Class Outline

Newborn Characteristics

Newborn Behaviours

Newborn Procedures

Breastfeeding

Umbilical Cord The umbilical cord is bluish-white immediately after delivery (jelly-like)

As cord dries it becomes dark green or black and will spontaneously fall off (1-3 weeks)

Most hospitals now leaving the clamp on and it falls off with cord.

Clean area with dry Q-Tip

Contact your Physician/Public Health Nurse if:

Bleeding

Redness around cord stump

Foul odour or discharge from stump

Vernix Caseosa White cream cheese like substance, serves as a

protective covering for the skin while babe is developing

Forms a thick covering between 36-38 weeks

By 40 weeks gestation, usually only found in skin folds

Gradually absorbed by skin

Acrocyanosis Localized bluish coloration of the hands &

feet is common in newborns

Results from sluggish peripheral circulation

Most noticeable when babe is cold

Lanugo Hair Fine downy hair that covers the fetus while developing in uterus

Gives babe the “fuzzy” appearance

Hair begins to rub off in utero & is usually only found on shoulders, back, upper arms & ears by 40 weeks

Gradually removed in first few weeks due to friction of clothing & bed linen

Skin: Dry & Peeling Normal result, skin has been in a moist environment for 9

mths & now exposed to air

Common on palms of hands, soles of feet, wrists & ankles

Overdue babies will peel more

No treatment necessary, moisturize with:

Petroleum jelly

Olive oil, baby oil

Lotion for babies, sensitive skin

Head Shape after Delivery Molding vs non-molding

Baby born by c-section, with no partial labor or descent through the birth canal, will have a normal, rounded shaped head at birth

Molding can occur with vaginal deliveries

Varying amount of hair

Sucking Blister Small callous-like areas, especially in center of

top lip as a result of friction from feeding

Will eventually dry up & fall off without

treatment

Sometimes have blisters on hands & arms from

practicing sucking in utero

Newborn Rash A blotchy red rash in first few days of life

May appear anywhere on skin

Common on back, shoulders & buttocks

Occurs in 30-70% of newborns & resolves without

treatment in 2-3 days

Stork Bites Collection of superficial blood vessels on eyelids, nose,

forehead or back of the neck

Not permanent

Fade or disappear by 1-2 yrs of age, those on the neck may remain longer

Most visible when infant is tired or crying

Milia Pinhead-sized white spots on baby’s nose, cheeks and chin

due to obstructed sweat & oil glands

DO NOT try to remove

Disappear on own as glands begin functioning (usually within first few weeks of life)

Wash babe’s face with warm water (no soap on face)

Vacuum Deliveries Also known as caput succedaneum

Swelling of the scalp that crosses the suture lines

Normal result of pressure (suction) applied to tissue

Head may be tender as a result

Resolves within 1-3 days

Swelling: Puffy Face Pressure of cervix & vaginal walls on head

may cause swelling of cheeks & eyelids

Most swelling resolves in first day

Buttocks may be swollen & bruised in a breech birth

Swelling: Labia May have red, swollen labia, along with scant amounts

of vaginal bleeding &/or discharge

Due to hormones passed from mom to babe in pregnancy

No treatment is necessary, resolves on own

Swollen breast tissue in both females & males also common

Swelling: Scrotum Male infants often have a large red scrotum at birth due

to maternal hormones

Pressure of uterine contractions may aggravate condition

In some infants, testes do not descend into the scrotal sac until after birth

Swelling resolves without treatment

Circumcision No medical reasons supporting the circumcision of a

male newborn

The Canadian Pediatric Society does not recommend routine circumcision

Canadian rate of male circumcision has been estimated at 23%

Choice to circumcise is a personal one which should be discussed with each other & your physician

Considered cosmetic surgery & costs approximately $200 for the procedure. Cost increases drastically if done after 2 months old

Uncircumcised Penis DO NOT retract

foreskin

Retracts on own when

child is 3-5 years old

Sometimes not until

puberty

Cradle Cap Develops on scalp, yellow in colour, scaly, patchy

Not itchy or harmful to baby

Soak head with baby oil for 15 minutes,

shampoo, rinse well & brush with baby brush

Eyes Appear blue at birth, true color at about 3-12 mths

Vision is blurred for first few weeks

The newborn focuses well on objects approximately 12 inches away

Favor black and white for 1st 3 mths, until more able to distinguish different colors

Thrush White patches in babe’s mouth (tongue, gums, insides of

cheeks) that you cannot remove by gently wiping with a clean cloth

Caused by fungal infection (yeast)

Can results in a sore mouth, poor feedings & an unhappy babe

Prevention: mom limit sugar, yeast containing foods, eat yogurt (probiotic), wipe baby’s mouth & gums after feeds

Treatment: over the counter drops, prescription meds

Breathing Patterns Nose breathers, allows them to feed &

breathe at the same time

Babe may snort, grasp, groan or even pause in breathing

It is very normal for newborns to have periods of irregular breathing, although this can upset new parents.

Breathing Patterns Sneeze to clear nasal passage

Generally not considered a cold unless baby has a fever,

nasal discharge or accompanying cough

Hiccups are also common, no treatment is required

Babes exposed to second hand smoke have a much higher

incidence rate of pneumonia and bronchitis…two times

greater

Rooting Reflex Turn head towards anything touching cheek & opens mouth

Helps baby locate it’s food source

Mom can brush her nipple against baby’s cheek & baby

will try to latch on

Diminishes by 5-6 mths & disappears by 1 year of age

Startle Reflex (Moro Reflex) This reflex is used as a gauge of gestational age/

neurological development (disappears at 4-5 mths)

Usually elicited when baby is laying quietly

A sudden stimulus, change in position or sudden loud noise, causes babe to draw up legs and bring arms forward in an embracing motion

Thought to be remnant of ancient ancestors, babies would use this reflex to grab on to mothers about to flee from danger

Grasping Reflex Baby will grasp any object placed in it’s hands, cling

briefly then let go

This reflex is present at birth in both hands & feet for

infants of term gestation

This reflex will diminish by the 4 mths

Also thought to be remnant of ancient ancestors, after

startle reflex babies would grasp on to moms

Walking/Stepping Thought to be to help newborns “walk” up mom to get to

breast

Diminishes at 1-2 mths of age

Baby will not attempt stepping motions again until he/she

is ready to stand or walk

Smiling Many people say babies have “gas” & aren’t smiling

However starting b/w 2-6 wks babies can smile

Usually in response to stimulation & pleasurable sensations

such as talking & touching them

Right After Delivery Suctioning only done if necessary to help clear baby’s

airway

Then placed skin-to-skin on mom’s tummy

Dad offered to cut the cord

Initially, baby is purple/blue & quickly turns pink after crying

First set of VS done, Identification Bands applied: 1 to mom, 2 to baby, 1 extra band for whomever mom decides

During Recovery Period After a short while, baby placed on scale to be weighed

Baby then placed on radiant warmer for assessment by nurse, medications & measurements

Pediatrician/baby’s doctor will perform a 2nd assessment at some point before baby goes home

Eye Medication Many bacteria present in the birth canal

Within 1 hr after delivery antibiotic eye ointment is

applied to baby’s lower eyelids (with parents permission)

Prevent eye infections in the newborn

Not required by law, however definitely recommended

Vitamin K This is required by law, Health Canada mandate, if

parents ‘refuse’ health care provider must document this in baby’s chart

An intramuscular injection of Vitamin K is given to every newborn

Prevents excessive bleeding in case there is trauma or bruising from delivery or in the early newborn period

Vitamin K is an important clotting factor that baby doesn’t start making until 2 wks of age

Jaundice 2 types: Physiological & Pathological

Yellowing of the skin, eye-whites & inside baby’s

mouth

Caused by excessive bilirubin in baby’s bloodstream

If jaundice present, blood is drawn to determine the

bilirubin level

Usually worse at 4-5 days old and then receeds.

Physiologic Jaundice Physiologic jaundice is common in newborns & is

caused by an immature liver

Slower at breaking down old red blood cells

Starts >24 hrs of age

Higher risk if: baby is premature, has bruising or

infection

Pathologic Jaundice Less common

Present <24 hrs of age

Pathologic jaundice can result from blood incompatibilities

& results in more severely elevated levels of bilirubin

If left untreated, extremely elevated bilirubin levels can

cause brain damage, therefore careful monitoring is

required

Phototherapy If jaundice severe or not diminishing….

White-light (not UV light) placed shining on baby’s skin

Helps baby’s liver breakdown bilirubin faster

Depending on blood test, doctor will order single or double phototherapy

Bili-blanket: smaller portable phototherapy unit, allows for continuous treatment while baby breastfeeds

Postpartum Period Baby’s VS taken every 8 hrs

Is monitored for jaundice

Will sleep a lot in first 24hrs, important to wake baby up every 2-3 hrs & offer breast

Or every 3-4 hrs if formula feeding

Baby will be awake and usually upset during second day. (overstimulation compared to quiet uterus!)

Good idea to check diapers before every feeding

At 24 hrs of age baby is re-weighed

Before discharge, Newborn Metabolic Screening done

Meconium

Breastfeeding

The decision to breastfeed doesn’t have to be

complex.

The decision is primarily emotional and not

always based on the facts, although educating

yourself about it will increase your comfort level

and success.

It is good to discuss feelings & attitudes with

your partner

Breastfeeding But in the end, make the decision that is

best for you & baby

Whether you choose to breastfeed or bottle, it is important to make feeding a pleasurable time

ANY amount of breastfeeding gives you baby a great start to life

Cost of Breastfeeding The cost of breastfeeding comes from the extra 450 - 500

calories per day mom needs to eat, to meet her energy needs and

to produce adequate milk for baby

This amounts to:

1 peanut butter sandwich

2 slices bread, 1 tbsp. peanut butter

1 8oz. glass 2% milk

1 medium apple

Colostrum

Yellowish thick fluid produced in the latter half of pregnancy

The perfect 1st food for your baby

High protein, low fat content & easy to digest

Available in limited supply (2-10 ml per feed)

Milk production increases on day 3-4

Once Breastmilk is in… Breastfeed on demand or at least every 2-3 hrs (total 8

times in 24 hrs)

Allow baby to stay on each breast until satisfied

Allow 1st breast to drain completely, then offer 2nd breast until baby falls asleep

Start on the same side you finished on with the last feed (ensures breasts empty completely)

Supply & Demand Milk is produced in response to infant suckling

So..the more baby nurses effectively; the more

milk will be produced

Start early & nurse frequently

Breastfeeding Tips Get comfortable

Position baby - use pillows

When baby is well positioned, tickle lower lip

with the nipple, Hold breast in ‘C’ shape

Wait until baby opens mouth wide, then quickly

& gently move babe to breast

Breastfeeding Tips There may be some discomfort as baby latches on,

but this should not persist during suckling

If pain persists, unlatch by inserting clean pinky

finger into corner of babe’s mouth

Start over

Your Public Health Nurse is a great resource if you

have questions or issues about breastfeeding.

Cradle Football Side-Lying

Feeding Cues Early Cues:

Turning head, open mouth (rooting)

Sticking tongue in & out, repeatedly

Fists to mouth

Sucking on fists or anything near their mouth

Late Cues:

Crying

Breastfeeding Video

Postpartum Period Refers to the 6 week period following delivery

The time needed to recover & heal from the effects of pregnancy on the body

May be shorter or longer for some women

Physical Changes Uterus returns to pre-pregnant size b/w 2-5 wks

After delivery weighs 2-3 lbs. & should be:

Hard

Sitting in the middle of your abdomen

Below umbilicus (belly-button)

After Pains Serve 3 main purposes:

Squeeze out any blood collected in uterus

Close off blood vessels

Prevent postpartum hemorrhage

Cramps often increase with breastfeeding or full bladder & every delivery

Subside by week 2 or 3

Lochia Shedding of the inner uterine lining

Usually heavier than a menstrual cycle at first, then over time

Progresses from: Heavy red flow

Lighter pink/brown flow

Small yellow/white flow

Seek Medical Advice If: Drastic, sudden increase in amount of flow

Suddenly becomes heavy & bright red, accompanied by large clots

Clots the size of a loonie or larger

Foul odour or purulent discharge

Chills or high fever (38 degrees)

Perineum May be swollen, bruised & uncomfortable

Episiotomy heals within 2-3 weeks, if no infection present

Return to sexual activity when you feel comfortable doing so (recommended to wait until 6 wk check-up)

Initially, vagina may be drier (hormones), use water-based lubricant

Bowel Habits Possible to suffer from constipation, due to relaxed

muscles, sore perineum, episiotomy, hemorrhoids &/or altered eating patterns

Avoid constipation by:

water/fluid intake

Exercise, walking

High fiber diet; fruits, vegetables, whole grains

May need to use a stool softener to counteract narcotic pain medication’s constipation effect.

Hemorrhoids Relieve discomfort & promote healing by:

Avoiding constipation

Pelvic floor exercises

Warm baths

Cold compresses, tucks

Pain medications

Emotional Changes

Great variations

Emotions fluctuate due to hormonal & physical reasons

They are easier to deal with & accept if anticipated

Important to talk-out or unburden yourself to partner, family, friends, nurse, doctor, etc.

Postpartum Feelings Emotions fluctuate due to hormonal & physical

reasons

Mom may feel:

Loss of ‘fantasy’ baby & need to grieve the same

Loss of old self

Fear of unknown future

50-80% of new moms experience temporary emotional distress (Baby Blues), gone by 2 weeks

Other Causes Fatigue

Uncomfortable hospital routine

Inexperience/lack of confidence with baby

Anxiety r/t baby’s health

Continuing full-time demands made by baby

Changes to figure

Postpartum Depression 1 in 8 new moms experience PPD

Those with a personal or family history of anxiety or depression, type A personality, have a slightly higher risk

Some women don’t realize they need assistance or deny they need help

Important to identify & acknowledge signs

If symptoms last for more than a few days, or are very intense in nature, you should seek help

Contact any health care provider immediately & remember that you are not alone, TALK TO SOMEONE

Postpartum Depression Signs that may indicate a need for counseling:

Excessive talking, constant worrying

Extreme changes in behaviour, depressed

Frequent crying spells

Inability to sleep or concentrate

Lack of attachment/resentment of baby

Unable to cope, anxiety attacks, extreme fatigue

Postpartum Feelings in Dads Dad may experience mood swings – torn between laughter &

tears

May suffer acutely upon leaving hospital r/t feelings of surrendering wife & baby to strangers/strange environment

May feel ignored

Important for mom & others to remember dads & acknowledge their importance

Vulnerable time for family…financial concerns

Coping May Be Influenced By: Physical effect of birth (fatigue, hormones, length of labor,

difficulties with labor & delivery)

Birth experience (plan vs reality)

Health & personality of baby

Parent’s expectations postnatally (?realistic)

Support available to new parents (PHN, Families First,

Step ‘n’ out with mom

Remember, you

can call your

Public Health

Nurse at ANY

time.

References pregnancy.about.com

inhabitots.com & newborns.stanford.edu

newborns.stanford.edu

plagiocefalia.com

(vacuum) icup-gyneas.com

(lanugo) deardahlia.wordpress.com

(peeling) newborns.stanford.edu

(stork bites) webmd.com, loroati.com

(cradle cap) http://en.wikipedia.org/wiki/Cradle_cap

(jaundice) kidshealth.org