Nursery Discharge Instructions with Formula Instructions
Symptoms of Illness
Signs of illness are difficult to detect in a newborn. Report any of these problems to your baby’s doctor:
⦁ Fever: If your baby’s skin is flushed, or feels warm, check the baby’s temperature. We recommend taking the temperature under the arm (axillary). If the axillary temperature is greater than 101° call your baby’s doctor. Do not give any medicine for fever until the baby’s doctor advises you to do so.
⦁ Change in Activity Level: As you care for your baby, you will become familiar with his/her normal patterns of activity. Some babies sleep more than others. If your baby suddenly becomes more irritable than usual or is more difficult to awaken for a feeding, notify the doctor.
⦁ Change in Feeding Habits: Spending time with your baby will help you become familiar with how often, how much and how well your baby eats. If you notice your baby does not eat well for a couple of feedings in a row, or if you have to awaken your baby for feedings and then notice the baby does not eat as much as usual, notify the doctor.
⦁ Difficulty Breathing or Turns Blue: Many times, babies will have difficulty breathing if they become ill. If you notice your baby breathing harder or faster than usual or if you hear wheezing or grunting each time your baby breathes, notify the doctor. You should also notify the doctor if the baby’s color is very pale or blue. An Infant CPR class is offered at Women’s Hospital every Tuesday at 4:00 p.m. and on select Saturdays. The class is free, but you must sign up ahead of time by calling 662-377-4934.
⦁ Rash Persisting More than One Day: Most babies will occasionally get a diaper rash. Keeping your baby’s bottom clean and dry should keep the skin healthy. If your baby gets a red bottom, you may use Desitin or A&D ointment to help the skin heal. Leaving the baby’s diaper open so the rash is exposed to air is helpful in healing the skin. Usually you will see the redness begin to improve within 24 hours of starting Desitin or A&D ointment. If the rash does not improve in 24 hours, or if it worsens, notify the doctor. The baby may have a rash caused by yeast, which will not heal without a prescription medication.
Bulb Syringe
If nasal stuffiness or congestion is noticed, use the bulb syringe to remove mucus from the baby’s nose. To use the bulb syringe, squeeze the bulb portion (to force the air from the bulb syringe), insert the spout of the syringe into the infant’s nostril and let go of the bulb portion of the syringe. This causes a gentle suction, which should remove mucus from the baby’s nose. Repeat in the other nostril. The bulb syringe may also be used to suction the mouth, if the baby chokes. Important: If a baby is choking on a liquid, you always suction the mouth first, then the nose. Clean the bulb syringe by rinsing it with clear water. Allow the water to drain out and the bulb syringe to dry before using again.
Umbilical Cord Care
The most important things to remember when caring for your baby’s umbilical cord are:
Keep the diaper folded below the cord stump which will allow the cord to dry and fall off.
Do not bathe the baby in a tub until the cord stump has fallen off and stopped draining.
Use a cotton ball or cotton swab moistened with a small amount of alcohol to clean the
umbilical stump and cord two to three times a day.
It usually takes five to ten days for the cord to come off. A small amount of blood-tinged or brownish drainage noticed for two or three days after the cord falls off is normal. If the stump becomes infected, it will require immediate medical treatment. Call the doctor if you see any of these signs: 1) an odor other than the typical musty odor, 2) pus from the umbilical stump, 3) redness or swelling around the umbilical stump or 4) pain or tenderness around the umbilical stump.
Circumcision Care
After the circumcision, you will be given a tube of petroleum jelly to apply to the circumcision every diaper change until it is healed. If your baby’s circumcision was done using a plastibell, the plastic ring will usually come off in five to ten days. It is important to keep the circumcision clean. If your baby has a bowel movement and stool gets on the penis, wipe it gently with warm soapy water and then rinse. The circumcised area will look red the first few days and you may notice a yellow colored tissue on the area. This is a normal part of the healing process. Within a week to ten days, the redness and yellow colored tissue should go away. If the redness continues, or if there is swelling or greenish secretions (pus) on the circumcised area, notify the doctor. Remember, you should not bathe your baby in a tub until his circumcision and umbilical cord have both healed.
Home Safety
To prevent dangerous falls, do not leave your baby alone on a bed, sofa or changing table. To prevent drowning, do not leave your baby alone in a bathtub. To prevent kidnapping or death from heat stroke, do not leave your baby alone in a car. Once your baby is able to crawl, keep the floor free of small objects and place safety shields over the electrical outlets.
CPR for Infants
Infant CPR guidelines apply to babies one year and younger. Infant cardiopulmonary resuscitation (CPR) consists of Circulation, Airway and Breathing (C-A-B).
Steps of CPR:
1. Check for a response. Gently tap the infant on the shoulders and call the infant’s name. If the infant responds and is breathing normally, but is ill and/or injured, call 911 and wait for help. While waiting, recheck the infant, frequently.
2. Shout for help if the infant does not respond or is not breathing or is only gasping. If someone responds, send that person to call 911. If no one responds, you should begin the steps of CPR and do them for two minutes.
3. Begin CPR by doing 30 chest compressions. Place your fingers on the lower half of the breastbone and compress the breastbone 1/3 the depth of the chest. Push hard and fast, at least 100 times per minute.
4. Open the airway by gently tilting the infant’s head back, as soon as you finish the 30 chest compressions. Tilt the head back, slightly. An infant’s airway is so tiny, tilting the head too far back might block breathing passages instead of opening them.
5. Give two breaths. To give the breaths, place your mouth over the baby’s mouth and nose and breathe into the mouth and nose. The breath should last about 1 second. You should see the chest rise. It should look like the baby is taking an easy breath.
6. Repeat the cycles of 30 compressions and 2 breaths, 5 times. Five cycles of CPR should take approximately two minutes.
7. After 5 cycles of CPR, if no one has called 911, go to the phone and call 911. Give them your name, location and a brief description of why you are calling. As soon as they have obtained the information, resume CPR on the infant, beginning with chest compressions.
8. Continue cycles of 30 chest compressions and two breaths until the infant responds or trained help arrives. If the infant responds, recheck the infant, frequently while waiting for the emergency medical service (EMS) to arrive.
Safe Sleeping for Baby
There are a number of things you can do to keep your baby safe while sleeping. Here are the latest recommendations from the Center for Disease Control (CDC) and the American Academy of Pediatrics (AAP):
1. Babies should be placed on their back to sleep unless the baby’s doctor has suggested another sleep position for medical reasons. Placing your baby on his/her back to sleep is the most important thing you can do to reduce the risk of Sudden Infant Death Syndrome (SIDS).
2. Babies should sleep in the parent's bedroom, in a crib, for the first year of life.
3. Parents should use a crib that conforms to the safety standards of the Consumer Product Safety Commission (CPSC) and the American Society for Testing and Materials (ASTM).
4. Do not cover the baby’s head with blankets.
5. Do not over-bundle a baby with clothes or blankets or let the baby get too hot.
6. Keep the room temperature comfortable for a lightly clothed adult. Dress the baby lightly for sleep.
The baby should not feel hot or sweaty to the touch.
7. Do not use duvets, sheepskins or pillows in the crib.
8. Do not place babies to sleep on adult beds, soft mattresses, sofas, cushions or waterbeds.
9. Do not sleep with an infant. You may not wake up if you are impaired in any way.
This is especially true if you:
Have been drinking
Have been taking medicine for sleep.
Have been taking medication that causes drowsiness.
Are overly tired.
10. Do not smoke around your baby. Do not allow others to smoke around your baby.
Evidence shows that second hand smoke is associated with an increase in SIDS.
11. Babies should have a separate sleep space. Babies should not sleep in a bed with other children because it increases the risk of suffocation. Also, children generally will not recognize a baby in distress.
12. A firm mattress is necessary for a safe sleep environment for your baby. Make sure there are no spaces between the mattress and crib rails/walls in which the baby’s body may be trapped. Make sure there are no spaces between the crib sides or rails in which a baby’s head may be trapped. Keep the bed close to the ground to minimize injury from falls.
13. Keep quilts and comforters out of the bed. Use a light, thin blanket tucked in at the bottom and sides of the bed. Pull the blanket up no higher than the chest.
14. Keep toys out of the bed.
15. Give your baby plenty of time on his/her tummy when awake and while you can watch him/her. This special “tummy time” helps the baby’s muscles and nervous system develop normally. “Tummy time” also prevents flattening of the back of the head.
Rear Facing, Infant Safety Seat
Get and use an approved car seat for your baby. The AAP recommends keeping children in a rear-facing safety seat until the age of 2 years, or until they reach the upper weight and height limit of the rear-facing safety seat. Rear-facing safety seats should be placed in the back seat of the vehicle facing the rear window.
Proper Use of Rear-facing Safety Seats
1. Airbags can cause serious head and neck injury, or death in children. Airbags are especially dangerous for children seated in the front seat of a vehicle or for children who are not properly restrained. If there are front seat airbags in your vehicle, infants in rear-facing safety seats should ride in the back seat.
2. All infants should ride in the rear seat of a vehicle. The center of the rear seat is the safest position. In vans, the safest position is the middle seat rather than the rear seat.
3. If a vehicle with front air bags does not have a rear seat, and it is absolutely necessary for the infant to ride in the front seat, ensure the following:
wThe vehicle has air bags that can be turned off (automatically or manually).
wMove the seat of the vehicle back from the dashboard (and the air bag) as far as possible.
4. Any child safety seat used should be installed as directed in the child safety seat instructions and the vehicle owner’s manual.
5. Some infant-only seats have detachable bases, which can be left in the vehicle. You may purchase more than one base, if needed, to use in other family owned vehicles.
6. The safety seat should be positioned at an angle to prevent the infant’s head from falling forward, however, it should not be angled forward more than 45°. Once the child is able to maintain head control, the seat may be in a more upright position.
To angle the seat:
Use the angle adjusters on the safety seat.
Tilt the safety seat with a rolled towel or pool “noodles” under the front of the seat.
7. Rolled cloths put next to an infant in the safety seat may be used to keep the infant from slouching to the side. Nothing should be added under, behind or between the child and the harness unless it came with the car seat and was specifically designed and tested with that model. After market items should not be used.
8. Locking clips should be used as directed in the instructions that came with the child safety seat and the vehicle owner’s manual.
9. The proper vehicle belt path required in the instructions of your rear-facing safety seat must be used. Vehicles made after 2002 may have a Lower Anchors and Tethers for Children (LATCH) system for securing safety seats. Vehicles with a LATCH system will have anchors, in addition to seat belts, that may be used for added protection. Refer to your vehicle’s owner’s manual for specific instructions.
10. The correct positioning of the shoulder harness is at or below your infant’s shoulders, in the reinforced slots. For newborns in which the harness slot is above the shoulders, ensure the harness is threaded through the bottom slots and the harness is snug.
11. The safety harness should fit the child snugly. The harness should be readjusted with any change in the thickness of your child’s clothing. The pinch test is one method to check the harness for correct fit. The harness fits correctly if you cannot pinch a horizontal fold on the harness.
To perform a pinch test:
Grab the harness at the shoulder level.
wTry to pinch the harness together from top to bottom.
wIf you cannot, the straps are correctly adjusted.
12. The safety seat must be installed tightly in the vehicle. After installing the safety seat, you should check for correct installation by tugging on the seat, vigorously, side-to-side. The seat is correctly installed if it does not move more than 1 inch (2.5 cm) forward, backward or sideways.
13. Infant car beds may be used instead of safety seats for low weight infants or infants with special medical needs.
14. This information is based on guidelines recommended by the American Academy of Pediatrics. Laws and regulations regarding child auto safety vary from state to state. If you have questions or need help installing your car safety seat, find a certified child passenger safety technician. Lists of technicians and child seat fitting stations are available from the following web sites:
15. Safety recommendations:
Replace a safety seat after a moderate to severe crash.
Never use a safety seat that is damaged.
Never use a safety seat older than 5 years.
Never use a safety seat with an unknown history.
If your vehicle is equipped with side curtain airbags, consult the vehicle’s manual .regarding child safety seat position.
Formula Preparation
WATER FOR FORMULA PREPARATION
Concentrated and powdered infant formula should be prepared with hot water. Allow water to boil for no more than 1 to 2 minutes and let cool for a few minutes (no more than 30). Formula should then be prepared according to directions. Nursery water or bottled water should also be boiled before preparing formula. Make sure that formula has cooled before feeding your baby
FORMULA PREPARATION
Formula comes in three forms: Ready-To-Feed, Concentrated and Powdered. These step-by-step instructions should answer most of your questions about how to prepare the baby’s formula:
Ready-To-Feed: Wash your hands before you begin. Check the container for the expiration date and do not use if the formula has expired or if the container is damaged. Shake the container well to mix the ingredients. If the product comes in a can, wash and rinse the top prior to opening. Ready-To-Feed formula does not have to be mixed. You may either fill a clean bottle with enough formula for one feeding and refrigerate the rest, or prepare all of the bottles at one time. Remember, once you open a container of formula, it must be refrigerated and any remaining after 48 hours must be discarded.
Concentrated: This formula must be mixed with an equal part of water. Wash your hands before you begin. Check the container for the expiration date and do not use if the formula has expired or if the container is damaged. Shake the container well to mix the ingredients. If the product comes in a can, wash and rinse the top prior to opening. Mix the concentrated formula with an equal part of water. You may either mix the formula in the clean bottle (example: 2 ounces formula to 2 ounces water for a single feeding) or mix the 13 ounce container of concentrated formula with 13 ounces of water in a clean container then pour into the prepared bottles. Once the concentrated formula has been opened, it must be refrigerated and may only be used for 48 hours.
Powdered: This is a dry formula that is mixed with water. It is very important, for proper growth and nutrition of your baby, that the powder and water are properly mixed. Powdered formula incorrectly mixed will cause the baby to become very sick with vomiting, diarrhea and failure to gain weight. Wash your hands before you begin. Check the container for the expiration date and do not use if expired or the container is damaged. If the powdered formula comes in a can, wash and rinse the top of the can before opening. Use the correct number of scoops per ounce of water. Level off the scoop with the edge of a clean knife. You will have an easier time mixing the formula if you use a blender, mixer or egg beater. The remaining powdered formula must be covered and stored in a cool dry place. Fill clean bottles with enough formula for a single feeding and refrigerate. Once you prepare the formula by mixing it in water, it is only good for 24 hours.
STERILIZING BOTTLES
There are several acceptable methods of properly preparing your infant’s bottles. Wash your hands before you begin. You may wash the bottles, nipples, collars and caps with hot, soapy water and rinse. You may also place bottles, nipples, collars and caps in the dishwasher that uses heated water and a hot drying cycle. You may choose to place bottles, nipples, collars and caps into a large pot and fill it with enough water to cover them. Add the bottles. Begin timing five (5) minutes from the time the water starts to vigorously boil. After boiling five (5) minutes, all of the items will be sterile. Allow them to cool and then remove the bottles, nipples, collars and caps from the water and place them on a clean, dry towel on the counter or table to drain. Once the items are dry, they are ready to use. You may also purchase commercially available sterilizing bags or kits and use them according to the manufacturer’s specifications.
Information and Support after Discharge: Formula Feeding
You will be provided a formula preparation sheet. Follow these instructions regarding proper mixing and storage of formula. Feed your baby with hunger cues (8 or more times in 24 hours) and hold your baby close while making eye contact during feedings. This helps with bonding and brain development, and is the distance where babies can see you the best during these first days.
Mother & Baby Care Book- provided during hospital stay- includes a FREE Companion App.-Text UNDERSTANDING to 99000 from your phone. Redemption code located on first page in book.
Your baby will be scheduled a Newborn Follow-Up visit 1-2 days after discharge at the Women’s Hospital. (662-377-4971)
You will also need to schedule a two week visit with your Pediatrician. The following is a list of the Pediatricians that round at NMMC Women’s Hospital:
Children's Clinic of Tupelo: 662-377-7337
199 Grandstand Place Tupelo, MS 38824
Dr. Meeks
Dr. Valdez
Dr. Stone
Dr. Street
Dr. Grisham
Dr. Meyer
Dr. Price
WIC:
Lee Co. Support: 662-844-4170
Lee Co. Health Dept.: 662-841-9096
Itawamba Co. Support or Health Dept.: 662-862-3710
Lafayette Co. Support or Health Dept.: 662-234-5231
Monroe Co. Support or Health Dept.: Aberdeen 662-369-8132 / Amory 662-256-5341
Pontotoc Co. Support or Health Dept.: 662-489-1241
Union Co. Support or Health Dept.: 662-534-1926
Website Support:
Centers for Disease Control and Prevention: www.cdc.gov
Phone Apps:
FREE Mother/Baby Book Companion App
Nurselink:
Free telephone health information service provided by North MS Health Services: 1-800-882-6274