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.