Discharge Instructions- Newborn Melissa Wise Wet Diapers: Minimum of 1 for each day of life (day2=2, day3=3) until 5th or 6th day, then 5-6 per day to 14 days, then 610 per day. Urine should be straw to amber colored without foul smell. Stools: Normal progression of stool changes: 1) meconium (thick, tarry, dark green) 2) transitional stools (thin, brown to green) 3) breastfed: yellow gold, soft or mushy stool; 6-10 stools per day or only 1 stool every few days after breastfeeding is well established ( after about 1 month). Formula-fed: pale yellow, formed & pasty stools. Only 1-2 stools per day. Breastfeeding: Successful latch-on & feeding every 1.5-3 hrs daily. Turn baby’s entire body toward mother, w/ mouth adjacent to nipple & the ear; shoulder & hip are in direct alignment. Direct nipple straight into mouth so that during sucking jaw compresses ducts directly beneath areola. Allow baby to suckle @ 1st breast until breast is emptied. Insert finger in baby’s mouth near nipple to break suction. Burp before changing breasts. Burp again @ completion of feeding. Alternate breasts with each feeding. Rotate baby’s position at breast to avoid undue trauma to nipples & improve emptying of ducts. Avoid supplementary formula feedings until lactation is established. Formula Feeding: Successfully taking @ least 1-2 oz every 3-4hrs; voiding as above. Hold baby close to establish eye contact as in breastfeeding. Avoid feeding while baby is on back. NEVER prop the bottle. Nipple hole should allow only drops of milk to flow. Keep nipple full w/milk to decrease air ingestion. Burping: Position baby so head rests on mothers shoulder or face down on lap, or sit baby on lap w/ baby’s chin & chest supported. Gently pat or stroke back. Burp halfway through feeding & at end of feeding. Regurgitation of small amounts of formula is normal. Have burp cloth available. Formula: Start w/3oz in each bottle (newborn usually takes 1-3oz. every 2.5-4H). Prepare fresh, clean bottle w/each feeding. Warm under hot tap water, or in pan of heated water. Always test temp of formula by sprinkling a few drops on wrist. Nasal suctioning: Gentle suctioning w/ bulb syringe may be needed. To suction, compress bulb syringe then place tip in nostril. Expand slowly by releasing compression on the bulb, remove from nostril. Repeat in mouth if necessary, with compressions to side of mouth about 1” in. Bulb syringe should be washed in warm soapy water & rinsed daily (or boiled for 10 minutes). Swaddling: Place blanket in shape of diamond, fold top corner down slightly, place baby’s head at fold, Right corner is wrapped around infant & tucked under Left side, bottom corner is pulled to chest, & Left corner is wrapped around baby’s Right side. Circumcision: Squeeze warm water over circumcision w/ each diaper change. Rinse area off w/ warm water & pat dry. Apply small amount of petroleum ointment w/each diaper change. Fasten diaper loosely over penis. Check for any foul smelling drainage, bleeding, swelling or cessation of urination at least once a day. Let Plastibell fall off by itself (about 8 days after circumcision). Light, sticky, yellow film or granulation tissue (part of healing process) may form over head of penis. Uncircumcised: Clean uncircumcised penis w/water during diaper changes & w/bath. Do not force foreskin back over penis; foreskin will retract normally over time (may take 3-5 yrs). Activity: Has 4-5 wakeful periods per day and alerts to environmental sounds/voices. Melissa Wise Jaundice: Physiologic jaundice (not appearing in first 24hrs); feeding, voiding, & stooling as noted above or practitioner notification for suspicion of pathologic jaundice (appears w/in 24hrs of birth; hemolysis & ABO/Rh problem suspected), decreased activity, poor feeding, or dark orange skin color persisting on 5 th day in light-skinned newborn. Umbilical Cord: Wash hands, clean cord & skin around base with a cotton swab or cotton ball, 2-3x per day. Do not give tub baths until cord falls off in 7-14 days. Fold diaper below umbilical cord to let the cord air-dry. Check each day for any odor, oozing of greenish-yellow material, or reddened areas. Expect tenderness around the cord & darkening & shriveling of cord. Never pull on cord or attempt to loosen it. Vital Signs: HR 120-140 beats/min, RR 30-55 breaths/min without evidence of sternal retractions, grunting, or nasal flaring; temp 36.3-37 C (97.3-98 F) axillary. Temp: Demonstrate taking an axillary. Rectal temp is not recommended. Inform not to use a mercury thermometer. Taking axillary temp: place the tip of the thermometer underneath the baby’s armpit. Hold thermometer securely in place for 3-4 min. Medications: Parents should not give any medications to a child under 2yrs of age without first discussing with their HCP. In case of fever, acetaminophen or ibuprofen can be used to increase comfort, following dosage on label. Aspirin is not recommended, as it is associated w/ Reye’s syndrome. Position of Sleep: On back to reduce incidence of SIDS. Placement of babies in prone position for “tummy time” should be encouraged. No blankets, pillows or stuffed animals in with baby. Bathing: Sponge bath for 1st 2 weeks or until umbilical cord falls off. After the cord falls off, tub baths can be given every 2-3 days. Gather supplies. Bathe in warm, draft-free room. Warm water 100-105 degrees. Begin @ the eyes, wiping from inside to outside of the eye w/ a wet washcloth (no soap), changing the spot on washcloth to clean other eye. Using soap, wash from head to toe. Dry each area after washing to decrease heat loss. Wash scalp 1-2 times a week, using mild, no-tear shampoo. Wash neck creases. Clean in folds, dry folds carefully or skin may break down. Wash chest, arms, & hands. Wash under baby’s arms, wash trunk & back. Keep upper body warm by wrapping in towel or blanket before washing legs & feet. Cleaning baby’s bottom should be last- wash girls from front to back. Do not retract foreskin of uncircumcised boys. Nail Care: Nails may adhere to skin during first few days of life; cutting is contraindicated. Within a week the nails separate from skin & frequently break off. Nails can be gently filed with a newborn file while asleep or newborn socks or mittens may be used if scratching face. Dressing the newborn: Newborns need to wear a t-shirt (onesie), diaper, a sleeper, and a hat (to help reduce heat loss). At home the temperature determines the amount of clothing the baby wears. Transportation: Infants are mandated to be in an infant car seat when in a vehicle. Babies should never be in front seat of a car. The safest spot is the middle of the back seat. The car seat should be positioned to face the rear of the car until the baby weighs 20 lbs. Encourage parents to have safety seat checked by local groups trained specifically for that purpose. Primary practitioner visit: Follow-up appointment within 48hrs after discharge or per MD instructions.