5th day of life. It is not a serious problem and can last between 30 seconds and 20 minutes.
• Physiological neonatal erythema: The newborn's skin is an intense reddish colour, especially in premature babies, with the skin's blood vessels clearly visible because of the lack of subcutaneous fat. The colour returns to normal 24 hours after birth.
• Erythema toxicum: These are small red spots, like hives. They do not matter and disappear during the first week.
• Lanugo: Also called primitive hair. It is soft, lightly pigmented and grows on the shoulders, ears and back, disappearing in the first weeks of life.
• Birthmarks: Some babies are born with reddish marks on the nose, eyelids or nape of the neck that disappear at around 6 months. Some newborns have, on the lower back, a dark mark that looks like a bruise. Its size can vary from one child to another. It does not mean any illness and goes away by itself in the first years.
• Milia: These are small white spots. They can appear alone or in clusters on the forehead, cheeks, nose and chin. They are small fat cysts that disappear by themselves over a few weeks (between 4 and 12 weeks). Do not squeeze or touch them.
• Miliaria: These are rashes caused by sweat, in newborns exposed to too much heat and humidity.
• Milk Rash: This is a rash that appears in the first months of life and is mainly found on the cheeks. It is colloquially attributed to a milk allergy.
• Vernix caseosa: this is the greasy layer that covers the skin of full-term newborns, mainly in the skin folds. It usually dries and comes off a few hours after birth.

Clothes:

Baby clothes should be comfortable and loose, made of cotton or other natural fibres. Avoid garments that shed fluff. Do not use safety pins, bows, buttons, ribbons or cords, especially if they tie around the neck or could be dangerous for the baby. If you use dresses, check that they do not have very small buttons or buttons on the front (there is a risk of choking).

Do not overdress them. Your baby does not need more clothes than an adult would. Newborns often have cold hands and feet because their peripheral circulation is immature, but that does not mean they are cold. Overdressing a baby is as harmful as dressing them too lightly.

Sleep

Do not worry if your baby sleeps a lot. It is normal: between 12 and 14 hours during the first weeks. Should I wake my baby to breastfeed? If it is a healthy, full-term baby, the AEPED (Spanish Association of Paediatrics) recommends waking them every 3 or 4 hours until they start to feed more vigorously. Night waking is another matter. It is a natural phenomenon, at least during the first year of life. They acquire the ability to tell day from night (circadian rhythm) from 4 months of life.

If your baby is breastfed, night waking is common; they may need to feed between 1 and 5 times. If they sleep in your bed you will be able to rest better, it is more comfortable and you will not even notice some of the feeds, as the baby will fall asleep afterwards. The most advisable position for your baby to sleep is on their back. Dangers to avoid at sleep time:

• Sleeping with a baby on the sofa.
• Leaving the baby to sleep alone in an adult bed, a water bed or on a mattress that sinks.

Nails

There is nothing to stop you cutting your baby's nails, whatever their age. Cut them, but not too short. Toenails are cut straight across. Fingernails should be cut without leaving sharp corners, to avoid scratches. In both cases we should never cut down to the skin, to prevent the nails from digging into the finger.

Use small scissors with rounded tips. Cut the nails in a position that is comfortable for you, holding your baby's hand so that you can control their movements. If the parents do not feel confident using scissors, a nail file can be used.

Travelling

If we travel with the baby by car, all safety measures must be taken. Always remember that they must be well secured. For your peace of mind and your baby's safety, never leave them alone inside the car. There is no reason why your baby cannot travel by plane. Ear pain can be relieved by letting them suck at the breast or the bottle during take-off and landing.

Vomiting

During the first months babies may regurgitate (bring up small amounts of milk), which is considered normal if it does not affect their weight gain. It corrects itself, so no medication should be used, as it could be harmful.

Shoes

Until your baby starts walking they do not need shoes, but depending on the season you can keep their feet warm with cotton socks. Shoes should be comfortable and soft but, if they are going to walk outside, the sole should be strong enough to protect them from anything sharp.

Reasons to see the paediatrician immediately

• Crying
  • If they cry more than usual and in a different way and cannot be soothed with the usual measures, or when the crying is whimpering.
• Alertness
  • If they are very floppy or drowsy and hard to wake, and their skin looks pale yellow.
• Difficulty breathing
  • If they find it hard to breathe, grunt at the end of each breath out or breathe faster, you will need to consult the doctor immediately.
• Colour changes
  • If the baby's body turns bluish, especially the lips, or takes on a greyish colour (you will need to consult immediately).
• Red dots or spots on the skin
  • If dots or small dark red spots appear that were not there before.
• Feeding
  • If they get tired or sweat during feeds, or when they have projectile vomiting at several feeds.
• Fever
  • When their body temperature is above 38.5º rectally, or when they have hypothermia (low body temperature) below 36º.
• Rhythmic movements and loss of consciousness (seizures)
  • Trembling in the limbs and chin is natural and stops when you hold them. If they go stiff or have a blank stare, or go limp, it may be a seizure and we should go to the nearest health service

Conclusion of the general newborn care guide

With your baby's arrival at home, a very intense stage begins which, with this general newborn care guide, you will experience more calmly. Even so, you will still have questions, so always rely on your usual healthcare professional.