Parent and Baby

Booklet
 Table of Contents
Mom Care

 Nutrition ……………………………………p 5-6

 Exercise…………………………………….p 7-9
 Hygiene……………………………………...p 10
 Perineal care ……………………………….p 11
 Vaginal discharge and bleeding….............p 12
 Pain management …………………………p 13
 Bowel & Hemorrhoids …………….............p 14
 Caesarean births ………………………p 15-16
 Breastfeeding/Pumping………….…….p 17-24
 Adjusting to parenthood …………........p 25-26
 Postpartum disorders ……………........p 26-29
 Family planning …………………………….p 30
 Group B Streptococcus……………………p 31
 When to seek medical attention ………….p 32

Baby Care

 Usual newborn behaviour …………….p 35-36

 Sleep…………………………………………p 37
 SIDS……………………………….……...…p 38
 Cord and skin care……………….........p 39-40
 Bathing……………….………………….p 41-45
 Diapering…………………………………….p 46
 Bowel movement/wet diapers….. ……..…p 47
 Circumcision………………………………...p 48

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 Mucousy babies……………………………….p 49
 Dehydration…………………………………….p 49
 Weight loss and gain………………...............p 50
 Jaundice……………………………………p 50-52
 Vitamin D……………………………………….p 52
 Newborn screening……………………………p 53
 Car seat safety ……………………………p 54-55
 General safety…………………………………p 56
 When to seek medical attention….................p 57
 Resources……………………….………....p 58-62

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 Family-Centered Care
Welcome to Lakeridge Health!

Congratulations to you and your family on the

birth of your baby!

Our mission is to provide excellence in Family-

Centered Health Care to women and families.

The family is recognized as the most basic and

necessary social group. Our goal in the maternal
child program is to work together with families to
provide safe, skilled and individualized care that
supports the physical, emotional, and
psychosocial needs of the new parents and their
family.

Birth is a normal, healthy life event. To provide

optimal breastfeeding support and maximize the
time you can spend with your baby, your baby
will be staying in the room with you.

This booklet provides you, your family and

support people with information and answers to
frequently asked questions about mother and
newborn care.

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 Mom Care
This section will include information on

 Nutrition
 Exercise
 Hygiene
 Perineal Care
 Vaginal Discharge and bleeding
 Pain management
 Bowel and Hemorrhoids
 Caesarean Births
o Gas pains
o Incision care
 Breastfeeding
o Let-Down Reflex
o After pains
o Expressing milk
o Storing breast milk
o Supplements
 Adjusting to parenthood
o Rest
o Support
o Postpartum Blues and Depression
o Postpartum anxiety and Psychosis
o Family Planning
 GBS
 When to seek medical attention

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 Nutrition
Healthy eating, combined with balanced physical
exercise, is essential to rebuild nutrient stores after
delivery and important for your body to heal and prevent
illness.

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Main groups of food to include in your diet:

 Fresh vegetables and fruits, raw or cooked

 Whole grains
 Protein rich foods from animal and/or plant
sources

Breastfeeding requires an extra 500 calories per

day plus fluids to quench your thirst.

Extra calories can be gained by choosing

healthy snacks such as vegetables and fruits.
Try cheese and apples, hummus and veggies,
and/or yogurt topped with cereal.

Drink caffeinated beverages in moderation.

If you are breastfeeding, it is not necessary to

avoid eating certain foods, unless you find they
cause your baby to become fussy.

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 Exercise
During pregnancy, muscles and ligaments
stretch and joints loosen to supply room for the
growing baby.

After birth, your uterus will return to its original

size in about 6 weeks. Exercise will be needed
to return the other muscles to their former size
and function.

Depending on the kind of delivery, most types of

exercise can be gradually resumed in the
postpartum period, however with the added
fatigue that results from delivery and caring for
your newborn, you may need to reduce the
intensity or length of your exercise sessions.

Note that postpartum exercise is very individual

and should discussed with your doctor.

Benefits include weight loss, increased levels of

energy, and a decreased risk of postpartum
depression.

Moms who have had a C-section may also

gradually return to exercise unless restricted by
MD or midwife. Do the exercises slowly while
holding abdomen for support. Exercises 4A&B

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may be started 6 weeks post C-section, as directed
by your doctor.

Keep a good posture at all times, with shoulders

back, tummy in and seat tucked down.

Do these 5 times each, working up to 10 times, daily.

Continue with this exercise program at least until
your 6 week check-up.

All should be done slowly, lying on the floor or firm

surface.

Note: STOP any exercise that is painful and do not

exercise to the point of exhaustion

1. Deep breathing exercises: inhale through

nose, exhale through mouth. Attempt to hold
breath for 2 seconds. This maintains good
ventilation to the lungs.
2. Abdominal tightening and pelvic tilts: with
your hand in the small of your back, tilt your
pelvis by pulling in your stomach muscles and
tightening your buttocks as you press the curve
in your lower back into your hand. Hold for 5-10
seconds and slowly release. This strengthens
abdominal muscles and improves posture

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3. Lower back exercise: pull one knee to
your chest and hold for 20 seconds (with other
leg bent with foot on the floor). Do each leg 5
times. This helps to stretch and relax the lower
back

4. Modified sit-ups*
a. With hands on your thighs, tuck chin in
and curl up until your shoulder blades lift off the
floor, exhaling as you reach to slide your hands
towards your knees. Hold for 5 seconds
inhaling slowly as you slowly uncurl.

b. Clasp your hands in front of you, tuck in

your chin and curl up while reaching both hands
to touch the outside of one knee. Slowly uncurl
and repeat with other knee.
*not recommended post C-section
**full sit-ups are NOT recommended

5. Kegel exercises: Squeeze the pelvic

muscles as if to stop the flow of urine, hold for
10 seconds and release. Do this 10-20 times in
a row, at least 3 times a day.

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 Hygiene
Wash hands frequently: after going to the washroom,
before and after changing pad or baby’s diaper.

A squirt bottle will be given to you after

delivery. Use it each time you go to the
washroom; it will be soothing and cleansing for
your bottom. Use warm tap water and spray
from front to back.

Bathing

 Vaginal deliveries
o You may shower as soon as you are
up walking.
o Let your nurse know when you are
going to shower and ask for help,
should you need it.
o Emergency buzzers are located in the
bathroom should you need emergency
assistance.
 C-section
o Your nurse will assist you on your
second post-op day and will remove
your dressing then.
o Your incision will then remain open to
air

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 Tub baths are okay, but it is suggested
perfumes, bubble baths, and bath oils should
not be used.
 Swimming can be resumed once bleeding has
stopped.

Perineal Care
To decrease risk of infection, it is important to
keep perineal area clean.

You may have some discomfort or difficulty the

first few times passing urine. Try running water
or using the squirt bottle to stimulate the flow of
urine. Try to go to the bathroom every few hours
and avoid a full bladder. If you cannot pass urine
or have lots of pain when you try, speak with
your nurse.

Change your pad every time you pass urine or

stool and use the squirt bottle given to you to
cleanse the area. Pat the area dry, from front to
back.

Sitz baths are recommended for about 5 minutes

four times daily, or after any bowel movement.

Do not use tampons.

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If you had an episiotomy or tear, stitches may
have been used. These stitches dissolve within
2 weeks. You may clean as you would normally.

Vaginal discharge and bleeding

Your uterus will feel like a firm, round mass just

below your navel. It should drop by one finger-
width each day postpartum. If it feels soft to
touch, gently massage until it becomes firm.

Bleeding will continue for about 2-6 weeks

postpartum. It should decrease every day.

 Day 2-4: red

 Day 4-14: pink/brown
 6 weeks postpartum: heavy white

You may have cramps and heavier bleeding

when breastfeeding. If you pass clots with heavy,
bright-red bleeding or the discharge has foul
odour, speak with your doctor, midwife or nurse.

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 Pain Management
While in hospital, women who have had a
vaginal delivery will receive a self-medication
package. This allows you to take pain
medication as you need without having to ask
your nurse. Your nurse will explain the program
to you.

After birth, your nurse may give you a covered

ice pack to put on your bottom. Leave it on for
20-30 minutes. You can do this as often as you
like. It will help decrease swelling and discomfort
in your bottom.

Witch hazel pads are recommended as well to

reduce perineal pain; they can be found at your
local drugstore.

After C-Section, your doctor will prescribe pain

medications. Talk to your nurse about your pain
control options.

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 Bowel and Hemorrhoids
Your bowel movement patterns should return to
normal by 3 days post-delivery.

Prevent constipation by moving around, drinking

lots of fluids and eating foods such as fruits,
vegetables, and whole grains. Also, increase
fiber and fluid intake.

If you have hemorrhoids, your nurse will give

you a medicated ointment. You may find an ice
pack or warm bath will also provide comfort.
Witch Hazel pads may also be helpful to ease
discomfort and promote healing of hemorrhoids.

Avoid sitting or standing for long periods.

Hemorrhoids usually reduce in size or disappear
within 6 weeks of delivery.

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 Caesarean Births
These moms will normally stay in hospital for 48
hours.

Support your incision with your hands or a pillow to

decrease the strain on your muscles when you try to
get out of bed or when you need to cough, sneeze
or laugh. While you are in bed, change your position
every hour to help prevent stiffness and promote
recovery. Get up and walk as soon as you can.

You may want to place a pillow on your abdomen

when feeding your baby or try the side-lying position
or football hold.

Your body needs rest to recover properly. Try to

have at least one nap during the day when your
baby is sleeping and limit visitors.

Gas pain

Gas pains in the lower abdomen are common

following C-section. Walking, rocking in a chair or
lying on your left side may relieve the pains. Try to
avoid gas-forming foods, carbonated drinks, and the
use of straws. Drink lots of fluids, peppermint tea
and increase the number of high fibre and roughage
foods in your diet.

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 Incision care

After your second post-op day, you may have

a shower and your nurse will remove your
dressing and leave it open to air to help
healing.

Some may prefer to put a sanitary napkin over

the incision to prevent rubbing of the
underwear against it.

Your incision scar will fade with time. Seek

medical attention should you notice any of the
following on your incision:

 Increased redness, tenderness or swelling

along incision line
 Bleeding or other discharge
 Separation of the incision
 Fever

Your sutures will dissolve.

Your nurse will provide you scheduled pain

medication as long as you are in hospital. Talk
to your doctor about your pain management
options once you leave the hospital

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 Breastfeeding
Breast milk is the best food for your baby. The
Canadian Pediatric Society recommends babies
receive only breast milk for the first 6 months of
life. Breast milk is made special for each baby by
their mother, providing all of the fluid and
nutrients your baby requires.

Benefits for baby:

 Provides protection against ear and

respiratory infections, asthma, SIDS,
allergies, some bowel disorders, childhood
obesity, visual defects and many more
benefits

Benefits for mom:

 Offers some protection against

premenopausal breast cancer, ovarian
cancer, osteoporosis
 Helps return to pre-pregnancy weight faster
 Helps reduce bleeding after birth by
contracting uterus
 Convenient and free

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Let down reflex

Milk let down is responsible for making the milk

available to the baby, particularly the fatty hind-
milk, which baby needs for weight gain.

The let-down reflex is an aching pins and needles

sensation felt in the breast as the milk passes
through the milk ducts; it occurs when baby starts
to nurse.

Thinking about baby or hearing a baby cry can

stimulate milk let-down.

Signs of let-down:

 Increased swallowing of baby

 Cramping of uterus
 Thirst of mom

After pains

Some moms may feel cramping or pains in the

uterus as baby nurses. These “after pains” are
stimulated by the release of oxytocin when the
baby feeds to promote the shrinking of the uterus
back to pre-pregnancy size. Try deep breathing
and relaxation techniques to help with the pain.
Remember that this cramping is temporary.

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 Pumping
Choosing a pump

A good, quality pump will feel comfortable and

will express milk.

 Manual/hand pumps: small and inexpensive.

Works best for the occasional milk
expression when breastfeeding is going well.
 Small electric pump: used when you need to
miss several feeds in a day. It may not
maintain your milk supply without your baby
feeding well at the breast.
 High-quality electric pump: used when your
baby is not breastfeeding or not
breastfeeding well or is sick or premature.
This pump is usually rented through a
medical supply store.

Preparing the pump

 When first using an electric pump, the

suction level should be set to the minimum
level and then gradually increased to
mother’s comfort
 After each use, wash all parts of the pump in
warm, soapy water. Rinse with hot water and
drain on a clean towel

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Pumping is a learned skill. Most mothers can only
express a few drops when they first try a pump.
Pumping may be recommended in the following cases:
premature baby, not latching well, separation of mother
and baby due to illness, surgery, returning to work, or
engorgement

Tips for pumping

 Wash hands
 Warm, wet compresses, gentle breast massage and
nipple stimulation will help bring a quicker let-down
 If single pumping, you may switch breasts many
times to increase milk flow and several let-downs
 The amount of milk expressed may vary depending
on different factors (time of day, milk supply)
 Pump every 3-4 hours, and once in the night, ideally
at the same time each day
 Pump for 10-20 minutes per breast
 Relax while pumping. Don’t watch.
 Massaging in a firm circular motion or stroking the
breast may also help with milk let-down.
 If pump is hurting you, stop and seek help
 Remember: a baby who is breastfeeding well
is able to obtain more milk than any pump
 Keep your pump clean. Wash the parts that
touch your breast with hot water and dish
soap. Let it air dry on a clean towel.

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Storing Breast Milk

For a premature or hospitalized baby:

 Use a fresh, sterile container
 Refrigerate milk within one hour of pumping
 Use or freeze milk within 48 hours

For a full term / healthy baby:

 Room temp: 3-4 hours
 Cooler with a freezer pack: 24 hours
 Fresh milk in refrigerator: 3-5 days
 Thawed milk in refrigerator: 1 day
 Refrigerator freezer (separate door): 3-6
months
 Deep freezer: 6-12 months

Always label each bottle with month, day and

time.

Freeze milk in small amounts, 2-4 oz. to allow

room for expansion during freezing

Plastic bottle liners are NOT recommended

For healthy babies, clean containers in hot,

soapy water and rinse well with hot water. Allow
to air dry

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Thawing frozen milk

 Use the oldest container first, if not expired

 Thaw in the refrigerator overnight or under
cool running water, gradually increasing the
temperature to heat the milk to feeding
temperature
 When warm, shake bottle to even out the
temperature. Test milk on wrist before feeding
to baby
 Use thawed milk within 24 hours and do not
refreeze
 Never use a microwave to heat up breastmilk

Babies who are premature or sick require

different care in terms of hygiene and storing
breastmilk. Talk to your doctor, midwife or
lactation consultant about this.

NOTE: There are some medications that cannot

be taken during breastfeeding. Talk to your
doctor if you are concerned about the safety of
medications you are taking while breastfeeding.
Another resource is Motherisk at 1(800)382-
6780, a service which specializes in giving advice
about medication safety

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Supplementing

Breast milk is a complete food and water source, all

built into one. Giving your baby extra fluid like formula
(unless medically necessary) or water is not
recommended as it may interfere with breastfeeding
success.

Sometimes babies will need extra help for medical

reasons like low blood sugar, jaundice or extreme
weight loss. Your nurse will work with you to create a
feeding plan and choose what method of
supplemental feeding works best for you and your
baby.

Signs of breastfeeding problems (seek medical

attention)

 Baby has fewer bowel movements or wet diapers

than indicated on the bowel movement chart
 Baby is still passing meconium after day 5
 Baby is sleepy and difficult to wake for feeds
 Baby is feeding less than 8 times in 24 hours
 Mother has sore nipples not improving by day 3-4
 Mother has red, painful area of the breast
accompanied by fever, chills, or flu like symptoms
 Engorgement that is unrelieved by breastfeeding.

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 Keys to breastfeeding success

 Start early, let baby lick and nuzzle if that is what

baby wants. Lots of skin to skin!
 Encourage frequent and unrestricted feedings.
Follow baby’s cues
 Don’t watch the clock, watch your baby. The
length of feed will vary; allow infant to feed as long
and as often as they want
 Offer both breasts with each feeding
 The more you feed, the more you’ll produce
 Feed 8-12 times in 24 hours
 Cluster feeding is common. Baby will want to feed
every hour for a time, followed by a longer sleep
period
 For the baby who is not waking for feeds, try and
wake your baby by undressing and laying him/her
on your chest, next to your skin
 Avoid the use of pacifiers while breastfeeding is
being established
 Mother and baby need lots of time together for
holding and cuddling. Baby needs to get to know
the breast as a warm, wonderful place to be.

For more breastfeeding information, please refer

to the Breastfeeding Matters Booklet in your
teaching package.

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 Adjusting to parenthood
Your life has now changed! Your normal daily
schedule must now include the needs of a baby.
Your baby is a person and depends on you for
love, nurturing and physical needs. You, as
parents, gain strength and support from each
other and those close to you. Talk with friends,
family and neighbors. Accept help as it is offered
and do not forget to take time for yourself.
Feeling frustrated with the baby from time to time
is normal and a common emotion. These feelings
surface when you are tired, overwhelmed or
unsure of how to care for your baby.

Crying is the baby’s way to telling you he/she is

hungry, soiled, tired, hot, cold, ill or sometimes
over stimulated. Movement, rocking, riding in a
car, or going for a walk may help.
NEVER shake your baby.

Rest

Tiredness is the most common concern of new

parents. Anxiety, excitement, and lack of sleep all
play a part. Get in the habit of resting during the
day when your baby is sleeping. Unplug the
phone. Do not try and do everything as before.
Ask for help with household chores and meal

25
preparation. Share infant care like burping or
changing diapers.

Support

It is common for relatives, friends and others to

want to give you support and advice. Listen, but
only use what is helpful for you! Let them help
with food prep, baby-sitting while you rest,
laundry, cleaning the house, etc.

Doing things together is especially important

when you have a baby. Babies are very
portable; so don’t hesitate to include yours in
your plans.

Postpartum blues (aka baby blues)

A mild depression characterized by weariness,

irritability, moodiness, tearfulness, and feelings
of helplessness or of being overwhelmed.

It is not uncommon for new moms to have mood

swings following the birth of their baby. The baby
blues is caused from hormonal changes,
excitement, emotional let-down, expectations of
motherhood, change in or difficult relationship
between you and your partner, lack of social
support, stressful pregnancy or delivery and lack of
sleep. They usually begin in the first 1-3 days after
delivery and can go on till about 2 weeks after birth.

26
These feelings can be made worse by trying to
do everything right and not always succeeding.
Getting as much rest as possible is very
important to help you cope with the blues. If they
last longer than a few weeks, consult your
doctor, midwife or nurse to discuss ways to help
you cope.

Postpartum depression

May start right after birth or after several weeks

or months. 10-20% of all mothers develop
postpartum depression. Postpartum depression
differs from the baby blues in that it begins within
2 weeks to 12 months after birth and is a form of
clinical depression.

If any of these apply to you, get help!

 Overwhelming feelings of sadness, guilt or despair

 Can’t sleep, even when baby is sleeping. Or sleeps
all the time, even when baby is awake.
 Have trouble concentrating or remembering things.
Can’t make decisions
 Lose your appetite, don’t want to eat even when you
are hungry
 Have thoughts of harming yourself or the baby
 Baby blues that have not gone away after 2 weeks
 Cry all the time
 Feel hopeless and as if you have lost control

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 Having panic attacks
 Feelings of anger towards the baby
 I worry about the baby too much; am obsessed
about him/her.

Postpartum anxiety

Begins like postpartum depression but may

also experience panic attacks, extreme
anxiety, feelings of dread, racing thoughts,
difficulty sleeping, lump in your throat, fear of
being alone with the baby

Postpartum psychosis

 Postpartum psychosis is rare

 Rapid onset; about 3-6 days after birth
 Requires emergency treatment
 Mother may experience
o Hallucinations
o Paranoia
o Difficulty sleeping
o Strange behaviour

IF YOU HAVE ANY OF THE SIGNS LISTED,

GET HELP RIGHT AWAY.

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If you know a new mother who has these signs,
get help for her! Partners and family members are
often the first ones to notice these signs rather
than the mother herself. Call Durham Health
Connection Line at 1(800)841-2729 for
information on support groups for moms. Distress
centres are available 24 hours a day at (905) 433-
1121. If you are concerned, take the mother to
the emergency room.

29
 Family Planning
The right time to resume intimacy is a very
individual decision. It may take some time,
adjustment and communication. You may find
sex to be a little uncomfortable the first time.
Take some time each day to reconnect with each
other by cuddling, talking or sharing an activity
that you both enjoy. Patience and communication
with your partner are very important.

Sexual intercourse can be resumed when the

bleeding has stopped and the stitches healed (if
you had them). Postpartum physical changes for
the mother may include vaginal dryness, longer
arousal time and slackness of pelvic muscles.
Use lubricant and experiment with different
positions to lessen any discomfort.

Remember that you can get pregnant soon after

you have your baby so don’t forget to protect
yourself from pregnancy until you are ready for
another child. Breastfeeding is NOT a reliable
method of birth control.

A regular birth control pill should not be used,

however, there is a “mini-pill” (progesterone only)
which can be taken safely. Consult with your
family doctor about family planning options and
before resuming the pill while breastfeeding.

30
 Group B Streptococcus
Towards the end of your pregnancy you are
swabbed for bacteria that grows in the vagina,
rectum or bladder called Group B
Streptococcus. GBS does not usually cause an
infection in the pregnant woman, but can cause
problems for the baby.

During birth 40-70% of women can pass this

bacterium to their babies. A very small number
(1-2%) of these babies will develop a GBS
infection. This may cause mild to severe
problems which may affect the baby’s blood,
brain, lungs and spinal cord.

If a mother has the GBS bacteria, she will be

treated with antibiotics during the birth process
to decrease the risk of baby becoming infected
with GBS.

All newborns are watched closely for symptoms

of an infection. Babies who show signs of GBS
infection after birth will also be treated with
antibiotics.

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 When to seek medical attention
Your birth doctor usually requests to see you in 4-6
weeks. You should see your family doctor within 1-2
days after discharge.

Seek urgent medical attention if you have the

following:
 Heavy vaginal bleeding
o Bright red bleeding from vagina that
completely soaks one or more maxi pads
in 2 hours and does not slow with rest
 Blood clots
o Larger than a loonie with heavy vaginal
bleeding
 Breathing trouble or chest pain
 Foul-smelling vaginal odour
 Red, sore breasts
o Breasts that are red, swollen and painful
o With a fever
o With flu-like symptoms
 Painful, swollen lower leg(s)
 Pain when passing urine
o Burning
o Hard to pass urine
o Fever
 Change in your caesarean incision
o Redness or discharge from the incision
o Fever

32
 Baby Care

Enjoy your baby and all the firsts of his or her

new life

Talk to your baby, play baby games, caress and

cuddle

You’re parents now!

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 This section includes

 Usual newborn behaviour

 Sleep & SIDS
 Cord and skin care
 Cradle Cap
 Bathing and diapering
 Bowel movement and wet diapers
 Circumcision
 Mucousy babies
 Colic
 Signs and symptoms of dehydration
 Weight loss and gain
 Jaundice
 Vitamin K & Erythromycin eye ointment
 Vitamin D
 Newborn screening
 Car seat and general safety
 Flat head and tummy time
 When to see a doctor

*Additional resources:

“Breastfeeding Matters” booklet for information on

burping, crying baby and more baby information

“Infant Formula: What you need to Know” booklet

for information about feeding your infant formula

34
 Usual Newborn Behaviour
Skin to skin

Babies love being skin to skin with you. It allows them

to smell, hear, feel and get to know you. Skin to skin
babies stay warmer, calmer, breastfeed better and
have better blood sugar levels than swaddled babies.
Skin to skin is easy and will promote bonding between
you and your baby.

For more information about skin to skin, refer to

“Breastfeeding matters”.

The senses

Vision: babies can see contrasting colours and shapes

(black and white) at about 15 minutes of age. Their
eyes look for “face” shapes. Vision will gradually get
better with time.

Hearing: from birth, babies can hear clearly and will

turn to look at someone talking to them or jump at loud
noises

 All babies should have a hearing screen done. If

your baby is not screened in hospital, please call the
number in your teaching package to book your
baby’s hearing screen.

35
Touching and cuddling: holding your baby is important
for your baby’s growth and development. They respond
to touch, especially face, hands and soles of feet

Taste & Smell: both well-developed at birth

Personality: each baby is their own unique person with

likes and dislikes. Crying is very common. This is how
the baby communicates hunger, pain, wet or soiled
diaper, temperature, or need for attention.

Developmental milestones show skills that mark the

progress of young children as they learn to
communicate.

Babies like it when you:

 Get down to their level so they can see your face –

showing them you’re interested in what they’re
doing and saying. It makes it easier for them to
interact with you.
 Repeat the sounds they make
 Sing and laugh, especially when feeding, bathing,
and changing them. Remember to talk to your
baby throughout the day about things you do and
see
 Tell them the names of the objects they are looking
at and playing with. Babies are interested in
exploring and learning about new things, and like
to hear what things are called.

36
 Sleep
The Canadian Pediatric Society recommends
you place your baby on his/her back to sleep.
Babies sleep best on a firm surface without
pillows, bumper pads, or stuffed toys around
their head, allowing for open circulation of fresh
air.

Do not put baby to sleep in car seats.

Babies should sleep in a crib in your room for

the first 6 months. This can make night-time
breastfeeding easier and may help protect
against SIDS. Keep your baby away from
cigarette smoke. Make sure your crib meets
Health Canada’s most current safety standards.

Bed sharing is not recommended as baby can

become trapped in space between mattress and
wall or bed frame. There is also a risk of baby
falling off the bed, soft bedding covering the
baby’s head and causing overheating, and a risk
of you rolling over and suffocating the baby. The
safest place for a baby to sleep is in a crib close
to your bed.

Your baby will sleep about 17 hours a day at

first. Wakeful periods will gradually increase.

37
Sudden Infant Death Syndrome
SIDS: the sudden and unexpected death of an
apparently healthy infant under one year of
age. Usually occurs while the child is sleeping
and remains unexplained even after a full
investigation.

Nobody knows how to prevent SIDS, but

research shows things you can do to make the
baby safer.

 Place baby on his or her back to sleep

 Make sure that nobody smokes around your
baby
 Avoid putting too many clothes and covers
on your baby
 Keep the crib uncluttered
 Have a firm crib mattress
 Breastfeed your baby, it may give some
protection against SIDS
 Comforters, duvets, or pillows should not be
used.

http://www.caringforkids.cps.ca/

38
 Cord and Skin Care
Cord care

 Cord will fall off 1-2 weeks after the birth. There may be
a little amount of bleeding when this happens. If
bleeding is bright red, apply pressure for 5 minutes. If it
continues and is a copious amount, seek medical
attention.
 Wash your hands thoroughly before and after handling
your baby’s cord to prevent infection
 The cord does not need any special treatment. Simply
keep the cord as clean and dry as possible.
 To help the cord stay dry, fold the diaper away from the
cord so it does not get wet from baby’s urine.
 Clothing which rubs at the cord may cause irritation
 Watch the cord for signs of infection
o Draining a foul-smelling discharge
o Baby cries when you touch the cord or the skin next to
it
o Baby develops a fever
o Skin around the baby’s cord begins to get warm and
red
o If any of these symptoms are present, take your baby to
the doctor
 Do NOT pull the stump
 Dry carefully around the base of the cord after the
baby’s bath using a clean, dry face cloth

39
Skin care

 Clean baby’s face and bottom daily

 You will notice normal changes on the baby’s
skin. Surface cracking and peeling, especially
on hands and feet is normal. Apply a small
amount of Vaseline to those areas
 Redness/rashes are common in newborns.
White spots (milia) may also appear on baby’s
face- cheeks and nose. These will disappear
within the first week of life
o If you are concerned, take baby to see your
family doctor or midwife
 Fingernails do not need to be cut with
clippers. They are very soft and will break or
peel off on their own.

Cradle Cap
Cradle cap is a greasy yellow scale that sometimes
forms on baby’s scalp. You can get rid of it when
bathing the baby by massaging the baby’s head
during the bath and rubbing it well with a towel. It
may also help to soften the scales by massaging in
baby oil or mineral oil for 15-20 minutes. Shampoo
thoroughly and brush gently.

40
 Bathing

Babies do not need to have a full tub bath every

day. Every 2-3 days is plenty – but you should
clean between the creases in the skin daily.
Bathing your newborn should be a relaxing time;
most babies will learn to enjoy bath time by 1
month. Avoid bathing your baby when he/she is
hungry or just after feeding.

41
Safety

 Always check the temperature of the water

prior to immersing the baby
 NEVER leave the baby alone in the bath or
on the table
 Do not add warm or hot water to the bath tub
while the baby is in it
 When holding your newborn, always support
the head and neck
 Baby powder is NOT recommended for use
on baby
 If you feel that baby’s skin appears too dry, it
is safe to use Vaseline
 A good rule of thumb is to dress your baby in
one more layer of clothing than you are
comfortable wearing.

Preparation

1. Gather all the equipment you will need:

 Basin
 Mild, fragrance-free soap
 Large towel and wash cloths
 Outfit, diaper, blanket
 Lotion (if needed)

42
 2. Ensure the room is free of drafts and comfortably
warm
3. Remove sharp rings, watch and bracelets
4. Wash your hands
5. Before putting baby in tub, fill with warm water. Test
the temperature with your wrist or inside of your
elbow. You can also use a digital thermometer which
should read around 37 degrees Celsius

Directions

Before putting your newborn in the water, bundle him/her in

a blanket and keep diaper on until his/her hair is washed.
Wash in the following order:

1. Eyes: Gently clean the eyes with a moistened, clean

washcloth, wiping from the inner side of the eye out. Use a
separate corner of the washcloth to do the second eye.

2. Face: Clean the face with your facecloth and clean water.
Do not use soap.

3. Nose: Wipe only particles that are outside the nose. Do

not use cotton tipped swabs as you might hurt the nose, or
push particles further into the nose

4. Ears: Cleanse the outer ear with the facecloth. Don’t attempt
to clean with cotton tipped swabs as this may cause damage
by pushing wax further into the ear canal. Ear wax will
naturally work its way out.

43
5. Hair: Hair washing is needed only 1-2 times per week to keep
the scalp clean. Keep your baby bundled for the hair wash
with the baby’s head over the bathtub, facing upwards. Use
mild soap or baby shampoo. Rinse well and dry. Brush the
hair gently every day.

6. Body: Place unbundled baby in the water and wash with your
hands or the washcloth beginning at the neck and paying
special attention to the creases of the neck, armpits, fingers,
toes and groin. Turn your baby over, supporting the head,
and wash the back.

7. Genitalia:
a. Female:
 Wash gently, from front to back
 Then cleanse the rectal area again by wiping from front
to back.

b. Male uncircumcised:
 Do not push back the foreskin of the penis to clean. The
foreskin will naturally retract back itself as your boy gets
older (3-4 years). At that point he can be taught to
cleanse himself.

c. Male circumcised:
 Your nurse or doctor will instruct you how to care for
your baby’s penis after circumcision.
 Read the pamphlet given to you regarding circumcision.
44
Be sure to rinse your baby well and dry
thoroughly, paying attention to skin creases

A bath demo video can also be

viewed on the Lakeridge website:
https://www.lakeridgehealth.on.ca
/en/ourservices/patient-
resources.asp

45
 Diapering
Good diaper care is essential for prevention of a rash.

Clean and dry genitalia thoroughly with every diaper

change. It is recommended to use non-scented baby
wipes or a warm washcloth.

For girls, wipe front to back. For boys, clean and dry
penis and scrotum and do not retract the foreskin (if
uncircumcised).

If you are using disposable diapers and are having

difficulty detecting urine, place a Kleenex in the diaper
to make urine more visible. Baby’s urine should be
clear, not dark. You may notice “brick” stained urine in
the diaper, this is normal in the first week of life.

It is common for girls to pass a pink, mucous discharge

from their vagina during the first week; this happens
due to extra female hormones from their mom still in
their system.

Do NOT leave baby unattended during bath or diaper

changes. Place baby in a secure area before leaving
the room. If reaching for something, always keep one
hand on the baby.

46
 Bowel Movements and Wet diapers

Your baby will pass many bowel movements in the

first month of life; you may be changing a dirty diaper
with every feeding. This is normal and a sign that
your baby is feeding well! By one month, your baby
will settle into a more normal stooling pattern.

Baby’s urine may have an orange colour once or

twice during the first few days of life. This is called
‘uric crystals’. If you see this, try and feed your baby
more often.

Baby’s Wet Stools per day

Age Diapers per
day
1 day 1 wet diaper 1-2 sticky dark green/black
stools
2 days 2 wet 1-2 sticky dark green/black
diapers stools
3 days 3 heavy, 3+ brown/green/yellow
wet diapers stools
4 days 4 heavy, 3+ brown/green/yellow
wet diapers stools
5-6+ days 6 heavy, 3+ large, soft, yellow,
wet diapers seedy stools
Baby should NOT be
passing meconium at this
age

47
 Circumcision
Circumcision of baby boys is a surgical procedure to
remove the layer of skin that covers the head of the
penis and part of the shaft, also known as the foreskin or
prepuce. This procedure is not medically necessary. It is
an individual decision, sometimes based on religious,
social or cultural reasons.

Because circumcision is surgery, usual surgical risks like

bleeding and infection are possible, as well as the risk of
cutting the foreskin too short or too long, and poor
healing. Scarring from the procedure can cause the
opening of the penis to become too small which would
interfere with the baby’s ability to pass urine.

To help make your decision, talk to your doctor or

midwife about the risks and benefits.

The procedure takes 10-15 minutes. Healing takes 7-10

days.

Frequent diaper changes will help prevent irritation or

infection. You will be given an instruction care sheet.

48
 Mucousy Babies
Babies may have mucous in their throat after
birth. If your baby is spitting up mucous or milk,
tilt the baby forward and pat their back until the
mucous is cleared.

Signs and Symptoms of

Dehydration
If you notice any of the following, contact your
doctor:

 Small amounts of concentrated urine (not having

as many wet diapers as appropriate for age)
 Absent/decreased bowel movements
 Bowel movements that return to the green or
black colour
 Extreme sleepiness
 Abnormally irritable
 Dry mouth and lips
 Sunken eyes
 Sunken soft spot on baby’s head
 Poor feeding

If you are concerned about your baby being

dehydrated or unwell, contact your doctor right
away.

49
 Weight Loss and Gain
Weight loss is common in the first 3-4 days of life. It’s
caused from passage of baby’s bowel movements and
loss of extra fluid from baby’s tissues. It is normal for
baby to lose 5-7% of its birth weight.

By 2 weeks of age, baby should have regained the

weight they lost. Your doctor should see your baby 2-3
days after discharge to make sure the baby is healthy
and growing.

Babies will often have growth spurts at 3 weeks, 6

weeks, 3 months and 6 months. You will notice that your
baby will be very hungry during these times and you will
need to feed more often.

Jaundice
Jaundice is the yellow colouring of the skin caused by
increased bilirubin. Bilirubin is a normal pigment made
when red blood cells break down in the body. It is usually
processed by the liver, recycled and eliminated in the
baby’s stool. Minor jaundice is common in newborns in
the first 1-2 weeks.

Increased jaundice can be worrying and may require

baby to remain in hospital to receive phototherapy
treatment. A blood sample is taken prior to discharge to
assess bilirubin levels.

50
Cause of Jaundice

When baby is jaundiced, it means either his/her body is

making too much bilirubin or the liver is not getting rid of
it quickly enough.

Prior to birth, the baby has a large number of blood cells

that they don’t need after birth. Therefore, the baby’s
body begins to breakdown these extra RBCs and pass
out the bilirubin through the bowel movements.

If the baby is not having lots of bowel movements,

bilirubin can build up and cause the skin to become
yellow.

Some babies can have jaundice in the first day of life,

usually due to an incompatibility of baby and mom’s
blood types leading mom’s blood to react with the baby’s
blood. Some factors can make a baby more prone to
becoming jaundiced. Talk to your doctor or bring the
baby back to the hospital if you are concerned.

Phototherapy Treatment

Baby will be placed in an incubator under an ultraviolet

light source. Small coverings will be used to protect the
baby’s eyes from the light intensity

51
The baby will only wear a diaper so that the light can
shine directly on the skin. You can take baby out for
feedings. It is important for baby to get extra fluids
during this time, so the baby will need to feed more
frequently. It’s also important for your baby to hear your
voice and feel your touch.

Call your doctor or come back to the hospital if:

 Baby is refusing to feed

 Is sleepy all the time
 Has lost a significant amount of weight
 Is extremely jaundiced

Vitamin D
The Canadian pediatric society recommends
breastfeeding babies receive 400 IU of Vitamin D
per day. Please discuss this with your doctor or
midwife.

52
 Newborn Screening
PKU - A blood sample will be taken from your
baby’s heel to test for very rare, but very serious,
disorders.

The Newborn Screening Program will report test

results to the hospital, doctor, midwife or individual
who sent the test. If the test is positive, the
program office will notify the treatment centre that
will contact you directly and may also notify one of
the above practitioners.

CCHD - This pulse oximetry test tests for critical

congenital heart disease. It is a safe, quick and
painless test to detect low oxygen levels which is
a common sign of CCHD. A sticker is placed on
the baby and attached to a monitor. The test is
done at 24-48 hours and takes only a few
minutes. The results are available immediately.

To learn more about newborn screening, talk to

your doctor or midwife, call 1(866)532-3161 or visit
www.newbornscreening.on.ca/bins/index.asp

53
 Car Seat Safety

It is the law in Ontario that infants ride in a properly

installed, infant car seat. Always read the instructions
that came with the car seat you purchased and your
vehicles owner manual when installing the car seat.

Newborn babies and infants need special protection

while in a vehicle. In a collision, a properly installed rear-
facing child car seat can save your baby's life.

Ontario's Highway Traffic Act requires children to use a

rear-facing car seat until the child weighs at least 9 kg
(20 lb.).

It's best to keep your child in a rear-facing child car seat

until they reach the manufacturer's recommended
maximum weight and height limits. Some rear-facing car
seats are made for children that weigh up to 20 kg (45
lb.)

It is NEVER safe for your baby to ride in a car in your

arms.

NEVER LEAVE AN INFANT UNATTENDED IN A

CAR SEAT

54
 Remember the following rules:

 Baby should be sitting in an infant car seat

that faces the back of the car
o Follow manufacturer’s instructions for
installing the seat in the car
 Baby cannot be placed in the car seat
wrapped in blankets
o Put the baby in the seat first
o Adjust the harness straps
o Then wrap the blanket around the
baby
 The harness straps should be tight enough
that you can only fit one finger between the
strap and the baby’s collarbone
 The centre clip should be placed in line with
the baby’s armpit
 Do not use a car seat older than 7 years
 Never use a car seat as a crib or a place for
baby to sleep
 Read car seat instructions and car owner
manual to install your car seat
 Using a car seat purchased outside of
Canada is illegal. Consult Transport Canada
for more information
http://www.tc.gc.ca/en/services/road/child-
car-seat-safety.html

55
 General Safety
 Never leave your baby along on a bed, table,
chair or bath
 Check that your baby’s crib meets the safety
standards for cribs
 Babies should sleep in a bed with a firm mattress.
Use of bumper pads, pillows, thick bed pads or
water beds is not recommended
 Keep cribs and playpens away from windows,
blinds, and cords
 Never tie anything around your baby’s neck
 Avoid exposing your baby to cigarette or cigar
smoke
 Be gentle with your baby; do not swing by the
arms or throw up in the air
 Closely monitor family pets
 Do not carry or drink hot liquids when holding
baby

56
 Seek medical attention if…
 Baby feels warm to touch and temperature is greater
than 37.5°C (99.5°F) in the axilla (check your
thermometer for normal ranges)
 Diarrhea
 Vomiting (frequent or explosive)
 Persistent rash
 Persistent change in feeding pattern – no interest in
feeding
 Lethargy (baby does not wake for feeding) or
prolonged irritability
 Baby feeds less than 8 times per day
 Baby looks ill (eyes do not look interested, colour is
pale)
 High-pitched cry along with above symptoms
 Difficulty breathing or breathing in panting-type breaths
 Baby has a seizure (call 911)
 Skin very yellow before 2 days old or after 10 days old
 Skin has bluish colour
 Discharge or foul smell from umbilical cord
 Umbilical cord is red or with pus
 Loose green foul smelling stools
 No stools for 2-3 days
 Passing urine less than 4-5 times a day
 If fever persists
 Yellow or green discharge from the eyes

57
 Resources

American Academy of Pediatrics. (2016) SIDS and Other

Sleep-Related Infant Deaths: Updated 2016
Recommendations for a Safe Infant Sleep Environment.
Pediatrics 2016;138(5):e20162938

American Academy of Pediatrics and American College of

Obstetricians and Gynaecologists. (1997). In Hauth
JC, Merenstein GB (eds), Guidelines for Perinatal
Care (4th ed). Elk Grove Village IL, American Academy
of Pediatrics.

American Academy of Pediatrics (June 17, 2016) Tips for

Dressing Your Baby Retrieved on Sept 21, 2017 from
www.healthychildren.org/English/ages-
stages/baby/diapers-clothing/Pages/Dressing-Your-
Newborn.aspx

Artal, R.(June 2017). Exercise during pregnancy and the

postpartum period. UpToDate. Retrieved from
www.uptodate.com/contents/exercise-during-pregnancy-
and-the-postpartum-

58
 period?source=search_result&search=exercise%20after
%20childbirth&selectedTitle=1~150

AWHONN. Skin Care Guidelines. October 2017.

http://www.infantskincareguidelines.com/updates-to-
guideline.html

Berkowitz, L., Foust-Wright, C. (Jun 2017) Postpartum perineal

care and managemet of complications. UpToDate
Retrieved on Oct 1,2017 from
www.uptodate.com/contents/postpartum-perineal-care-
and-management-of-
complications?source=search_result&search=perineal%
20care%20with%20stitches&selectedTitle=1~150

Canadian Paediatric Society (1999) Reducing the

Risk of Sudden Infant Death Syndrome in
Canada Joint Statement: Canadian Foundation
for the Study of Infant Deaths, the Canadian
Institute of Child Health, the Canadian
Paediatric Society and Health Canada.
Paediatrics & Child Health1999;4(3)223-4.

59
Canadian Paediatric Society (2005) Position
Statement: Exclusive breastfeeding should
continue for six months. Paediatrics& Child
Health 2005;10(3):148

Dairy Farmers of Manitoba (2011). Eating Well with

Canada’s Food Guide. Retrieved from
www.milk.mb.ca/wp-
content/uploads/2014/10/print_eatwell_bienma
ng-eng.pdf

Quattrin, R., Iacobucci, K., De Tina, A. L., Gallina, L.,

Pittini, C., & Brusaferro, S. (2016). 70% Alcohol
Versus Dry Cord Care in the Umbilical Cord
Care: A Case–Control Study in Italy. Medicine,
95(14), e3207.
http://doi.org/10.1097/MD.0000000000003207

Khan, S. (2004) Maternal Nutrition during

Breastfeeding. New Beginnings, Vol. 21 No. 2,
p. 44 Retrieved from
www.llli.org/nb/nbmarapr04p44.html

60
La Leche League International (March 21, 2016).
Identifying Infant Dehydration in Breastfed
Babies. Retrieved on Sept 25, 2017 from
www.llli.org/nb/nbnovdec94p184sup.html

La Leche League Canada (November 27, 2014).

Thursday Tip: Breastfeeding on a Vegan diet.
Retrieved on October 3, 2017 from
www.lllc.ca/thursday-tip-breastfeeding-vegan-
diet

La Leche League international (2014) What are the

LLLI guidelines for storing my pumped milk?
Retrieved from www.llli.org/faq/milkstorage.html

Lowdermilk, D. L, et al (2000) Maternity and

Women's Health Care. 7th Ed. Mosby,
Philadelphia. Medes, M., O=Brien B., (1997)
Cleaning Solutions and Bacterial Colonization
in Promoting Healing and Early Separation of
the Umbilical Cord in Healthy Newborns.
Canadian Journal of Public Health. Volume 99
No.6. 380-382.

61
Riordan, J (2005) Breastfeeding and Human
Lactation 3rd Ed.Jones and Bartlett Publishers,
Massachusetts.The Nordic Epidemiological
SIDS Study, Pediatrics 100 (4):613-621.

Transport Canada. Child Car Seat Safety. October

2017.
http://www.tc.gc.ca/en/services/road/child-car-
seat-safety.html

62
 Updated By : Danielle Whittle
Clinical Practice Leader
January 2018

LAKERIDGE HEALTH OSHAWA

905-576-8711 ext 3232

LAKERIDGE HEALTH AJAX PICKERING

905-683-2320 ext 1201

LAKERIDGE HEALTH PORT PERRY

905-576-8711 ext 5525

63