Newborn Care at Home

Warning Signs for Babies

Contact a doctor, midwife, nurse practitioner or HealthLine (811) right away or go to the hospital if you have any concerns about your baby’s health. Watch for these important warning signs:

• If the baby has a temperature of 38.0°C or 100.4°F or higher and is 0-6 months of age. 
• If the baby seems to be breathing fast, over 60 breaths in a minute or has a blue coloring to their lips or inside of their mouth that does not go away. This is not normal. Newborns normally will have irregular breathing rates, so you need to count their breaths for a full minute. There should be no pauses longer than about 5-10 seconds between breaths. If a baby is making wheezing, grunting or whistling sounds while breathing, this is also not normal. Call for help immediately. 
• If the baby looks yellow in their face, in the whites of their eyes and on their chest when you see them in good daylight and is very sleepy and not feeding well. It may be harder to see yellow on the face or chest if the baby has a darker skin color - check the inside of their mouth to make sure the gums and cheeks are pinkish in colour and not yellow.    
• If the baby is crying excessively, or is irritable or twitching (jittery) and does not settle with cuddling and comfort. 
• If the baby is so sleepy they cannot be awakened to feed. 
• If the baby shows signs of sickness (for example, cough, diarrhea, pale color).
• If the baby is not having a normal amount of wet and dirty diapers.
• If there is redness around the umbilical cord or a bad smell from the cord. 

Temperature

Normal body temperature for a newborn is 36.6-37.3° C or 97.8-99.1°F.  If a fever is when the baby's temperature is higher than normal body temperature. This is usually a sign of infection. If your baby has a fever, watch for other signs of illness.

Take your baby’s temperature under the armpit. Electronic digital thermometers are recommended. Place the tip of the thermometer in the center of your baby’s bare armpit. Tuck baby’s arm snugly against the body. Leave the thermometer in place until it is done reading or beeps.  Ear (tympanic) thermometers are quick but the results may not be accurate. Forehead strips, pacifier (soother) and disposable thermometers are not accurate and should not be used. Glass thermometers can cause mercury poisoning if they break, and should not be used. 
 
If your baby’s temperature is high, dress them in light clothing and re-check the temperature in 15-20 minutes. If your newborn baby has a fever of 38° C (100.4° F) or higher, call your doctor, midwife, nurse practitioner or HealthLine 811 immediately. 

Common causes of increased temperature in newborn babies:

• Infection
• Dehydration - not enough liquids
• Too many clothes or the room is too hot

What you can do:

Hold your baby skin to skin with you or keep your baby lightly dressed. Do not cover your baby with heavy blankets. Bath your baby in lukewarm water (never cold water) for less than 15 minutes. Keep the room temperature no warmer than 20 to 21°C or 68 to 70°F. Feed your baby often to keep them hydrated. Write down dates and times when you take your baby’s temperature. Contact a nurse, doctor, midwife or a pharmacist before you give your newborn baby medicine for their fever.

Infant Care

Sleep and Rest

Newborns usually sleep 16-18 hours a day in blocks of 2-4 hours. Your baby’s sleep patterns will change as they get older. 

Try to change the baby’s schedule gently. If the baby sleeps for a long time during the day and is awake all night, try to talk, sing and play with them during the day. Keep nighttime feedings quiet and the lights low.  

Babies sleep best when:

• They are well-fed and burped
• They are warm but not hot
• They have dry, clean clothing and a quiet place to sleep

Sudden Infant Death Syndrome (SIDS)

Creating a safe sleep environment for your baby will lower the risk of injury and sudden infant death syndrome (SIDS). Although the causes of SIDS are not known, there are certain things we can do to keep babies safer. 

SIDS is more common in babies whose parent’s smoke and babies who sleep on their stomachs. 

To create a safe sleep environment:

• Lay your baby on their back to sleep. Do not lay them on their side or stomach. Do not use sleep positioners or rolled up blankets to keep your baby on their back they increase the risk of suffocation.
• For the first 6 months, the safest place for your baby to sleep is in your room, beside the bed, alone in a crib or bassinet. Sharing a bed with the baby is not recommended.
• Make sure your crib meets Canadian Safety Standards. Use a firm mattress that fits the crib. Crib sheets should fit tightly. Soft surfaces such as adult beds, sofas and armchairs can increase the risk of suffocation. 
• Do not place soft objects in your baby's sleep area such as pillows, plush toys, comforters, thick blankets or bumper pads as they increase the risk of suffocation. 
• Baby swings, bouncers, strollers and car seats are not made for safe sleep. Sleeping in a sitting position can cause your baby's head to fall forward which can make it hard for your baby to breathe. 
• Make your home smoke free.
• Do not overheat your baby with too many clothes or blankets. A sleeper is all the clothing your baby needs for sleep time. If you use a blanket, choose a thin blanket and tuck it firmly under the bottom end of the mattress. The blanket should only reach your baby’s chest leaving the arms free. Do not swaddle baby or cover baby’s head with the blanket.
• Breastfeeding can protect your baby from SIDS. 

Talk to your support person(s) and baby caregivers and ask them to follow your sleep routine and these safe sleep practices when putting the baby to bed. 

Comforting Your Baby

Crying is normal. It is how babies talk to you. Some babies cry more than others, and babies may cry for many reasons. They cry because they are hungry, they have a dirty diaper or they may be feeling hot or cold, tired or bored. A baby may be fussy if they feel gassy or are in pain. Your baby needs to know you will respond to them and give them comfort. 

Things to try to comfort and calm your baby:

• Feed your baby. Even if you only fed a short time ago, your baby may still be hungry.
• Hold your baby close, try placing your baby skin to skin with you. This close contact often will stop your baby from crying. 
• Try burping your baby. 
• Change diapers if wet or dirty.
• Take a walk, sway from foot to foot, rock your baby, or take him for a stroller or car ride. Use a baby carrier, snuggly, or baby sling that holds baby close to you.
• Talk or sing quietly to your baby.
• Dress the baby in the same number of layers of clothing that you are wearing. 
• Dim the lights in the room.

Be patient and stay calm. If one idea does not work, try the next and repeat it over and over.

Urine and Stool

Urine (“pee”) - is pale yellow in colour and has a mild smell. In the first 1 - 4 days of life, a baby may have red or orange colour in their urine. This is normal to see, it is called uric acid crystals and it happens when the urine is still coming in small amounts. By five days of age, you should no longer see uric crystals in your baby’s urine and your baby will have six or more heavy wet diapers every day. 

Signs of dehydration: 

• Decreased number of pees per day
• Urine looks darker in color and has a strong smell
• Dry, chapped lips 
• A later sign is if the soft spot on the top of your baby’s head looks sunken in.

Stool (“poop”) - At birth, your infant’s stool is black, sticky and tar-like. This is called meconium. After a few days, the colour changes from green to brown to golden yellow. The softness and firmness of stool can vary. Often stool will seem loose and runny. Your baby may grunt, groan or turn red in the face when they are having a bowel movement (poop) - this is normal. 

Constipation and Diarrhea: 

Constipation is when your baby’s stools are firm, dry and difficult to pass. Constipation is rare in babies. 

Diarrhea is stool that is watery and more frequent than their usual bowel movements. Continue to feed your baby to keep them hydrated. 

Talk to your nurse, midwife or doctor if you have concerns about your baby’s wet and dirty diapers.

Umbilical Cord Care

The umbilical cord falls off on its own usually within the first two weeks of life.

• Keep the cord open to the air as much as possible by folding down the top of the diaper.
• Clean the cord daily. Clean around the base of the cord with a Q-Tip ® soaked with warm water and then dry with a dry Q-Tip®. It does not hurt the baby to touch the cord.
• Expect a bit of blood for a day or two after the cord falls off. Clean the belly button area until there is no more blood and it is dry.

Consult a nurse, midwife or doctor if the skin around the cord gets red, warm, swollen, or smells bad with or without yellowish-green discharge. It may be infected.