Discharging Newborns

Feeding

• Promote breastfeeding whenever possible
• Solely breastfeeding provides infants with optimal nutrition and immune advantages (and best avoidance of allergens)
• The most common reason for supplementing is the wrong idea that the mother "cannot make enough milk". Explain that colostrum (not copious in amount but rich in nutrients and immune factors) is adequte.
• Nearly all breastfeeding problems can be avoided or overcome by frequent feedings.  Mothers should feed every two hours.  Some feedings go better than others.  Many babies do better on one side than the other, but try to feed on both sides, about 10-15 minutes per side.  Burp frequently.
• First two weeks are difficult, the rewards come later
• Try different positions of holding the infant.  Get as much of the areola in the mouth as possible.  Mothers should be in comfortable positions themselves (e.g., with the use of pillows)
• Mothers need support and rest; drink plenty of water.  Limit visitors ("doctors orders...").  Explore support network, who is helpful?
• Breast feeding counselors can be consulted for specific problems.
• Monitor input by observing the output.

After day two of life, expect 6 voids per 24 hours.  Stools should change from black/green meconium to brown then yellow seedy appearance by about the fourth day of life.  Stool frequency is highly variable (from once per feeding to once every several days).  Weights in the nursery and at the outpatient checkups also help confirm good input.  We do not recommend parents weighing infants.
• Formula feeding parents need to know how to properly mix the formula.  Powdered formula is the least expensive: mix one scoop of formula with two of water.
• Vitamin supplements are not routinely needed.  Water should not be given.
• Many infants get overfed if parents do not try other comforting skills (e.g., holding, rocking, putting to sleep if tired, movement, sound).  Show size of infant stomach for illustration.

Cord Care

• Apply alcohol at least four times daily, applying down to the bas of the cord (not just on the tip).  Keep diaper rolled down off the cord.  Do not wrap binders or apply coverings to the cord.  Call M.D. if cord has oder of if there is redness in the skin surrounding the umbilicus.

Skin Care

• No powders! Use mild soap (e.g., Dove) and water.  Do not immerse until cord has fallen off.  Avoid "wipes".  For mild diaper area irritation: Balmex or A&D ointments, Desitin cream.  Leave diaper off when possible, bathe with water.

Circumcision Care

• Bathe penis with water; apply vaseline to glans for 24 hours; leave open to air.  If diaper adheres to the healing area, soak diaper off with water.

Jaundice

• Jaundice is frequent in newborns.  Frequent feedings (to maximize output) help.  May put by sunny window (avoid drafts, however).  May need to repeat blood tests several times to ensure that levels are coming down.

Safety Issues

• Use an approved carseat, installed and used correctly (facing backwards in back seat) to prevent the most common cause of infant injury/death
• Do not expose infant to cigarette smoke (to decrease chance of asthma, otitis, etc.)
• Sleep position: place the infant on back or side (to lessen SIDS risk)
• Use a smoke detector
• Do not allow older siblings unsupervised access to infants
• Never leave infant on bed, changing table, or other raised surface without protection from falls

Routine testing

• The newborn metabolic screen is done on all infants to look for several kinds of problems that do not show up easily on exam.  Usually, these tests are performed at a State laboratory.  Abnormal results should be phoned in to the physician as they are detected; routine results may take 2 weeks to come back.
• Hearing screening is recommended, and may be required in certain jurisdictions.

Preparation for possible illness

• Use a thermometer if the child seems ill.  Infants under three months of age with fever must be seen by a doctor immediately.  Fever is more than:

• Nasal congestion: Use a bulb syringe; saline nose drops; humidifier/vaporizer (change water daily and add no medications to the water)
• Seek medical attention for
• Fever
• Not feeding well or "looking sick"
• Emesis
• Inadequate urine output
• Jaundice
• Inconsolable crying
• Give no medications without checking with a doctor
• Burping, sneezing, hiccuping, flatulence, straining with stools...are normal.

Record Keeping

• Urge parents to keep records they are given about their children, such as the newborn summary sheet, immunization records
• Bring all medications to the appointment so you can review them

Acknowlegment