Umbilical cord care.
The mom's going to want to know
what to do with the umbilical cord.
We used to recommend all kinds of interesting
things like cleaning with alcohol,
none of it is necessary.
Basically, keep it
clean, keep it dry,
fold the diaper just below the cord and
you can show mom how to do that.
If it’s dirty, you may wash it
gently with soap and water.
It generally falls off
at two to three weeks.
If there’s a delay in detachment,
certainly for more than two months,
you have to consider a rare disease
called a leukocyte adhesion defect.
This is when the white blood
cells have a hard time
binding to the cell adhesion molecules
on the side of the blood vessel
and allowing those white blood
cells to crawl into a tissue.
These patients will have a normal CBC,
but a history of a delayed cord
detachment may make you think of it.
Also, parents should watch
out for omphalitis.
Omphalitis is an infection
of the belly cord.
It’s pretty significant.
When kids get a redness or an
irritation around the cord
and it becomes infected with
heat, red, warmth or pus,
that’s an emergency.
That baby needs to be seen right
away because those kids --
it can develop into a
peritonitis very quickly.
They can get very sick.
How do we care for their
skin in their diaper?
We should do sponge baths
until the stump falls off,
then they can do regular baths.
Frequent diaper changes are
important to avoid diaper rashes.
Expect some vaginal bleeding
from your infant girl
or vaginal discharge from your
infant girl, that’s common.
It’s because the baby was
exposed to mom’s hormones.
Also in circumcised boys,
keep the site clean and covered with
Vaseline gauze like she was shown
until it’s healed over.
Moms with newborn babies want
to know when to call a doctor.
Any newborn who has fever, that’s an
emergency and they need to be seen,
certainly for the first
4-8 weeks of life.
So, teach them how to use
a rectal thermometer.
They should not put it in their ear.
They should not put it in their mouth.
All infants should use
A digital thermometer is cheap.
You can buy them in a
store for 5-10 bucks.
So any fever more than
38 degrees rectally --
use a little Vaseline --
is a reason to call the doctor.
If the baby is sleeping or is
lethargic but is sleeping too much,
that’s a reason to
call the doctor.
But watch out,
for the first few days of life, the average
baby sleeps almost 20 hours a day.
So they can expect,
they will gradually wake up more and more
over the first several weeks of life.
Any forceful emesis or specifically
green emesis is an emergency.
Any infant who has diarrhea
should probably be evaluated.
They are prone to dehydration easily.
Any child with blueness
to the skin or difficulty
breathing should be
And any infant with a jaundice that's
worsening should be evaluated immediately.
So all of these are reasons for
parents to call the doctor
when their infants are
doing something odd.
What about safety?
It turns out safety is very important.
Car seats in the United States
are not used frequently enough
and are often installed
So, parents should be taught
about car seat installation
and they should know what center near
them where they can get that checked
if they can’t figure it out.
Most cars now have the latch system
which makes it pretty easy to install.
But without latch system,
it can be quite hard.
Patients should be taught
to sleep facing up.
We call this sleep hygiene.
It’s not the baby who’s
hygienic, it’s the crib.
So SIDS or sudden infant
death syndrome is
associated with babies who
sleep on their belly.
It’s also associated with babies who sleep
with too much bedding or pillows around.
They should teach these parents
how to swaddle their baby
and leave them with a simple blanket
and let them sleeping face up.
Counsel parents about immunizations
and how they are going to continue
and that they're are huge
part of staying healthy.
Immunizations are always good for infants.
They’re really a good thing.
On average, infants do much better if they’re
immunized than if they’re not by far,
so encourage families
Warm them about crying,
this sounds like a weird discussion to
have, but it’s normal for babies to cry.
It doesn’t mean something bad is going on.
It doesn’t mean you’re
failing as a parent.
Sometimes the crying can
really get to parents.
It can really bother them
and they have to be taught
that crying is okay.
Sometimes parents start to hit the edge.
Sometimes mom or dad needs
to take a time out.
They need to leave the baby with the
grandparent or babysitter and take a break.
If the baby is too fussy and the
parents start getting frustrated
like they want to shake the
baby or be angry with the baby,
they need to put the baby down,
walk to the other room and
take a personal time out.
Child abuse is common in United States.
A lot of parents feel guilty afterwards.
They were just so overwhelmed
with the parenting.
They shook the baby.
They didn’t know and then
the baby has brain damage.
So we need to encourage parents to be able
to rely on each other, to take turns,
to give each other personal time outs.
Time when they’re away from the baby
so that when they’re with the baby,
they can be the support of
caring parent they need to be.
So that’s my review of basically all the
advice you need to give the parents
before they go home from the hospital.
Thanks for your time.