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The role of the Registered Nurse or Newborn Care Provider is to feed, soothe, bathe, change & provide all other gentle care to baby through the night.

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Your First Night Home: Newborn Diapering and Bathing

To conclude our three part, “Your First Night Home with Baby” series, here are the most common diapering and bathing questions our Night Nurses and Newborn Care Providers receive. Your First Night Home: Newborn Diapering and Bathing answers FAQ’s about clothing, bathing and circumcision care when transitioning your newborn from hospital to home.

Your First Night Home: Newborn Diapering and Bathing

Bathing FAQ’s

Should I bathe my baby every day?

Babies don’t need to be fully bathed everyday. Their skin is sensitive and can dry out a lot faster than adults. It’s best to give baby a sponge bath their first week or two. Making sure to get in their rolls and in between their fingers and toes. You would be surprised how much lint collects in fingers and toes! Once your newborn’s umbilical stump has fallen out and heals up, it’s okay to give baby a full bath.  Babies do not need to be bathed more than 3 times a week.

What temperature should my baby’s bath water be? 

Newborns and infants should be bathed in warm water, not too hot.  Test the water with your wrist, not your hand. Also, babies bodies lose heat quicker than adults.  Keep the bath time brief to avoid chills.

What kind of soap should I use on my baby?

Warm water is just fine for bathing newborns.  If you do use soaps, lotions or oils be sure they are non-toxic and infant safe so baby’s skin does not dry out or become irritated.  Avoid a scented soap or bubble bath.

Diapering FAQ’s

How often do I change my baby’s diaper?

It is best to change baby’s diaper every time you feed your newborn. Try to change your baby before feeding them. If you change their diaper immediately after feeding, they might spit up because laying horizontal can cause distress.

How do I care for my newborn son’s circumcision? 

If your male baby was circumcised, you were probably instructed to use petroleum jelly and gauze at each diaper change. When bathing, stick to sponge baths only and use unscented soap and warm water.  If you notice any continuous bleeding, trouble urinating, fever, or swelling, call your pediatrician immediately. The circumcision should heal in about seven to ten days.

Can I use baby wipes on a newborn?

Many doctors and newborn care professionals suggest using warm water and a clean washcloth to wipe at each diaper change.  Others say it is fine to use disposable wipes on newborns, as long as they are the unscented type.  The important thing is to be sure that baby is completely dry before putting on diaper creams or vaseline.  It is also fine to let your baby go diaper-free for 10-20 minutes (or longer if you’re okay with it) to allow the diaper area to stay dry.  

How Do I Know if My Baby is Eating Enough?

Your newborn will usually nurse/feed 8 to 12 times per day. It can be hard to know exactly how much is being taken in during each feeding session. But that’s okay because you’ll always be able to tell how much is coming out! You’ll see plenty of wet and soiled diapers once you arrive home with your newborn on day 3 or 4 of baby’s life.

Every baby is different of course but this wet and soiled diaper chart can help assure parents that baby is feeding well. You’ll also be visiting the pediatrician during this first week home and baby’s weight will be checked. As our postpartum doula Shiro says, weight gain is the other sure sign that your newborn is eating enough!

know if your newborn is eating enough with this diaper chart
Diaper expectations

For more information, on what to expect on your first night home with your newborn, please see:

Your First Night Home with Baby: Questions About Newborn Feeding

Your First Night Home with Baby: Questions About Newborn Sleep

sleeping infant is monitored by certified newborn care provider
this is an artist rendering it does not show safe sleep

Cradle Cap, Eczema, and Infant Acne Explained

There are several common newborn care skin conditions; cradle cap, eczema and infant acne. How can they be -and should they be- treated? This blog Cradle Cap, Eczema, and Infant Acne Explained can help.

Cradle Cap, Eczema, and Infant Acne Explained

What is Cradle Cap?        

Cradle cap is scales and redness on a baby’s scalp.  When this rash occurs on the scalp alone, it’s known as cradle cap.  It may start as scaling and redness of the scalp and can also extend to the face and diaper area, too.   When it does, pediatricians call it seborrheic dermatitis (because it occurs where there are the greatest number of oil producing sebaceous glands).

newborn or infant cradle cap is not harmful and will go away on its own
Cradle Cap

Seborrheic dermatitis is a noninfectious skin condition that’s very common in infants, usually beginning in the first weeks of life and slowly disappearing over a period of weeks or months. It is rarely uncomfortable or itchy.

Treatment:        Cradle cap is not harmful and will typically go away on its own by baby’s first birthday. It can be treated, by washing hair frequently with a mild baby shampoo and using a soft brush to remove the scales. Some doctors recommend a stronger, medicated shampoo or cortisone cream. These may remove the scales quickly but can be irritating to baby’s sensitive skin. Only use them after consulting a pediatrician.

It is not recommended to use baby oil or mineral oil on cradle cap. Doing so allows the scales to build up on the scalp, particularly over the fontanelle, or soft spot on baby’s head. Sometimes a yeast infection may form on the crease areas of the skin (rarely on the scalp.) If this happens, the area will be red and itchy. Seek the care of a pediatrician who may prescribe an anti-yeast cream.

What is infant eczema?        

Infant eczema known as atopic dermatitis (AD), is a chronic skin problem that causes red, dry, and itchy rashes. In babies, the rashes usually occur on the face or scalp or folds of skin. According to the American Academy of Pediatrics, it is the most common skin problem treated by pediatric dermatologists. Eczema can be hereditary and occur in conjunction with allergies or asthma. Also baby’s saliva from drooling can provoke irritation. Eczema in babies tends to be worse in the drier, winter months.

infant eczema can be hereditary

Eczema. See more examples of eczema via the Mayo Clinic 

Treatment:

Infant eczema usually clears up before 4 years of age. Before then however, different triggers cause eczema so treatment can vary.

Parents should contact their pediatrician for specific direction but common non-medical treatments include:

  • eliminating certain foods from baby’s diet – we should note that eliminating certain foods to see if baby’s eczema clears up is appropriate for children on solid food, there is conflicting advice on elimination diets for exclusively breastfed babies.
    • The AAP suggests that “lactating mothers with infants at high risk of developing AD should avoid peanuts and tree nuts, and should consider eliminating eggs, cow’s milk, and fish from their diets.”
    • However, La Leche League states that mother’s almost never need to limit their diets. So, parents can try an elimination diet while breastfeeding or use the other tips below.
  • using mild soaps, moisturizers and detergents specially made for sensitive baby skin
  • dressing baby in lightweight, loose fabrics or try skin -soothing fabrics
  • putting a cool-mist humidifier in baby’s bedroom
  • In some cases, a prescription cream or oral medicine may be prescribed.

What is infant acne?        

Infant acne is harmless acne that is often caused by exposure to maternal hormones in utero. Many babies develop infant acne around a few weeks of age, and in most cases, the acne is gone before baby reaches six months. While we think of acne appearing most often on the face, it can also occur on baby’s chest or back.

newborn and infant acne is harmless
Infant Acne

Treatment:

Unlike acne in adolescents and adults, infant acne requires no special treatment or medication. Clean the area daily with warm water, mild soap, and pat gently dry. Since baby acne is not caused by dirt, do not over wash the area, which can cause irritation. Since infant acne usually clears up within a few months, it is not cause for concern. However if the bumps look unusual, parents should mention the acne to their pediatrician to rule out other skin conditions.

The thing to remember about these three skin conditions is that they just happen.  Parents aren’t doing anything wrong when these conditions present, and there is usually no reason for nursing mothers to change their own diets.

Skin issues are usually simply due to baby’s little body adjusting to the world outside the womb.

Why Your Baby Wakes Overnight

Our team gets lots of questions about how to help babies to sleep through the night! Sometimes when babies “should” be old enough to sleep 8 hour stretches, there are 3 main reasons why they don’t. Why Your Baby Wakes Overnight can help infants and parents sleep peacefully.

Why Your Baby Wakes Overnight

1. Why does my baby wake through the night when I know he or she is not hungry?

There are typically 3 reasons for this:

  1. Illness – when baby has an illness or discomfort such as congestion or ear infection; laying horizontally makes fluid in the inner ear or chest settle and makes getting comfortable very difficult for baby.  Baby might also need their nasal passages cleared. Responding to baby quickly, for as long as baby needs is of course recommended.  
  2. Teething – good old teething pain is often the answer to overnight wakefulness. Comforting baby is again the way to go (of course!)
  3. Habit – for healthy babies who have never slept through the night (and we are not saying whether they should or shouldn’t) wakefulness overnight means they are simply repeating their 3-4 hour daytime schedule of being awake for a few hours and then going to sleep for a few hours.  For parents wishing to increase baby’s sleep time in this case, a gentle weaning of overnight feeds and increase in daytime feeds is appropriate.  Here’s what we mean by that.

2. How do I know when to get rid of the swaddle?

When baby is rolling onto her stomach, the swaddle becomes a hazard. When baby is consistently “busting out” in the late 3rd month or month 4, he’s telling you he does not need the swaddle anymore.  To eliminate the swaddle parents can simply go cold turkey or take a gradual step-down approach where we allow one arm out for several nights, then 2 arms and then eventually no swaddle at all.

3. How do I eliminate overnight feeds/the pacifier?

Anytime we are helping baby -and well, anyone really- learn a new way to do things we have two choices: cold turkey or gradual introduction.   Cold turkey certainly cuts to the chase, but the gradual approach can be much more gentle and less jarring for baby.

For feeding this means that we can eliminate milk/formula altogether between certain hours or we can gradually wean the amount taken in during these hours. For nursing moms, gradual weaning is essential…it’s more gentle for baby and also gives mom’s body time to adjust. When it comes to the pacifier we can “cold turkey” it or gradually remove the pacifier after less and less time per pacifier “session”.  For sleep training, it’s typically recommended to remover pacifier when baby stops sucking for a few moments, repeating this removal over and over until the pacifier is eventually not needed.    

Whether baby room shares, sleeps in a crib, uses a pacifier or does any number of sleep behaviors, there are a LOT of right answers to what works to make a happy and peaceful family. 

Why Your Baby Wakes Overnight
Why Your Baby Wakes Overnight

Repaying Sleep Debt as a New Parent

updated, Aug 1, 2023 – Sleep debt is defined as the difference between the amount of sleep you should be getting and the amount you actually get. Parents of newborns realize that sleep deprivation is something that comes with the territory but every time you miss out on sleep, you add to the debt. Over time this debt builds up and can lead to both mental and physical health issues.  This blog, Repaying Sleep Debt as a New Parent tells how you can get back your health and wellness.

Repaying Sleep Debt as a New Parent

Repaying Sleep Debt as a New Parent

Research shows that a combination of naps and overnight recovery sleep can be effective in counteracting some negative effects of sleep deprivation. However, one or two nights of substantial sleep aren’t enough to fully pay off a long-term sleep debt. What does this mean for parents of single babies and twins?

A 2010 study conducted by acclaimed British sleep scientist Iftikhar Mirza found that during a child’s first 2 years of life, new parents miss out on an astonishing total of 6 months worth of sleep! Sleep deprivation can lead to poor eating habits, mood swings, arguments, adversely affect your performance at work and can make getting behind the wheel very dangerous. 

How to Minimize Your Sleep Debt

While there are no perfect foolproof solutions, here are some practical ways for new parents to minimize their sleep debt:

  1. Switch nighttime duties with a partner or caregiver. If possible, alternate nights or times of night between one partner sleeping and the other is “on call.” If nursing, mom can breastfeed and partner can do the diaper changes and soothing. Other options are for Mom to pump during the day and having partner give baby a bottle or supplement with formula overnight. Work with your lactation consultant or pediatrician to figure out what is best for you.
  2. Get regular exercise. Exercise releases endorphins, increases healthy energy levels and lowers the risk of mood swings. Even if you are too tired, gentle exercise during the day, such as walking or yoga, can increase sleep.
  3. Do not consume too much food or alcohol before bedtime. Eating or drinking too much in the evening can over stimulate the digestive system and interfere with natural sleep rhythms, particularly reducing reduces rapid eye movement (REM) sleep.
  4. Ask for help! It is important to rely on family members, friends, babysitters, night nurses, etc. for help. There is nothing wrong with having another person tend to the baby or household tasks while you catch up on much needed rest if it will make you a better, more attentive parent.
newborn sleeping in crib, postpartum mom in bed

Being a new parent is tiring, especially for those in the postpartum phase recovering from childbirth. IT IS OKAY to have dirty dishes and unfolded laundry. New parents, especially breastfeeding mothers, need their energy and while you may feel like you are missing out on “getting things done,” you will actually be catching up on something very important…repaying your sleep debt.

How to Offer a Bottle to A Breastfed Baby

Question: I will be returning back to work soon, and my breastfed baby refuses to take a bottle of breastmilk or formula.  Help! Amy Black, IBCLC answers this common question in how to offer a bottle to a breastfed baby.

How to Offer a Bottle to A Breastfed Baby
photo by Rainier Ridao on Unsplash

How to Offer a Bottle to A Breastfed Baby

When attempting to offer a baby a bottle for the first time, there are a couple things to remember. First, your baby is very smart! Since s/he connects food with mom, sometimes it is best for mom to leave the house. Second, it’s widely advised to introduce a bottle only after breastfeeding is fully established, usually after 4 weeks. This avoids confusion and ensures your supply remains at the level baby needs. La Leche League recommends starting with pumping after one feeding session a day, when you feel like your breasts may still be a little full. As LLL says, Remember you are pumping “leftovers” and should only expect a small amount.

Additionally these tips can help:

  •  Offer the baby a small amount of food when the baby is not too hungry and perhaps a little sleepy. In other words, when baby is in a good mood and more open to change. 🙂
  •  Let someone other than mom feed the baby in a location that is not the normal nursing spot for mom and baby.
  •  Tickle the baby’s lips with the nipple of the bottle to get the baby to open his mouth wide.  Let baby take the lead in drawing the nipple into the mouth.
  •  Hold the baby in an upright position with the bottle at a horizontal position to the mouth.  This will mimic breastfeeding and allow baby to eat at their own pace without overfeeding.
  •  Once the baby starts drifting off and letting go of the nipple, cease feeding.  Follow the baby’s cues and be finished when he or she is done. Don’t force the last bit of milk by jiggling the nipple or waking him up.
  • If the bottle has been in the refrigerator, don’t forget to warm the nipple as well as the milk. You can run the nipple under warm water so it’s not too shocking to your baby.

How Should the Bottle be Given?

Caregivers can practice a method of feeding called paced bottle feeding ensures that your baby receives the right amount of milk. This feeding method slows down the flow of milk into the nipple and the mouth, allowing baby to eat more slowly and take breaks the way s/he would when nursing. Milk is slowed because 2 things are happening:

  1. Your baby is being held upright, the way s/he might be during a nursing session.
  2. Milk should only filling the bottle’s nipple about halfway. This makes sure baby isn’t being overfed. By not overfeeding the baby, mom will be able to keep up with pumping at work and maintaining milk supply. Here’s an excellent video showing paced bottle feeding.

Of course babies are all different and will accept a bottle in their own time. Even with all of these tips the best way to make sure bottle feeding is successful is to be consistent and patient.

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