Caring for your newborn

During the first few days of age (days 1-4) your baby will have periods when they cry a lot and want to breastfeed very often.

Your baby is sucking to receive colostrum/milk as well as for comfort. This is normal baby behaviour. This frequent sucking helps you make more milk.

What your baby may do

• Need very long or frequent breast- feeding and does not settle after breastfeeding
• Wake often with hunger
• Need to be held & cuddled a lot
• Cry a lot - does not want to be put down

Babies have a strong need to suck. Frequent breastfeeding builds your milk supply.

Parents often feel:

• Tired
• Sleepy
• Frustrated
• Upset
• Worried they do not have enough milk
• Concerned their baby is hungry again so soon

Your baby will cluster feed again when they have growth spurts between 3-6 weeks, 2-4 months and 6-9 months.

What parents can do

• Keep breastfeeding your baby when they show feeding cues - mouth opening, rooting, hand to mouth, crying (often every 1-2 hours).
• Hand express drops of colostrum onto a spoon and give to your baby after each feeding.
• When your baby is not settling after taking both breasts, try latching again and switching from breast to breast until baby is settled.
• Try other positions; side lying or laid back positions - may be more restful.
• Keep your baby skin-to-skin after feeding until they get into a deep sleep before moving them.
• Your partner can hold and carry your baby if you need a break to rest. If your baby is still not settling keep breastfeeding.
• Try sleeping or resting when your baby sleeps.
• Ask your nurse for help. If you are at home, call the Sunnybrook Breastfeeding Helpline 416-480-5900 press 4, 24 hours/7 days a week.

• The umbilical cord was attached to your placenta and your baby's belly button. Here is how to care for the baby's cord.
• Wash your hands with soap and water before and after touching the cord.
• At birth the cord is clamped. When the cord is dry (about 24 hours) your nurse will take the clamp off.
• Keep the area clean and dry until the cord falls off.
• Fold your baby's diaper down under the cord to keep it dry.
• The cord stump usually falls off in 7 – 10 days. There may be a little bleeding.
• Your baby can have a tub bath before the cord falls off. Make sure the cord area is dried well after the bath.

• Change your baby's diapers often. For example before or after each feeding.
• At each diaper change wash the skin with warm water or use diaper wipes, then pat or air dry.
• Talk to your caregiver if your baby has a diaper rash.
• Do not pull your son's foreskin back.
• Wipe your daughter's vagina front to back.
• Some wet diapers may have a pink/red colour. This is normal in the first 3 days. If it lasts longer, please contact your baby's caregiver.

Tip: Exposing the buttocks to air can help dry diaper rash.

Uncircumcised Infant

There may be a whitish discharge around the tip of the penis-this is called smegma. Gently clean and wash as usual. Do not forcibly retract your son's foreskin as it will naturally retract by the time he is 3 to 4 years old.

More information is available on the Canadian Pediatric website.

Birth may change the shape of your baby's head for a little while. This is normal and your baby's head will become round again by the end of the first week.

Your baby has two soft spots on their head. One is on the top of the head and closes by 18 months of age. The other is near the back of their head and closes by 2 to 6 months of age. A strong layer of skin covers both of these soft spots. Touching, shampooing, brushing or stroking will not hurt the soft spots.

It is normal for parents to be concerned when they hear "Your baby looks jaundiced".

Please ask your nurse if you have any questions not answered here.

What is Jaundice?

• Jaundice is common in newborns and is the yellowing of the skin that can occur in babies of any nationality.
• Jaundice occurs when a chemical called bilirubin builds up in the baby's blood.
• Bilirubin levels are usually at their highest between 3-5 days after birth.

Why is Jaundice common in newborns?

• Bilirubin is in everyone's blood and is removed by the liver.
• Before birth, the mother's liver does this for the baby.
• A newborn's liver is not fully matured to remove bilirubin at birth, causing jaundice in the first few days of life.

Which babies require more attention for jaundice?

Some babies have a higher risk for increased bilirubin, such as babies:

• Born at less than 37 weeks gestation
• Weighing less than 2500 gms at birth
• With birth related bruising
• Who have jaundice in the first 24 hours
• Who have an infection
• Who needed resuscitation at birth
• Who are breastfeeding ineffectively

Can jaundice hurt my infant?

• Most babies have mild jaundice that is harmless
• In unusual situations the bilirubin level can get high enough to cause brain damage

How is my baby checked for jaundice?

• The nurse will use a skin test or ‘flash' on the baby's forehead to screen the jaundice level.
• A blood test will be done if the ‘flash' indicates the jaundice level is high.
• A bilirubin blood test is always necessary if jaundice occurs in the first 24 hours

How can jaundice be decreased?

The need for treatment is dependant on the age of the baby and the jaundice level.

• Breast milk has a laxative effect and helps babies to get rid of bilirubin through their bowels.
• If you are breastfeeding, nurse your baby 8-12 times each day. This will help produce enough milk and increase the number of wet and dirty diapers which will help eliminate the bilirubin
• One way to reduce the bilirubin levels is to expose the undressed baby under special lights, a process called phototherapy.
• Phototherapy is safe and only used when necessary until the baby's liver gets better at removing the bilirubin.

What can I expect if my baby needs phototherapy?

• The baby's eyes are protected from the light by eye patches
• The baby may have frequent, loose, green bowel movements while under phototherapy. This is temporary and the baby's bowel movements will return to normal after the bilirubin level decreases.

Comforting your baby under phototherapy

• It is very important that your baby spend as much time as possible between feedings under the lights.
• While your baby is receiving phototherapy, he/she still needs to be touched and talked to.
• The best time to cuddle your baby and talk to him/her is during feedings.
• Some babies have trouble settling under the lights. Stroking and talking to your baby may help him/her to settle.
• The nurse may place rolls beside the baby so they feel secure.
• You may also try using the biliblanket while feeding the baby.

What do I need to know about jaundice at home?

If you baby was under phototherapy on the day of discharge, a healthcare provider should see your baby within the next 24 hours for further assessment.

You should call the baby's doctor if:

• Your baby's skin appears yellow in good light.
• The arms, legs and abdomen are yellow.
• The whites of the eyes are yellow.
• Your baby is hard to wake up, is fussy or not nursing or taking formula well.

Putting your baby in sunlight is not recommended as a safe way to treat jaundice at home.

Where can I learn more?

• Canadian Pediatric Society: Jaundice in Newborns
• American Pediatric Association: Jaundice

Your baby may have a lot of mucous, thick fluid which can make them gag or spit up. You may see this after feeding. Holding your baby skin-to-skin will help.

If your baby begins to gag or spit up, turn your baby to the side and lightly rub your baby's back. Call your nurse for help.

Almost all babies spit up. The spit up will usually be breastmilk or formula. If it has been a long time since their last feeding, the spit up may look lumpy.

The reason your baby may be spitting up is because of air trapped in the stomach, which comes out with part of the feeding.

Tip: Burp your baby prior to feeding if they have been crying, as babies swallow air when they cry.

Forceful (across the room) vomiting is not normal. If this happens contact your baby's physician/midwife.

Instructions

When you take your baby home from the hospital, you will have been given instructions to put your baby to sleep on his or her back. But because of this, we need to give the baby opportunities to develop shoulder and abdominal muscles, and to prevent flattening of the back or side of the baby's head.

Every time you change your baby's diaper, turn your baby gently over onto his or her tummy. Gently put pressure on his or her bum, and bring his or her elbows in front of the shoulders. This will encourage your baby to lift his or her head. Do this for one or two minutes to ensure good strength of your baby's shoulder and abdominal muscles.

Watch a demonstration of tummy time exercises:

• Fact sheets: Infant formula: what you need to know - Baby-Friendly Initiative Strategy for Ontario (pdf file)
• Video: Safe formula prep - BFI Strategy for Ontario

Learn how to reduce your baby’s pain during newborn blood tests.

Baby's Health Card

A health card number has been assigned to your baby. Please come to Triage - M5 220 to sign the health card number registration form and obtain your baby's temporary health card before you leave the hospital.

Birth Registration/Child Tax Credits

Registration for your baby's birth certificate and child tax credits is available through the Service Ontario Newborn Registration Service.

Before you leave the hospital, your baby will be assessed for a number of conditions. If you have any questions or concerns, please discuss with your nurse.

Hearing screening

Hearing screening is the first step in finding babies who are deaf or hard of hearing. The screening is done before your discharge from the hospital. The technology used is completely safe and reliable. Your baby may sleep through the entire experience.

More info from the Ministry of Health

Metabolic screening

Blood testing is done on all newborns to ensure your baby gets the best start in life and stays healthy. Your newborn and all newborns in Ontario are screened for at least 29 rare metabolic disorders.

Learn more about newborn screening in Ontario, including the screening process, conditions screened, results, privacy and more. You can also find out more about reducing your baby’s pain during newborn blood tests.

If your baby tests positive

Learn more about what to expect if your baby tests positive at Newborn Screening Ontario.