INFANT TEACHING
Feeding
Are you planning to breast feed or formula feed?
Is this your first baby?
How do you feel about feeding your baby?
Benefits of Breastfeeding
The benefits of breastfeeding are:
 Stronger immune system, less diarrhea, constipation, gastroenteritis, gastroesophageal
reflux, and preterm necrotizing enterocolitis (NEC)
 Fewer colds and respiratory illnesses like pneumonia, respiratory syncytial virus
(RSV) and whooping cough
 Fewer ear infections, especially those that damage hearing
 Fewer case of bacterial meningitis
 Better vision and less retinopathy of prematurity
 Lower rates of infant mortality
 Lower rates of Sudden Infant Death Syndrome (SIDS)
 Less illness overall and less hospitalization
 Parents have up to six times less absenteeism from work
Explain and Demonstrate Positioning for Breastfeeding.
Cradle hold
 Position your baby so his head rests in the bend of your elbow of the arm on the side you'll be
breastfeeding, with the hand on that side supporting the rest of the body.
 Cup your breast with your other hand, placing your thumb above your nipple and areola at the
spot where your baby’s nose will touch your breast.
 Your index finger should be at the spot where your baby’s chin will make contact with the
breast. Lightly compress your breast so that the nipple points slightly toward your baby's nose.
Baby’s now ready to latch.
Crossover hold
 Hold your baby's head with the hand opposite to the breast you’ll be nursing from (i.e. if
nursing from the right breast, hold the head with your left hand).
 Rest your wrist between your baby’s shoulder blades, your thumb behind one ear, your other
fingers behind the other ear. Using your free hand, cup your breast as you would for the cradle
hold.
Football
 Had a C-section and want to avoid placing your baby against your abdomen
 Large breasts
 A small or premature baby
 Twins
 Position your baby at your side, facing you, with baby's legs are tucked under your arm (yes,
like a football) on the same side as the breast you're nursing from. Support your baby’s head
with the same hand and use your other hand to cup your breast as you would for the cradle
hold.
Laid Back
 A laid-back nursing position can be particularly helpful for moms who have smaller breasts,
for newborns and for babies with super sensitive tummies or excess gas.
 Lean back on a bed or couch, well supported by pillows in a semi-reclining position, so that
when you put your baby tummy-to-tummy onto your body, head near your breast, gravity will
keep him molded to you.
 Your baby can rest on you in any direction, as long as the whole front of the body is against
yours and he can reach your breast.
 Your infant can naturally latch on in this position, or you can help by directing the nipple
toward your little one's mouth. Once baby is set up at your breast, you don’t have to do much
besides lie back and relax.
Side lying
 This position is a good choice when you’re breastfeeding in the middle of the night.
 Both you and your baby should lie on your sides, tummy to tummy.
 Use your hand on the side you’re not lying on to cup your breast if you need to.
 When using this position, there should be no excess bedding around the infant that could pose
a suffocation hazard. This position shouldn’t be used on a recliner, couch or waterbed for that
same reason.
Principles of breastfeeding.
Improper Latch
Now that baby’s in position, it's important that your baby is latched on properly. Improper latching is
the most common cause of breast discomfort, especially sore nipples.
Latching
Latch your newborn onto your breast using the following tips:
 Gently tickle baby’s lip with your nipple
This should open your baby’s mouth very wide, like a yawn. Some lactation consultants suggest
aiming your nipple toward your baby’s nose and then directing it down to the upper lip to open the
mouth wide. This prevents the lower lip from getting tucked in during nursing
 Bring your baby toward your breast
Don't move your breast toward the mouth or stuff your nipple into an unwilling mouth — instead let
your baby take the initiative. It might take a couple of attempts before your baby opens his or her
mouth wide enough to latch on properly.
 Be sure baby's mouth covers both the nipple and at least part of the areola
Sucking just the nipple won’t compress the milk glands and can cause soreness and cracking. But in
the right spot, the action of the mouth, tongue and lips will massage the milk out of the milk glands.
Once your little one is properly latched on, you can lightly depress the breast with your finger to move
it away from baby’s nose. Elevating baby slightly may also provide a little breathing room. But as you
maneuver, be sure not to loosen baby’s grip on the areola.
Break a Latch
 Make sure your fingers are clean.
 Place your finger at the corner of your baby's mouth.
 Gently slide your finger into the side of the mouth.
 Go past your baby's lips and between his gums as you press down slightly against the
skin of your breast. This action will break the suction between your child's mouth and
your breast.
 Once your baby opens her mouth, remove your breast.
 To prevent your baby from accidentally biting down on your nipple as you try to remove
your breast from their mouth, keep your finger between your baby's gums until your
nipple is safely out of the way.
Unlatching Your Baby
 Break the suction first by pressing the breast near the mouth, or by gently inserting your finger
into the corner of baby’s mouth.
Recommendations for Vitamin D Supplementation in Breastfeeding Babies
Breast milk alone does not provide infants with an adequate amount of vitamin D. Shortly after
birth, most infants will need an additional source of vitamin D. To avoid developing a vitamin D
deficiency, the Dietary Guidelines for Americans and American Academy of Pediatrics
recommend breastfed and partially breastfed infants be supplemented with 400 IU per day of
vitamin D beginning in the first few days of life.
Use of Medications, Cigarettes, Alcohol and Recreational Drugs when Breastfeeding.
Maternal Nutritional Needs While Breastfeeding including
Recommendations Regarding Supplemental Vitamins.
Explain and demonstrate the mechanics of burping and when to burp both
breastfed and bottle fed babies.
 Over Your Shoulder: Stand or sit comfortably, slightly reclining, and hold your
baby under their bottom for support. Make sure they're facing behind you, looking
over your shoulder, with their chin resting on a soft cloth to absorb any spitup from a burp. Tap or rub the fingertips of your free hand across your baby's
shoulder blades. They may move back and forth a bit; this won't hurt as long as
your shoulder supports their head.
 Sitting on Your Lap: Place your baby sideways on your lap, with their chest
leaning slightly forward. Position your hand under their chin (not their throat) to
support their chest and head. Pat their back across the shoulder blades to burp
them.
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Face-Down on Your Lap: Lay your baby across your knees on their belly, with
their head slightly higher than the rest of their body, and firmly rub and pat their
back.
When to Burp Your Baby
You can often tell that a baby needs to be burped if he or she is squirmy or pulling away while
being fed. This being said, the American Academy of Pediatrics recommends that parents try to
burp their baby:
 When a nursing mother switches breasts or Every 2-3 oz. if being bottle-fed (60 – 90 mL)
Pausing to burp frequently slows feeding and reduces air intake.
Burping Methods
There are three popular methods for burping newborns and babies. All will require a burping
cloth to protect from spit up or wet burps and a gentle patting motion across a baby’s back to
coax out the burp. The main difference is how the baby is held.
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Leaning
Rest your baby’s chin or belly on your shoulder. (If opting for the belly, make sure that
your baby can breathe easily. Parents may benefit from trying this option after their baby
has better head/neck control.)
Support and hold your baby in place with one hand, while using the other to gently pat
your baby on the back.
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Sitting
Place a burping cloth or towel across your lap and put a bib on your baby.
Using your palm to support your baby’s chest and your fingers to support his or her jaw
(not throat), place your baby sitting on your lap, facing away from you.
With your free hand, gently pat your baby on the back.
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Laying
Place a burping cloth or towel across your lap.
Lay your baby across your knees, perpendicular to your body.
Use one hand to support your baby’s head so that it is higher than the chest. This will
prevent blood from rushing to the head.
With your free hand, gently pat your baby on the back.
For bottle feeding mothers: explain and demonstrate the preparation and sterilization of
formula, holds, types of formula, amount, and frequency of feeding, and principles of bottle
feeding.
 Soy formula
Infant soy formula is suitable for babies with allergies to cow’s milk.
*This formula must not be confused with regular soy milk, which does not provide suitable
nutrition for babies*
 ‘Follow on’ formula
Suitable for babies six months of age and over.
Available based on cow’s milk, soy or goat’s milk.
Made for babies over six months of age and contain higher protein and mineral content than
starter formula.
 Specialised infant formula
Infant formula can be modified in a variety of ways, including changes to the fat, carbohydrate or
protein content. Specialised infant formula is sometimes necessary for babies with certain
medical conditions and may be prescribed by paediatricians through the Pharmaceutical Benefits
Scheme (PBS).
Reasons for using one of these formulas might include:
 severe allergy or intolerance
 fat or carbohydrate malabsorption
 severe digestive disorders.
Examples of specialised infant formula and when they are used include:
 Low lactose – is used for lactose (milk sugar) intolerance.
 Modified protein content – in some formula, the cow’s milk protein is broken down into
smaller units. In other formula, the whole protein is replaced by amino acids, the
individual building blocks of protein. These preparations are used for severe allergy,
malabsorption and digestive disorders or metabolic conditions.
 Modified fat content – this includes formula with a high concentration of triglycerides
and lower levels of fatty acids, which may be used for babies with liver or gastrointestinal
conditions.
 Thickened formula – sometimes recommended for babies who frequently regurgitate
(vomit or cough up) large amounts after feeding, although a thickened formula may not
solve this problem. Only use under medical advice.
 Premature infant formula– designed for preterm (born premature) babies while they are
preterm. Premature babies need a formula with additional energy and mineral content.
This is not suitable for full-term babies or for preterm babies who are now full term,
unless under medical advice.
Introduction of Solids
The American Academy of Pediatrics says that for most children, you do not need to give foods
in a certain order. Your child can begin eating solid foods at about 6 months old. By the time he
or she is 7 or 8 months old, your child can eat a variety of foods from different food groups.
These foods include:
 infant cereals
 meat
 other proteins
 fruits
 vegetables
 grains
 yogurts
 cheeses
If your child is eating infant cereals, it is important to offer a variety of fortifiedalert icon infant
cereals such as oat, barley, and multi-grain instead of only rice cereal.
Only providing infant rice cereal is not recommended by the Food and Drug Administration
because there is a risk for children to be exposed to arsenic.
Elimination
Review the normal colour, number, and consistency of stools for both breastfeeding and
bottle-feeding infants.
Black
 1 week, black is a healthy color for stool. After this time, however, it could indicate a
health problem.
 24 hours of life, a newborn will pass meconium thick, black stool
 Made up of cells, amniotic fluid, bile, and mucus ingested while in the womb.
 Meconium is sterile, so it usually does not smell.
 Over the first few days of life, a newborn will continue to pass meconium.
 The color should gradually change from black to dark green, then yellow.
 After 1 week of life, stool should no longer be black. If a black color persists, seek
medical advice. It could mean that there is some bleeding in the digestive system.
Yellow
 This is a normal color of poop from a breastfed baby. Their poop tends to be dark yellow
 and may have small flecks in it.
 These flecks come from breastmilk and are harmless. Poop from breastfed babies is often
described as “seedy.” The so-called seeds may resemble curds in cottage cheese but are
yellow.
Brown or orange
 This is a normal color of poop from a formula-fed baby.
 When a baby drinks formula, their poop tends to light brown or orange. It may be slightly
darker and firmer than stool from a breastfed baby.
Green
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Red
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Many babies occasionally have green poop. Some possible causes include:
slow digestion, usually because the baby has eaten more than usual
green foods in the diet of the breastfeeding mother
a cold or stomach bug
a food allergy or intolerance
antibiotics, either in the baby or the breastfeeding mother
treatment for jaundice
Some infants’ poop is naturally slightly green. If the baby is putting on weight and seems
content, green poop is not necessarily a cause for concern.
This is not a healthy poop color.
Poop is usually red because there is blood in it. Seek medical advice.
The baby may have a health problem, or they may have swallowed a small amount of
blood. This could happen if a breastfeeding mother has cracked or bleeding nipples.
Another cause of red poop is bleeding from the baby’s bottom.
White
 White poop is uncommon and could indicate a liver problem.
 Pale or white poop may suggest liver disease. Another sign to look for is yellow pee.
 If the baby has white or pale stool, the doctor may test their bilirubin levels. Bilirubin is a
compound that helps the body get rid of waste. There are two types of bilirubin, and if
levels of one type are too high, it can cause health problems.
Color
 Normal breastfed baby poop should be light-to-medium brown, green, or yellow. Some
babies have whitish or yellow seed-like crumbs in their poop.
 The color tends to be fairly bright, causing some parents and caregivers to worry that the
baby has diarrhea, especially when the transition from meconium to normal baby poop
occurs.
Texture
 Breastfed baby poop is soft and occasionally runny.
 Runny poop is not a problem as long as the baby is feeding well and does not have other
issues, such as blood in the stool.
 Some breastfed baby poop looks like seeds or grains floating in water or fluid. This is
normal.
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Formula-fed babies typically have thicker poop. If a baby has both breast milk and
formula, their poop may be thicker and resemble peanut butter.
Smell
 The smell of breastfed baby poop is very mild. Some parents and caregivers do not notice
an odor at all or say that the poop smells like milk or cheese.
 If a baby has formula along with breast milk, the scent may be stronger.
 When a baby transitions to solids, the smell of poop may become stronger and more
unpleasant.
Frequency
 During the first 6 weeks of a baby’s life, frequent bowel movements show that they are
getting enough food.
 Most babies poop two to five times per day, or even after every feeding.
 A baby who poops significantly less than this or does not poop most days may not be
getting enough breast milk. It may be necessary to try breastfeeding more frequently or to
consult with a lactation counselor to assess milk supply.
 After 6 weeks, babies’ pooping habits vary more. Some babies poop daily, often right
after feeding. Others only poop a couple of times a week.
 Parents and caregivers may wish to pay attention to the baby’s normal pooping schedule.
A sudden, unexplained change may warn of a problem such as constipation, though this
is rare in exclusively breastfed babies.
Urine Output/Wet Diapers for First Week of Life and Beyond
The number of wet (urine) diapers a breastfed baby has each day changes during the first week
of life. During the first few days, your newborn may not receive much breast milk, so they won't
have many wet diapers. Then, as the days go on and your supply of breast milk increases, your
baby will produce more urine and have more wet diapers.
Here's what to expect:
 Day 1: A newborn baby will pass urine for the first time within 12 to 24 hours of birth.
During the early hours and days of life, an exclusively breastfed baby may not have many
wet diapers.
 Day 2: You should look for at least two wet diapers a day until your breasts begin to fill
with milk by the third or fourth day postpartum; as your milk supply increases, so will the
wet diapers.
 Days 3–5: Your baby should have at least three to five wet diapers.
 Day 6 and on: Your baby should be having at least six to eight wet diapers every 24
hours but may have more; some babies have a wet diaper at every feeding.
Bottle-Fed Infants
Even if you bottle-feed, your baby may not take much formula or pumped breast milk during the
first day or two after birth. The amount of urine that your newborn produces is directly related to
the amount of fluid they take in.
If your baby is a great eater and takes 2 ounces of formula every three hours right from the
beginning, you will see more wet diapers. But, if your newborn is sleepy or not taking in much
fluid during the first day or so, they'll have less wet diapers.
Here is a general guide:
 Day 1: Your baby should have their first wet diaper by the time they are 12 to 24 hours
old.
 Day 2: You should look for at least two wet diapers a day.
 Days 3–5: Baby should have at least three to five wet diapers.
 Day 6 and on: You should expect at least six to eight wet diapers a day.
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Whether you're bottle-feeding or breastfeeding, your newborn should be settling into a
feeding pattern and eating well by the second week of life.
You should see at least six to eight wet diapers each day, but your child could have up to
10 or more.
A newborn's bladder holds about one tablespoon (15 mL) of urine. Some newborns will
pee up to 20 times in 24 hours. A change before or after each feeding, approximately
every two to three hours.
Normal colour of urine
• Review how parents can assess whether there is urine in a disposable diaper.
• Teach care of the skin if an infant develops a diaper rash.
Most of the time, urate crystals in a baby's diaper in the first three days of life are normal in a
breastfeeding infant. During this time the crystals are harmless, a problem only because they can
cause parents to fear there is a problem or undergo unnecessary tests looking for blood in the
urine of their newborn.1
Urate crystals that persist for longer than three days can be a sign of dehydration or an indication
that a baby is not getting enough milk.
The Color of Newborn Urine
 Your baby's urine should be colorless or light yellow.
 Certain foods, food dyes, herbs, and vitamin supplements that you add to your
everyday diet could change the color of your breast milk as well as add a tint of green,
pink, or orange to your newborn's urine.
 Concentrated Urine: Concentrated urine is very dark yellow. It may also have a strong
smell. After your milk comes in, a diaper with concentrated urine now and then is OK.
However, if your baby has many diapers with very dark yellow urine, call the doctor.
 Brick Dust Urine: Very concentrated urine during the first few days of life can
contain urate crystals. These urate crystals can cause a pink, red, or orange-colored,
powdery stain in your baby's diaper called brick dust. Brick dust is normal for many
newborns. Concentrated urine and brick dust should go away by the fifth or sixth day
when you're making more breast milk.
Pseudomenstruation: Baby girls may have blood-tinged vaginal discharge during the first few
days of life. IIt is from the hormones in your baby's body, and it's not harmful.
Activity
Normal variations of sleep/wake patterns.
Generally, newborns sleep about 8 to 9 hours in the daytime and about 8 hours at night. Most
babies do not begin sleeping through the night (6 to 8 hours) without waking until at least 3
months of age, or until they weigh 12 to 13 pounds.
Amount of time babies spend sleeping and how it changes over time.
However, this varies considerably, and some babies do not sleep through the night until closer to
1 year. Newborns and young infants have a small stomach and must wake every few hours to eat.
In most cases, your baby will awaken and be ready to eat about every 3 hours
Review reasons babies cry.
 Hunger
 Stomach problems from colic and gas
 Needs to burp
 A dirty diaper
 Needs sleep
 Wants to be held
 Too cold or too hot
 Something painful and hard to notice
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Teething pain
Wants less stimulation
Wants more stimulation
Not feeling well
Soother use: purpose, risks and use in breastfeeding babies.
 The AAP recommends giving a pacifier at naptime and bedtime because some studies
have shown that they may help protect babies from sudden infant death syndrome
(SIDS).
 Many babies have a need to suck even when they are not hungry; a pacifier can satisfy
this desire for non-nutritive sucking.
 Non-nutritive sucking has been shown to provide pain relief. Babies with colic, who are
receiving vaccines, or who are injured, sick, or undergoing a medical procedure may be
soothed by the use of a pacifier.
 Premature babies may particularly benefit from pacifier use; one study showed that
giving preemies pacifiers resulted in a quicker sucking success and transition to oral
feeding.
 A pacifier is a soothing tool that a non-breastfeeding caregiver can provide, offering the
breastfeeding parent a break.
 Pacifiers are helpful during travel on an airplane as sucking can relieve painful pressure
in the middle ear.
 Pacifiers can also present some downsides. Some of these drawbacks, like concerns about
nipple confusion and milk supply, apply only to breastfed babies. Most often, however,
the cons of pacifier use can be mitigated by following recommended guidelines.
Risks
 Introducing a pacifier too early could get in the way of your baby's ability to latch on and
breastfeed. Lead to sore nipples, engorgement, plugged milk ducts, and mastitis. AAP
advises waiting until around 3 to 4 weeks to introduce a pacifier.
 Milk supply may be impacted or lead to weight loss in your baby.
 Pacifiers have been linked with ear infections, AAP recommends limiting or eliminating
the pacifier after 6 months of age.
 Pacifiers often fall out of babies’ mouths, which means they can become conduits for
germs, especially if they are not frequently cleaned and sanitized.
 The overuse of a pacifier during the day could prevent your baby from getting enough
milk at daytime feedings, which can cause them to wake more often during the night to
eat.
 Pacifier use was associated with poor dental development, specifically anterior open bite
and posterior crossbite.
Appropriate Stimulation of the Infant.
 Introducing a variety of textured objects
 Playing in water at the appropriate temperature
 Holding the baby up to face level, or lying down where the baby can see the caregiver’s
face
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Spending time outside the house in quiet listening
Sucking on clean objects
Playing music appropriate for the child
Watching moving objects such as fan blades, leaves, branches or shadows on a wall
Bouncing balls where the baby can see them bounce and come back up again
Rattles and other colorful and movable toys or objects (should be light and without sharp
edges)
Foods of different tastes and textures
Coloring, painting, stamping, and other art activities for toddlers
Smelling various safe substances such as foods, flowers (if not allergic to pollen), and
grass
Looking through various transparent colored objects
Musculoskeletal/Neurological:
What are the normal movements of an infant.
Babies usually display:
 Rooting
 Sucking
 Startle
 Grasp
 Tonic neck reflexes soon after birth.
 These reflexes are involuntary movements that are a normal part of infant development.
These early reflexes gradually disappear as babies mature, usually by the time they are 3–
6 months old.
 The rooting and sucking reflexes help a newborn get nourishment. Rooting prompts an
infant to automatically turn in the direction of a food source, whether that's a breast or a
bottle. You can see this response if you gently stroke your newborn's cheek near the
mouth with your hand. Your infant will turn in that direction, mouth open, ready to suck.
When a breast or a bottle nipple is placed in the baby's mouth, the baby will reflexively
begin to suck.
 A baby is also born with a startle response called the Moro reflex. An infant who is
startled (for example, by a loud noise) or abruptly moved may respond by throwing out
his or her arms and legs and curling them in again.
 Your baby also may show a grasp reflex by taking hold of your finger when you place it
in his or her palm. If you touch the sole of your newborn's foot, it will flex and the toes
will curl.
 A baby will also likely show the tonic neck reflex, or fencer's pose. This happens when a
newborn's head is turned to one side and the infant automatically straightens the arm on
that side of the body while bending the opposite arm.
Teach the benefit of “exercise” (ex. passive movement)
What are the benefits of passive baby exercise?
 Baby passive exercise is a good way to promote physical and mental development.
 Strengthen the baby’s blood circulation and breathing function
 Exercise the bones and muscles
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Increase appetite and body resistance
Promote movement development
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Babies can also do unconscious and disorderly movements, and gradually form and
develop differentiation into purposeful coordinated movements, laying a good foundation
for thinking ability and active activities.
Infant exercises is also a good way to promote infant movement development.
It is divided into passive infant exercises and active infant exercises. The former is
suitable for infants from 2 to 6 months old, and the latter is suitable for infants from 7 to
12 months old.
Research has proved that passive exercises for babies can promote their physical and
intellectual development.
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Demonstrate Correct Supporting of the Head.
Skin/Mucous Membranes
Teach and demonstrate a newborn bath.
 Keep the room warm so your baby does not get cold. Bathe your baby quickly to avoid
chilling.
 Keep water around 100° Fahrenheit (F) or 37.8° Celsius (C). Test the water with a bath
thermometer, your elbow, or your wrist (Picture 1). The water should feel warm, not hot.
 Set water heaters at 120°F (48.9°C) to prevent burns.
 Keep one hand on your baby at all times.
 Never leave your baby alone in any amount of water.
How to Bathe Your Baby
 Fill the sink or baby tub with no more than 3 inches of warm water. Test temperature of
the water.
 Undress your baby. Place them on the pad, if giving a sponge bath, or in a basin of water.
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Before putting soap on a washcloth, gently clean your baby’s eyelids. Using a clean spot
on the cloth, start at the inner corner of the eye and wash toward the ears.
Then, wash your baby’s face with only water. Do not use soap on their face.
Use clean water to wash the outer part of the ear. Do not use cotton swabs, like Q-tips®,
inside your baby’s ears.
Wet your baby’s head with water. Put mild soap or shampoo on the washcloth. Gently
rub the washcloth over their head from front to back. Keep soap out of their eyes. Rinse
their head with clean water and gently pat dry with the towel.
While your baby is lying on the pad or in the basin, reach under them to lift their back
and head up with your arm (Picture 2).
Make a soapy lather on the washcloth or with your hands. Start at the neck and lather
your baby’s entire body. Be sure to clean between fingers, toes, and skin folds.
Use the soapy washcloth or your hands to clean the diaper area.
Start at the front and move back to the buttocks.
If your baby is not circumcised, do not pull back the foreskin to clean the penis.
Rinse the soap off your baby with a clean, wet washcloth.
How to change a baby's diaper
With a newborn, the basic moves of changing diapers remain the same whether you're using cloth or
disposable diapers.
Step 1: Place your baby on a clean, soft, safe surface
 A changing table, a dresser equipped with a changing pad, a crib or a bed (preferably
protected with a towel or waterproof pad) all work.
 Spread a protective cloth on the surface if you're anywhere but your own changing table.
 No matter where you're changing diapers, make sure to keep one hand on the baby at all times,
even before your little one has started rolling over. Strapped-in babies also should remain with
arm's reach.
Step 2: Open up the diaper and clean your baby
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For a wet diaper: Fold the dirty diaper underneath the baby (so the clean, outer side is now
under his or her bottom) and wipe the area.
 For a poopy diaper: Wipe as much as possible with the diaper itself, then fold it underneath,
as above. Lift the legs and clean baby's front well with warm water or wipes, being sure to get
into all the creases. Then lift both legs and clean baby's bottom thoroughly.
 Once baby's diaper area is clean, slip the soiled diaper out and put a fresh one under baby
before releasing baby's legs.
 Pat baby dry before putting on the clean diaper or any diaper rash creams.
 If the umbilical cord is still attached and you aren't using special newborn diapers, fold the
diaper down to expose the area to air and avoid getting it wet. Fasten it tightly to avoid leaks,
but not so tightly that irritation occurs (you'll notice the telltale red marks during the next
diaper change).
Step 3: Throw out the dirty diaper
Step 4: Dress baby
Step 5: Wash your hands again
Skin Protection in the Diaper Area.
 Using water based wipes or cotton balls
Principles of Laundering the Baby’s Clothes.
 Wash brand new clothes before the baby wear them
 Scent
 Unless your baby has allergies, eczema/atopic dermatitis, or another condition causing
sensitive skin, washing your little one's clothes with the rest of the family's clothes isn't
likely to irritate your baby's skin.
 If you switch from a baby detergent, test wash one piece of your baby's clothing with a
color- and fragrance-free detergent. If you notice a skin reaction, stick with baby
detergent for a little while longer. Whatever detergent you choose, avoid anti-static
products or fabric softeners, which often have chemicals and fragrances that can irritate
skin.
Physiological Jaundice: etiology, diagnosis, symptoms, treatment,
observation and care at home.
When the baby is growing in the mother's womb, the placenta removes bilirubin from the baby's
body. The placenta is the organ that grows during pregnancy to feed the baby. After birth, the
baby's liver starts doing this job. It may take some time for the baby's liver to be able to do this
efficiently.
Most newborns have some yellowing of the skin, or jaundice. This is called physiological
jaundice. It is usually noticeable when the baby is 2 to 4 days old. Most of the time, it does not
cause problems and goes away within 2 weeks.
Teach Parents Regarding Unusual Marks or Lesions.
The most common skin conditions in newborns include desquamation, cradle cap, milia, miliaria.
newborn acne, erythema toxic and transient pustular melanosis.
The most common types of birthmarks include infantile hemangiomas, nevus simplex,
Mongolian spots, vascular malformations and melanocytic nevi.
A baby's skin is much thinner and fragile than an adult's and needs to be specially cared for.
Trim your baby's nails to prevent them from scratching themselves.
Babies can develop many types of skin conditions shortly after they are born. A lot of these
conditions last only a short time and will go away. Others, however, are birthmarks that may not
be visible at birth but will stay with babies throughout their lives.
Head
Teach parents regarding normal head shape, including discussion of moulding
Labour and delivery can be hard on a baby's body. Your newborn baby may look a little less than
perfect in the first few days or weeks after birth. His or her head may not be round.
It's important to know that whatever caused this, it doesn't mean your baby's brain has been
injured. The things that make a baby's head does not look round usually happen outside of the
skull.
Your baby's head is more likely to look this way if you had a long labour and a vaginal delivery.
The shape may also be caused by the way your baby's head rested against your pelvic bones
while the baby was inside your uterus.
Or it can happen if your doctor used forceps or suction (vacuum-assisted delivery) to give your
baby a little extra help coming through the birth canal during delivery.
Your baby's head should start to have a more rounded shape in the days and weeks after birth.
Moulding: Your baby's head can be "moulded" as he or she moves through the birth canal. The
pressure inside the birth canal can make the bony plates in your baby's skull shift and overlap.
This can make your baby's head look stretched out or pointed at birth. Moulding usually goes
away in the days after birth. During this time, the bony plates should move into a more rounded
shape.
Significance of sunken fontanelles and bulging fontanelles.
 Bulging anterior fontanel can be a result of increased intracranial pressure or intracranial
and extracranial tumors
 Sunken fontanel usually is a sign of dehydration
Prevention of Cradle Cap.
 Use a soft bristled brush to gently remove the scales from the scalp.
 Shampoo baby’s hair often.
 Apply baby oil to the scalp after shampooing.
Review Treatment of Cradle Cap.
It may include:
 Rubbing the scalp with baby oil or petroleum jelly to soften crusts before washing
 Special shampoo, as prescribed by your child’s healthcare provider
 Corticosteroid cream or lotion for a short period of time if the problem is really bad or
persistent
Eyes
Discuss normal vision and ability to focus in a newborn.
Over the first few months, babies may have uncoordinated eye movements. They may even
appear cross-eyed. Babies are born with the ability to focus only at close range. This is about 8 to
10 inches, or the distance between a mother's face to the baby in her arms. Babies are able to
follow or track an object in the first few weeks of life. Focus improves over the first 2 to 3 years
of life to a normal 20/20 vision. Newborns can detect light and dark but can't see all colors. This
is why many baby books and infant toys have distinct black and white patterns.
Discuss vision changes over the first two years of life.
Teach parents the principles of eye cleansing.
Cleaning baby’s eyes, ears and nose
You can clean your baby’s eyes, ears and nose when you’re bathing your baby.
 Warm water is all you need. Avoid using soap because your baby’s skin is sensitive, and
soap can dry it out.
Steps for cleaning baby’s face
Here are the basic steps for cleaning baby eyes, baby ears and baby noses:
 Get some cotton balls.
 Soak one cotton ball in some warm water and squeeze out extra water.
 Clean the corners of your baby’s eyes, wiping gently from the inside corners to the
outside corners.
 Use a new cotton ball for each wipe.
 Wipe gently around each nostril to get rid of mucus. It’s best not to put anything inside
your baby’s nostrils. This can hurt the lining of the nose and cause bleeding.
 Wipe behind your baby’s ears and around the outside of each ear. Don’t stick anything
inside your baby’s ears because it’s very easy to cause damage.
Wipe gently under your baby’s chin and neck, making sure you wipe between the folds of skin.
Gently pat your baby’s skin dry using a soft towel. Make sure you dry under the skin folds and
behind baby’s ears.
Babies can get upset when you try to clean their face. Talking gently to your baby or singing a
song can help with this.
Significance of redness and discharge.
Review normal changes in colour of the eye.
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The first 6–9 months is generally when you will see the most changes in your baby’s eye
color. Due to the production of melanin, their eyes may begin to darken. You likely won’t
notice it all of a sudden; it will often appear fairly gradually.
12 months, many babies have their 'final' eye color. However, some sources suggest that
your baby’s eye color may continue to change until the age of 3 or 6. Sometimes eye color
can experience subtle changes well into adulthood — but this is rare.
Ears
Teach parents how to cleanse the ears correctly.
 To clean your baby’s ears on a daily or regular basis, you’ll need a cotton ball that’s been
soaked with warm water. You can also use a gentle washcloth with some warm (not hot)
water.
 To clean baby’s ears:
 Wet the washcloth or cotton ball with warm water.
 Ring out the washcloth well, if using.
 Gently wipe behind baby’s ears and around the outside of each ear.
 Never stick the washcloth or cotton ball inside your baby’s ear. This can cause damage to
the ear canal.
Q-tip use and “baby Q-tips”.
 Cotton swabs are not safe to use on infants or young children. In fact, from 1990-2010,
ear cleaning was the most common cause for a child in the United States to be omitted to
the emergency room for an ear injury.
 The safest rule to keep in mind is that if you see any waxy buildup or discharge on the
outside of the ear, use a warm, wet washcloth to gently wipe it away.
 Leave anything inside the ear alone. Injury to the eardrum, hearing bone, or inner ear can
all cause long-term health complications for your child.
Speech sound disorder
 Keep all appointments with your child’s healthcare provider.
 Talk with your healthcare provider about other providers who will be involved in your
child’s care. Your child may get care from a team that may include experts such as
speech-language pathologists and counselors. Your child’s care team will depend on your
child’s needs and the severity of the speech sound disorder.
 Tell others of your child’s disorder. Work with your child’s healthcare provider and
schools to develop a treatment plan.
 Reach out for support from local community services. Being in touch with other parents
who have a child with a speech sound disorder may be helpful.
Respirations
 Typically, a newborn should take 40–60 breaths per minute. A single breath is one
inhalation and one exhalation.
 Babies can get congested when they breathe in cigarette smoke, pollutants, viruses, and
other irritants.
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Their bodies produce extra mucus in the nose and airways to trap and remove these
irritants. Exposure to dry air and other weather conditions can also trigger excess mucus
production and congestion.
Cyanosis
 condition in which the skin appears to have a blue tint. It occurs in areas where the blood
in surface blood vessels has lower levels of oxygen.
 refers to blue discoloration around the mouth only.
 It’s usually seen in infants, especially above the upper lip.
 If your child has darker skin, the discoloration might look more gray or white. You might
also notice it on their hands and feet.
Nasal flaring
 occurs when the nostrils widen while breathing.
 sign of trouble breathing
 indication of breathing difficulty, or even respiratory distress in infants.
Umbilicus
Normal Dry Cord Care:
Check the skin around the base of the cord once a day.
Usually the area is dry and clean. No treatment is needed.
If there are any secretions, clean them away. Use a wet cotton swab. Then dry carefully.
You will need to push down on the skin around the cord to get at this area. You may also
need to bend the cord a little to get underneath it.
Caution: Don't put alcohol or other germ killer on the cord. Reason: Dry cords fall off
sooner. (Exception: instructed by your doctor to use alcohol).
Bathing:
Keep the cord dry. Avoid tub baths.
Use sponge baths until the cord falls off.
Fold Diaper Down:
Keep the area dry to help healing.
To provide air contact, keep the diaper folded down below the cord.
Another option for disposable diapers is to cut off a wedge with a scissors. Then seal the
edge with tape.
Poop on Cord:
Getting some poop on the cord or navel is not serious.
If it occurs, clean the area with soap and water.
Genitals
Cleaning labia
 Nappy creams, sweat and other substances can collect in and around the labia. But in
general, you need to clean in and around the labia only to remove traces of poo.
 To clean your baby girl’s labia, wet a cotton ball with warm water, hold your baby’s legs
apart and wipe between the labia with the cotton ball. Start at the front and gently wipe
backwards. Use a new cotton ball if you need to wipe again. Dry your baby’s genital area
by gently patting with a soft towel.
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Don’t use vaginal deodorants or douches. They can upset the natural chemical balance of
your baby’s vagina and increase the risk of infection.
Sometimes your baby girl might have a thick milky discharge – this doesn’t need to be
cleaned away. If you’re unsure about any other discharge, see your GP or child and
family health nurse.
Potential benefits of circumcision
 Phimosis treatment
 UTI reduction
 STI reduction
 Cancer reduction
Potential risks of circumcision
 minor bleeding
 local infection
 unsatisfactory cosmetic result
 partial amputation of the penis
 death from hemorrhage
 sepsis
 meatal stenosis
Recommendations
 The CPS does not recommend the routine circumcision of every newborn male.
 Parents who choose to have their sons circumcised should be referred to a practitioner
who is trained in the procedure.
 Neonatal male circumcisions must be performed by trained practitioners whose skills are
up-to-date and strictly adhere to hygienic and analgesic best practices.
 The parents of circumcised boys must be thoroughly and accurately informed about
postprocedural care and possible complications.
 health professionals should ensure that the parents of uncircumcised newborn boys know
how to appropriately care for their son’s penis and are aware that the normal foreskin can
remain nonretractile until puberty.
If there is a dressing on the incision, apply a new one (with petroleum jelly) whenever
you change a diaper for the first day or two. Even after the dressing is no longer needed, put a
dab of petroleum jelly on the penis or on the front of the diaper until the penis is healed. This can
help avoid discomfort from the penis rubbing on or sticking to the diaper.
It usually takes between 7 to 10 days for a circumcised penis to heal. Initially the tip may appear
slightly swollen and red, and you may notice a small amount of blood on the diaper. You also
may notice a slight yellow discharge or crust after a couple of days. This is part of the normal
healing process.
Cleaning Penis
 Gently wash your baby’s penis and scrotum with warm water and a cotton ball.
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Dry your baby’s penis and scrotum by patting gently with a soft towel.
Only clean the outside of your son’s foreskin.
You can clean inside the foreskin when it easily pulls back on its own, which usually
happens when your boy is 2-3 years old. Sometimes it might not happen until puberty.
It’s common for a milky white substance (called smegma) to gather under the foreskin.
This is made of dead skin cells and natural secretions. It’s nothing to worry about.
Siblings
Your older child's age and development will affect how he or she reacts to a new sibling. While
older children are typically eager to meet a new sibling, younger children might be confused or
upset. Consider the following tips to help your child adjust.
Younger than age 2.
 Young children likely won't understand yet what it means to have a new sibling.
 Talk to your child about the new addition to your family. Look at picture books about
babies and families.
Children ages 2 to 4.
 Children at this age are still quite attached to their parents and might feel jealous sharing
your attention with a newborn.
 Explain that the baby will need lots of attention and encourage your older child's
involvement by taking him or her shopping for baby supplies.
 Read to your older child about babies, brothers and sisters.
 Look at your older child's baby pictures together and tell the story of his or her birth.
School-age children.
 Older children might feel jealous of how much attention a new baby gets.
 Talk to your older child about your newborn's needs.
 Point out the advantages of being older, such as going to bed later.
 You might display your older child's artwork in the baby's room or ask your older child to
help take care of the baby.
 Regardless of your older child's age, make sure that he or she gets individual attention
when the new baby arrives.
Safety
Appropriate Room Temperature and Ventilation
 Keeping your baby’s room cool, but comfortable is one way to maintain a safe sleep
environment. In fact, it’s recommended that babies sleep in a temperature between 68°
and 72°F (20° to 22.2°C).
Current Recommendations Regarding a Safe Crib
 No missing, loose, broken or improperly installed screws, brackets or other hardware on
the crib or mattress support.
 No more than 2 3/8 inches (about the width of a soda can) between crib slats so a baby's
body cannot fit through the slats; no missing or cracked slats.
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No corner posts over 1/16th inch high so a baby's clothing cannot catch.
No cutouts in the headboard or foot board so a baby's head cannot get trapped.
Current crib recalls
Current Recommendations Regarding the Mattress and Pillows in a Crib.
 The mattress support system should hold the mattress firmly in place.
 Avoid the use of loose bedding or soft objects in your baby's crib.
 Comforters, quilts, blankets, infant pillows, adult pillows, foam padding, stuffed toys,
bumper pads and sleep positioners should not be in your baby's sleeping area.
 Use a fitted bottom sheet made specifically for a crib mattress of the same size.
Car Seats and Booster Seats
All car seats must display a National Safety Mark that indicates they meet the applicable and
current Canada Motor Vehicle Safety Standards. Do not buy a seat that does not have a National
Safety Mark.
Change Tables
Remember that in the moment it takes you to reach for something, the baby can roll over and
fall. To limit the risk of falls, you may choose to use a changing pad on the floor instead of a
change table. If you choose to use a change table consider the following tips:
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Choose a change table with safety straps.
Take the baby with you if you have to leave the room for any reason.
Never place the baby in the main body of the playpen or crib while the change table
insert is still in place.
Check for the stability of the change table when it is attached to the main frame of the
playpen. Always follow the manufacturer's instructions.
Playpens
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Always supervise a baby while they are playing in a playpen.
Follow the manufacturer's instructions and recommendations for weight and age
restrictions.
Never leave a baby in a playpen with the side down; the baby can roll into the space
between the mattress and the mesh side and suffocate.
Never use playpens that have sharp edges or hinges that can pinch, scrape, or cut fingers.
Make sure side latches are in their fully closed position when setting up a playpen. If the
sides are not locked in place, a "V" shape can be created in which a baby can strangle.
Never put scarves, necklaces, or cords in a playpen or around a baby's neck. These items
can catch on the playpen and strangle a baby.
Remove mobiles and toy bars when the baby begins to push up on their hands and knees.
If using a model with mesh sides, make sure the playpen is a model with small holes in
the mesh.
Safety Gates
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Some gates manufactured before 1990 have wide V-shaped openings along the top, or
large diamond shaped openings along the sides, and do not meet current regulatory
requirements. These gates pose safety risks and should not be used. Openings in the gate
should be small enough that a child's head or body cannot fit through.
Select a gate that is recommended for the child's age and is appropriate for the area of the
house in which it will be used.
Install safety gates according to the manufacturer's instructions.
Use a secured gate at the top of the stairs and a pressure gate at the bottom of stairs and
doorways.
Make sure the gate is secure each time it is closed.
Avoid using gates with holes that can be used by children to climb over the gate.
Strollers
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Keep these points in mind when choosing or using a stroller:
Supervise children when they are in the stroller.
Choose a sturdy stroller and follow the manufacturer's instructions for the child's weight
and height.
Always use the safety harness and lap belts, and make sure that the child is seated
properly in the stroller.
Use the brakes when stopped, and when placing the child in or removing the child from
the stroller.
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Make sure that the child's hands and feet are not in the way before making adjustments to
the stroller especially while folding or unfolding the stroller.
Check the stroller regularly for signs of damage and to make sure the wheels are securely
attached and the brakes are in working order.
Never use pillows or blankets as padding as they pose a suffocation risk.
Never carry additional children, items, or accessories in or on the stroller, except as
recommended in the manufacturer's instructions.
Never use a stroller on an escalator.
Never leave children unattended to sleep in the stroller.
Suspended Baby Jumpers
Babies have been injured by falling when the jumper was not secured properly to the door frame,
used in the wrong type of door frame or when parts of the jumper broke.
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Supervise a baby while they are in a baby jumper. If you have to leave the room for any
reason, take the baby with you.
Look for a model that comes with well written and detailed instructions. Do not use the
product if you cannot setup the product as described in the instructions. Keep these for
future use.
Take down and store away the jumper when not in use.
Adjust the jumper so that the baby's toes are touching the floor when they are not
jumping.
Follow all of the manufacturer's instructions when installing the jumper, including the
guidelines for:
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age, weight and physical abilities of the baby.
dimensions and strength of the door frame.
Second-hand smoke on the baby
Secondhand smoke causes numerous health problems in infants and children, including more
frequent and severe asthma attacks, respiratory infections, ear infections, and sudden infant death
syndrome (SIDS).
Bonding
The act of holding, rocking, laughing, singing, feeding, gazing, kissing, and other nurturing
behaviors involved in caring for infants (and young children) are bonding experiences. The most
important ways to create attachment is positive physical contact such as hugging, holding, and
rocking.
Father’s Role
Fathers experience less stress and increased confidence when they have their own special time
with their newborns. Strong father-child bonds can help counter issues such as depression later
on in life.
Getting involved in the daily care of your baby – dressing, settling, playing, bathing and nappy
changing – is the best way to build your skills and confidence. These everyday activities also
create lots of one-on-one time with your baby, which is the building block of a positive
relationship
Immunization
2 and 4 months old:
 Diphtheria
 Tetanus
 Pertussis
 Polio
 Haemophilus Influenza type b
 Pneumococcal Conjugate
 Rotavirus
6 months old:
 Diphtheria
 Tetanus
 Pertussis
 Polio
 Haemophilus influenza type b
 Rotavirus
12 months old:
 Pneumococcal conjugate
 Meningococcal conjugate (Men-C-C)
 Measles
 Mumps
 Rubella
15 months old:
 Chickenpox (varicella)
18 months old:
 Diphtheria
 Tetanus
 Pertussis
 Polio
 Haemophilus Influenza type b
MOTHER TEACHING
Breasts
Prevent Breast Engorgement
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Breastfeed whenever you notice signs that your baby is hungry, such as eagerly sucking
on fingers or rooting. During the first few days and weeks, your baby will breastfeed at
least 8 times in a 24-hour period.
Make sure that your baby is latching on and feeding well. If your breasts are hard and
overfilled, let out (express) enough to soften your nipples before putting your baby to the
breast.
Allow baby to finish on the first breast first, before switching to the other breast. You can
tell that it's time to switch sides when the following things happen:
o Your baby lets go of the breast and turns their head to the side.
o Your baby's sucking slows down a lot or stops for a few minutes.
o You can no longer hear your baby swallowing on a regular basis.
Symptoms and Treatment of Mastitis
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Increased pain, swelling, redness, or warmth in an area on a breast.
Red streaks extending from a breast.
Drainage of pus coming from a breast.
Swollen lymph nodes in the neck or armpit.
Flu-like symptoms, such as fever of 38.3°C (101°F) or higher, chills, and fatigue.
To reduce pain and inflammation, you can:
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Apply warm, moist compresses to the affected breast every few hours or take a warm
shower.
Breastfeed every two hours or more often to keep milk flowing through the milk ducts. If
needed, use a breast pump to express milk between feedings.
Drink plenty of fluids and rest when possible.
Massage the area using a gentle circular motion starting at the outside of the affected area
and working in toward the nipple.
Take over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDS).
Wear a supportive bra that doesn’t compress the breast.
Nipples
Care of Tender, Cracked and/or Blistered Nipples
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Express some colostrum or breast milk and rub it onto your nipples. Allow it to air dry.
Expose your nipples to the air.
Keep breastfeeding or express or pump your milk. If your nipples bleed, you may see
blood in your milk or in your baby’s mouth. That's OK - the blood is not harmful and you
can still give your milk to your baby.
Look at your baby’s tongue. Sometimes a poor latch and damaged nipples happen
because the baby has a ‘tongue tie’ or tight frenulum - the piece of skin under the tongue.
A tongue tie is only a problem if your baby cannot latch well or if it's causing damage to
your nipples. Your doctor or a pediatrician can fix the tongue tie very easily.
Breast Pads
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Disposable nursing pads: Disposable nursing pads are designed to be worn once and
then discarded. They're available in a variety of shapes and thicknesses, so you may want
to try a few different brands to see which one you like best. Disposable pads are also
great for when you're going out or traveling since you won't have to worry about washing
them. But, over time, disposables can be expensive, since you have to continuously buy
new ones.
Reusable nursing pads: Reusable nursing pads are more cost-effective since you can
wear them, wash them and use them again and again. They're also environmentally
friendly since you're not throwing away multiple pads each day (they won't end up in a
landfill). You'll have to buy a few pairs since you'll need to change them often, and you'll
want to have a few pairs handy while others are in the laundry.
Silicone pads: Silicone nursing pads are not absorbent. Instead, they put gentle pressure
on the breast to prevent leaks. Made from soft silicone, these pads have a sticky surface
that adheres directly to your breast, so they can be worn with or without a bra. They're
often used under fancy clothing or for swimming.
Homemade nursing pads: Nursing pads can easily be made from a variety of items. You
could cut up disposable diapers or sanitary napkins to fit inside your bra, use a
handkerchief or other piece of cotton material, folding it and placing it over your breasts
or, if you know how to sew, you can stitch together a few layers of absorbent material
into a circular shape, or any other shape that's comfortable for you. When making your
own pads, avoid artificial materials. It's best to use 100% cotton fabric, which is better at
soaking up leaks, and soft against your skin.
Hydrogel pads: Hydrogel pads are not used for leaking. They're often used to help
soothe and heal sore nipples, and they can be kept in the refrigerator or freezer so they
can provide cool relief. If you have sore, cracked nipples, hydrogel pads may be helpful.
Bathing and Washing of Nipples
Keep your breasts and nipples clean by washing them daily with warm water in the shower or
bath. Also, avoid using soap on your breasts. Soap can cause dry, cracked, and irritated skin. It
can also remove the natural oils produced by the Montgomery glands located on the dark area
surrounding your nipples. These oils help to keep the nipples and areolas clean and moisturized.
Importance of Relaxation while Breastfeeding
Being relaxed and less stressed promotes the cyclical nature of aiding the let-down reflex, which
will lead to the infant getting more milk and emptying the breast
Lochia
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Lochia changes in appearance over time, as the uterus clears out the excess blood and
tissue. Typically, you will notice the following pattern:1
At first, lochia will look dark red and the flow may be heavy.
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After about four to 10 days, the lochia should lighten and look pinkish or brownish in
appearance.
After 10 to 14 days, the lochia should become similar to spotting, like what you may
notice just before or after your period.
For the remaining days or weeks, the lochia will look more like watery mucus and will be
white or yellow in color. It may also become very irregular.
If you had a cesarean section, you will still have lochia, though it’s possible you may
have less of it than if you had a vaginal delivery. After a cesarean procedure,
doctors inspect the uterine cavity to be sure all of the placenta has been removed; some of
what would traditionally pass later as lochia is often removed as well.
Assess Own Fundus When at Home.
Once you know, here are the basic steps to follow.
 Empty your bladder first. Studies show that a full bladder can change fundal height
measurements by several centimeters.
 Next, lay down on your back with your legs out in front of you. Using a tape measure that
measures centimeters, place the zero marker at the top of the uterus.
 Move the tape measure vertically down your stomach and place the other end at the top
of your pubic bone. This is your fundal height measurement.
Normal Involution of the Uterus
Uterine involution is about 80% complete by day 10 of the postpartum period. Conception rate is
comparable with that of nonparturient females by 15 to 21 days after parturition. Uterine
involution and the postpartum conception rate are determined by events during parturition and in
the immediate postpartum period.
Symptoms of Infection
 Blurred vision
 Chills or fever
 Feeling lightheaded, sleepy, or confused
 Heavy bleeding that doesn't slow or stop
 Nausea
 Pale or clammy skin
 Pain, cramping, or swelling in the vagina, abdomen, or perineum
 Rapid heartbeat
 Repeatedly soaking back-to-back menstrual pads
 You notice your lochia has a foul-smelling odor
 You pass a large blood clot or pass several clots in one day
 Your bleeding increases or gets lighter and then suddenly gets heavy again
Perineum
 After delivering the baby, the perineum must be kept clean. Lochia may drain for up to
four weeks, so pads should be changed frequently.
 Do not use tampons after delivery. Tampons may cause an infection.
 Take a bath or a shower once or twice daily. A sitz bath can be used after every bowel
movement. A sitz bath involves sitting in shallow water, only deep enough to cover the
hips and buttocks.
 Urinating can be painful after delivery. Squirting warm water over the perineum during
urination may ease the pain. When finished urinating, gently pat the perineum dry.
 Cold sitz baths help reduce swelling and discomfort after delivery. Sit in a lukewarm or
room temperature bath, and then gradually add ice cubes to the water. This prevents the
uncomfortable, sudden sensation of ice water on the skin. Soak for 20 minutes at a time,
up to three to four times a day. After the first two to three days, warm sitz baths will
improve blood flow to the perineum. Check with your physician before adding
medications such as epsom salts to the bath. An alternative may be ice placed in a sealed
plastic bag.
 Hemorrhoids are enlarged veins in the wall of the anus. They frequently occur during
pregnancy and often go away without treatment after delivery. Hemorrhoids may bleed
after bowel movements. If the hemorrhoids are painful, steroid suppositories may lessen
the discomfort.
 Stay well hydrated by drinking plenty of water.
 Straining with bowel movements will stretch the episiotomy scar and perineum and can
cause pain.
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Avoid constipation by eating fiber-rich foods such as fresh fruits and vegetables. If you
do get constipated, you can gently push up on your perineum as you bear down gently.
Using an inflatable “doughnut” cushion when sitting or lying down may help reduce pull
on the episiotomy scar.
Kegel exercises strengthen and tone pelvic muscles and lessen perineal pain. Kegel
exercises are small movements of the vaginal muscles similar to the movement you make
if you are trying to stop urinating.
If you are not allergic to acetaminophen (Tylenol) or ibuprofen (Motrin), you can take
them to help control your pain. Both drugs are safe for a mother who is breastfeeding.
Ibuprofen in particular is very helpful for episiotomy pain and postpartum uterine pain.
Avoid sexual intercourse until you have no more perineal pain. Most health care
providers recommend pelvic rest until four weeks after delivery, but there are no clear
guidelines. If you need to use a lubricant for sex, make sure it is water-soluble.
Abdomen
Treat your C-section Incision
During the C-section recovery process, discomfort and fatigue are common. To promote healing:
Take it easy. Rest when possible. Try to keep everything that you and your baby might need
within reach. For the first couple of weeks, avoid lifting anything heavier than your baby.
Seek pain relief. To soothe incision soreness, your health care provider might recommend
ibuprofen (Advil, Motrin IB, others), acetaminophen (Tylenol, others) or other medications to
relieve pain. Most pain relief medications are safe for breast-feeding women.
Look for signs of infection
Check your C-section incision for signs of infection. Contact your health care provider if your
incision is red, swollen or leaking discharge.
Manage other postpartum signs and symptoms
While you're recovering from your C-section, remember that you're also recovering from
pregnancy. Here's what to expect:
Vaginal discharge. After delivery, you'll begin to shed the superficial mucous membrane that
lined your uterus during pregnancy. You'll have vaginal discharge made up of this membrane
and blood for weeks.
This discharge will be red and heavy for the first few days. Then it will taper, become
increasingly watery and change from pinkish brown to yellowish white.
Contractions.
 You might feel contractions, sometimes called afterpains, during the first few days after
the C-section.
 These contractions — which often resemble menstrual cramps — help prevent excessive
bleeding by compressing the blood vessels in the uterus. Afterpains are common during
breast-feeding, due to the release of oxytocin. Your health care provider might
recommend an over-the-counter pain reliever.
Tender breasts.
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A few days after birth, your breasts might become full, firm and tender (engorgement)
once they begin making milk. Frequent breast-feeding on both breasts is recommended to
avoid or minimize engorgement.
If your breasts — including the dark circles of skin around the nipples — are engorged,
latching might be difficult for your baby. To help your baby latch, you might hand
express or use a breast pump to express a small amount of breast milk before feeding
your baby. To ease breast discomfort, apply warm washcloths or take a warm shower
before breast-feeding or expressing, which might make milk removal easier. Between
feedings, place cold washcloths on your breasts. Over-the-counter pain relievers might
help, too.
If you're not breast-feeding, wear a supportive bra, such as a sports bra. Don't pump your
breasts or express the milk, which will cause your breasts to produce more milk.
Hair loss and skin changes.
 elevated hormone levels increase the ratio of growing hair to resting or shedding hair.
 Stretch marks fade from red to silver.
 any skin that darkened during pregnancy — such as dark patches on your face — to
slowly fade as well.
Mood changes.
 Many new moms experience a period of feeling down, anxious or inadequate, sometimes
called the baby blues.
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Symptoms include mood swings, crying spells, anxiety and difficulty sleeping.
 The baby blues typically subside within two weeks.
Postpartum depression.
 If you experience severe mood swings, loss of appetite, overwhelming fatigue and lack of
joy in life shortly after childbirth, you might have postpartum depression.
 Contact your health care provider if you think you might be depressed, especially if your
signs and symptoms don't fade on their own, you have trouble caring for your baby or
completing daily tasks, or you have thoughts of harming yourself or your baby.
Weight loss.
 Most women lose 13 pounds (6 kilograms) during birth, including the weight of the baby,
placenta and amniotic fluid.
 After that, a healthy diet and regular exercise can help you return to your pre-pregnancy
weight.
Elimination
Normal poop is generally:
 Medium to dark brown: This is because it contains a pigment called bilirubin, which
forms when red blood cells break down.
 Strong-smelling: Bacteria in excrement emit gases that contain the unpleasant odor
associated with poop.
 Pain-free to pass: A healthy bowel movement should be painless and require minimal
strain.
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Soft to firm in texture: Poop that is passed in one single piece or a few smaller pieces is
typically considered to be a sign of a healthy bowel. The long, sausage-like shape of poop
is due to the shape of the intestines.
Passed once or twice daily: Most people pass stool once a day, although others may poop
every other day or up to three times daily. At a minimum, a person should pass stool
three times a week.
Consistent in its characteristics: A healthy poop varies from person to person. However, a
person should monitor any changes in the smell, firmness, frequency, or color of poop as
it can indicate there is a problem.
Deal with Constipation
 Increasing your fiber intake: Fiber-rich foods, such as fruits, vegetables and whole grains,
all help improve gut function. If you have bowel sensitivity, you'll want to avoid highfructose fruits, such as apples, pears and watermelon, which can cause gas.
 Getting more exercise: Regular exercise can help keep stool moving through the colon.
 Drinking more water: Aim for eight glasses daily, and avoid caffeine, as it can be
dehydrating.
 Go when you feel like it: When you feel the urge to go, don't wait.
Nutrition
Breastfeeding mothers generally need more calories to meet their nutritional needs while
breastfeeding. An additional 330 to 400 kilocalories (kcal) per day is recommended for wellnourished breastfeeding mothers, compared with the amount they were consuming before
pregnancy (approximately 2,000 to 2,800 kcal per day for breastfeeding women verses 1,600 to
2,400 kcal per day for moderately active, non-pregnant women who are not breastfeeding
Family Planning
Birth control
About
The pill
The pill contains the hormones estrogen and progestin. This method is not
recommended if you are breastfeeding. Certain health conditions may mean you
need to use a different form of birth control.
Minipills
These contain only the hormone progestin, making them safe to use while
breastfeeding or when health conditions prevent the use of the two-hormone pills.
They must be taken at the same time every day to be the most effective. The
minipills can decrease milk supply.
Contraceptive
skin patch
Hormones progestin and estrogen are released into your body through a patch on
your skin. This method is not recommended if you are breastfeeding. You need to
change the patch from time to time, based on the schedule for the product you buy.
Injection
A hormone shot is given once every one to three months. It may cause prolonged
or irregular bleeding. This injection may decrease milk production if given in the
first three days after birth.
Male condom
They are thin sheaths that unroll and fit over an erect penis. One must be used
each time before having sex and removed afterward.
Female
condom
A pouch with two rings placed inside the vagina before intercourse. One must be
used each time before having sex and removed afterward.
IUD or
intrauterine
device
A small, flexible device is placed in the uterus. It can stay in for 5 years (Mirena)
or 10 years (Paraguard).
Diaphragm
This is a thin, rubber dome that you cover with a spermicide (sperm-killing jelly),
and then insert into the vagina so it covers the cervix. It must be inserted each time
before having sex and removed afterward.
Note: Do not reuse your diaphragm from before your pregnancy. You must be
refitted after having your baby.
Cervical cap
A soft rubber cap smaller than a diaphragm but works the same way. It is usually
used with a spermicide.
Contraceptive
foam
The foam is a spermicide. (It kills sperm.) It both destroys sperm and blocks the
opening to the cervix. It is placed in the vagina before sex using an applicator.
Vaginal rings
Small rings containing hormones progestin and estrogen are placed within your
vagina. This method is not recommended if you are breastfeeding. Some rings can
be used only once. Some can be left in place for a period of time, depending on the
product you buy.
Tubal
ligation
This is a one-time surgical procedure that permanently sterilizes a female.
Vasectomy
This is a one-time surgical procedure that permanently sterilizes a male.
Natural
family
planning
This is a method of monitoring the female's basal body temperature, estimating the
time of ovulation, and timing intercourse to occur when the female is not fertile.
This requires careful personal observation and charting.
Lifestyle
Up to 400 milligrams (mg) of caffeine a day. Roughly the amount of caffeine in four cups of
brewed coffee, 10 cans of cola or two "energy shot" drinks.
Resources for smoking cessation in a mother who wants to quit smoking.
Your health care provider
Your local public health unit 1-866-532-3161
Smokers’ Helpline 1-877-513-5333
PREGNETS
Rest and Activity
If you had an uncomplicated pregnancy and vaginal delivery, it's generally safe to begin
exercising a few days after giving birth or as soon as you feel ready. If you had a C-section,
extensive vaginal repair, or a complicated birth, talk to your health care provider about when to
start an exercise program.
Regular exercise after pregnancy can:
 Promote weight loss, particularly when combined with reduced calorie intake
 Improve your cardiovascular fitness
 Strengthen and tone abdominal muscles
 Boost your energy level
 Staying physically active can also help:
 Relieve stress
 Promote better sleep
 Reduce symptoms of postpartum depression
 Better yet, including physical activity in your daily routine helps you set a positive
example for your child now and in the years to come.
Discuss practical measures a mother may use to help deal with the fatigue she
will likely feel.
 Make your priorities, and stick with them ex. laundry, home-cooked meals, and any
nonessential cleaning, which is pretty much all cleaning for now.
 Ask for help if you're not getting it.
 Take every shortcut in the book ex. resources that delivers, like grocery stores, or can
otherwise make your life easier, like cleaning services.
 Sleep when the baby sleeps
 Check in with your doctor. If your fatigue seems excessive, check with your practitioner.
 Take care of yourself ex. Eat right, take naps, exercise when you can and drink plenty of
water.
Discuss measures that can be used to help the mother get more rest.
 Talk about your sleep needs before you bring baby home.
 Use the hospital nursery.
 Just say no to added responsibility.
 Sleep when your baby sleeps.
 Say yes to help.
 Don’t worry that you won’t hear your baby cry.
 Outsource tasks.
 Don’t ignore the baby blues.
 Rule out underlying sleep disorders.
Discuss the importance of limiting visitors to the home.
 Are up-to-date on vaccines: Newborns don’t have fully developed immune systems,
making them particularly vulnerable to infections. Because of this, anyone who is around
babies (including parents and siblings) should be sure to receive the following routine
vaccines at least two weeks before meeting baby:
 Flu vaccine during flu season
 Whooping Cough (Pertussis) vaccine (called DTaP for children and Tdap for older
children and adults)
 Stay away if they’re sick: Visitors with symptoms of any illness (cough, cold, fever or flu
symptoms) should keep their distance from your house until they’re fully recovered.
 Wash hands frequently: It’s always a good idea to ask visitors to wash their hands upon
arrival, and before holding your newborn. Follow your instincts on when and how often
to ask guests to wash up
 Let baby have some space: Maybe you feel comfortable with certain visitors coming to
see baby, but aren’t sure about letting everyone hold your little one just yet. And that’s
fine, mama! Feel free to set limits. You can ask them to avoid close proximity to baby’s
face, and it’s up to you whether or not you want visitors to hold baby. Be sure that if you
have a partner, they’re on the same page about the rules.
 Bring/wear a mask: During flu season, or a pandemic, anyone holding baby should wear
a mask.
Post-Partum Exercises
Discuss and demonstrate appropriate post-partum exercises.
Exercising after you have your baby can improve your physical and mental wellbeing. It can:
 Help restore muscle strength and firm up your body
 Make you less tired because it raises your energy level and improves your sense of
wellbeing
 Promote weight loss
 Improve your cardiovascular fitness and restore muscle strength
 Condition your abdominal muscles
 Improve your mood, relieve stress and help prevent postpartum depression.
Kegal exercises
3 times a day:
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Make sure your bladder is empty, then sit or lie down.
Tighten your pelvic floor muscles. Hold tight and count 3 to 5 seconds.
Relax the muscles and count 3 to 5 seconds.
Repeat 10 times, 3 times a day (morning, afternoon, and night).
Breathe deeply and relax your body when you are doing these exercises. Make sure you
are not tightening your stomach, thigh, buttock, or chest muscles.
After 4 to 6 weeks, you should feel better and have fewer symptoms. Keep doing the
exercises, but do not increase how many you do. Overdoing it can lead to straining when
you urinate or move your bowels.
Strenuous Exercise
Wait until your 6-week postnatal check-up before you go back to the gym or start a group
exercise program. It's best not to return to your previous level of physical activity until 16 weeks
after the baby is born.
Breast Self-Exam
How to do a breast self-exam: The five steps
Step 1: Begin by looking at your breasts in the mirror with
your shoulders straight and your arms on your hips.
Here's what you should look for:
Breasts that are their usual size, shape, and color
Breasts that are evenly shaped without visible distortion or
swelling
If you see any of the following changes, bring them to your
doctor's attention:
Dimpling, puckering, or bulging of the skin
A nipple that has changed position or an inverted nipple
(pushed inward instead of sticking out)
Redness, soreness, rash, or swelling
Breast Self-Exam — Step 1
Larger Version
Step 2: Now, raise your arms and look for the same
changes.
Step 3: While you're at the mirror, look for any signs of
fluid coming out of one or both nipples (this could be a
watery, milky, or yellow fluid or blood).
Breast Self-Exam — Steps 2
and 3
Larger Version
Step 4: Next, feel your breasts while lying down, using
your right hand to feel your left breast and then your left
hand to feel your right breast. Use a firm, smooth touch
with the first few finger pads of your hand, keeping the
fingers flat and together. Use a circular motion, about the
size of a quarter.
Cover the entire breast from top to bottom, side to side —
from your collarbone to the top of your abdomen, and from
your armpit to your cleavage.
Follow a pattern to be sure that you cover the whole breast.
You can begin at the nipple, moving in larger and larger
circles until you reach the outer edge of the breast. You can
also move your fingers up and down vertically, in rows, as
if you were mowing a lawn. This up-and-down approach
seems to work best for most women. Be sure to feel all the
tissue from the front to the back of your breasts: for the
skin and tissue just beneath, use light pressure; use medium
pressure for tissue in the middle of your breasts; use firm
pressure for the deep tissue in the back. When you've
reached the deep tissue, you should be able to feel down to
your ribcage.
Breast Self-Exam — Step 4
Larger Version
Step 5: Finally, feel your breasts while you are standing or
sitting. Many women find that the easiest way to feel their
breasts is when their skin is wet and slippery, so they like to
do this step in the shower. Cover your entire breast, using
the same hand movements described in step 4.
Breast Self-Exam — Step 5
Larger Version
Pap Smear
The Pap test looks for cells that are not normal and can cause cervical cancer.
You may receive a regular pap test if you are between the ages of 21 to 69 – but it may not
always be necessary.
Ages 21 to 29: Most provincial and territorial guidelines recommend that if you are at least 21
years of age and are sexually active you should have a Pap test every three years.
Ages 30 to 69: The guidelines from the Canadian Task Force on Preventive Health Care and
others say that you should have the Pap test every three years.
Age 70 or older: You do not need any more Pap tests if your three previous tests have been
normal.
If you have an abnormal Pap test result when you are pregnant, your doctor will talk to you about
next steps. You may have a colposcopy. But doctors usually avoid taking a biopsy until after you
have given birth because there is a small chance that taking a biopsy sample can cause bleeding.
Post Partum Medical Check-up
4-6 weeks after her delivery or as advised by her physician.
1. Your Incision
2. Your Uterus, Ovaries, and Cervix
3. Your Breasts
4. Your General Health
5. Your Mental Health
Sexual Relationship
If you are breastfeeding, you may have some milk let-down during sexual activity
6-8 weeks to resume intercourse after a vaginal birth.
Sexual positions can be altered if the mother is experiencing discomfort.
 Use pillows
 Oral sex
 Use a water-soluble lubricant such as K-Y Jelly®. Do not use Vaseline®, baby oil or
mineral oil
Decreased lubrication with breastfeeding and strategies to deal with it.
Reduced estrogen levels are the main cause of vaginal dryness. Estrogen helps keep vaginal
tissue healthy by maintaining normal vaginal lubrication, tissue elasticity and acidity. Childbirth
and breastfeeding: The change in hormone levels after giving birth and while breastfeeding may
cause vaginal dryness. lactation causes estrogen levels to drop, it's common for women to find
they aren't well-lubricated during sex. An over-the-counter lubricant can help ease this
discomfort.
Emotional
You may have had a rush of feelings just after your baby was born that included joy, relief, and
amazement. Although you may still have these emotions at home, you may also start to feel
overwhelmed, uncertain, frustrated, or anxious.
“Post-partum Blues”
About eight in 10 people feel down after giving birth. The "baby blues" occur during the first
few days after birth, usually appearing on the third or fourth day. They are usually over by two
weeks postpartum.
Symptoms of a Post-partum Depression
 Depressed mood or depression with anxiety
 Anhedonia, which involves a loss of interest in things that would normally bring
pleasure, including the baby
 Changes in weight or appetite, which may involve gaining or losing weight
 Sleep disturbance and fatigue—common symptoms of depression but very difficult to
gauge, since both are normal for new mothers
 Physical feelings of being slowed down or restlessness, jumpiness and edginess
 Excessive feelings of guilt or worthlessness, which can be exacerbated by not bonding
with the baby, when feelings of extreme joy and love are expected
 Diminished concentration and inability to think clearly, which can be worsened by sleep
deprivation
 recurrent thoughts of death or suicide. For example, the woman may catch herself
thinking that the baby and she are better off dead, or that “the world is such an awful
place to bring a new child into that we would be better out of it.”
Signs of depression are often missed in new mothers because significant changes in sleeping
patterns, interests, cognitions, energy levels, moods and body weight are a normal part of new
motherhood.
New mothers often resist acknowledging these signs even to themselves because of the pressure
to meet societal expectations of what it means to be a “good mother,” including how she should
be feeling, thinking and behaving.