Necessary parental teaching prior to discharge include:

• • Temperature: How to take an axillary temperature, when to call the pediatrician (see Signs of Infection)

  • Respirations: Normal breathing/ rate; Looking for signs of respiratory distress

  • Feeding: Breastfeeding every 2-3 hours, good latch on breast; Formula feeding every 3-4 hours, how to prepare formula

  • Elimination: Assessing adequate amount of wet and dirty diapers; assessing for abnormal stools

  • Sleeping, positioning, and holding

    • Infants should be placed in the supine position for sleep during the first year of life to reduce the incidence of sudden infant death syndrome (SIDS)

    • When the infant is awake, “tummy time” can be provided under parental supervision so the infant can begin to develop appropriate muscle tone for eventual crawling; placing the infant prone at intervals when awake aids in preventing a misshapen head (positional plagiocephaly)

  • Rashes: How to avoid diaper rash; Assessing for abnormal skin rashes

  • Diaper rash

    • Many infants develop a diaper rash at some time

    • Usually irritant contact dermatitis or skin inflammation appearing as redness, scaling, blisters, or papules

    • Various factors can contribute to diaper rash, including infrequent diaper changes, diarrhea, use of plastic pants to cover the diaper, a change in the infant’s diet such as when solid foods are added, antibiotics, or when breastfeeding mothers eat certain foods

    • The warm, moist atmosphere in the diaper area provides an optimal environment for Candida albicans growth; this type of dermatitis can appear in the perianal area, inguinal folds, and lower abdomen.

  • Clothing:  Dress infant as you would dress for the temperature plus one layer

  • Car seat safety: Must be rear-facing in car in the back seat and appropriate for the size of the infant; See below on Car Seat Safety

  • Pacifiers: Do not use or use sparingly if breastfeeding; will be used for calming/ soothing a crying infant

  • Bathing and umbilical cord care

    • The goal of cord care is to prevent or decrease the risk for hemorrhage and infection

    • The umbilical cord stump is an excellent medium for bacterial growth and can easily become infected

    • Remove the plastic cord clamp applied at birth once the stump is dry (typically in 24 to 48 hours)

    • Stump and base of the cord should be assessed for edema, redness, and purulent drainage with each diaper change

    • Area should be kept clean and dry and open to air or loosely covered with clothing

    • If soiled, the area is cleansed with plain water and dried thoroughly. The diaper is folded down and away from the stump.

    • Umbilical cord begins to dry, shrivel, and blacken by the second or third day of life

    • Cord separation time is influenced by several factors, including type of cord care, type of birth, and other perinatal events

    • Average cord separation time is 10 to 14 days

  • Infant follow-up care: Typically follow up with the pediatrician within a few days of discharge to assess weight

  • Cardiopulmonary resuscitation: To take class if high-risk infant before discharge

  • Practical suggestions for the first weeks at home can be given based on the nurse's experience and the parent's needs

  • Interpretation of crying and use of quieting techniques: (see Bonding on previous page)

    • The longer parents are around their infants, the easier it becomes to interpret the meaning of infant cries and to respond

    • Parents need to understand what to do when crying episodes occur

    • If parents have a greater understanding of infant crying, they may be less likely to inflict harm, such as that which occurs with shaken-baby syndrome. For parent education, many facilities utilize the “Period of Purple Crying” program from the National Center for Shaken Baby Syndrome (https://www.dontshake.org/purple-crying)

  • Recognizing signs of illness: (see Signs of Illness)

Notify the pediatric health care provider if any of the following signs occur:

1. Fever: Temperature greater than 38° C (100.4° F) axillary; also a continual rise in temperature (Note: Tympanic [ear] thermometers are not recommended for infants less than three months of age.)

2. Hypothermia: Temperature less than 36.5° C (97.7° F) axillary

3. Poor feeding or little interest in food: Refusing two feedings in a row

4. Vomiting: More than one episode of forceful vomiting or frequent vomiting (over a six hour period)

5. Bilious (bright green in color) emesis: This can be a sign of bowel obstruction and should be reported to the pediatric health care provider immediately

6. Diarrhea: Two consecutive green, watery stools (Note: Stools of breastfed infants are normally looser than stools of formula-fed infants. Diarrhea leaves a water ring around the stool, whereas breastfed stools do not.)

7. Decreased bowel movement: In a breastfed infant, fewer than three stools per day; in a formula-fed infant, less than one stool every other day

8. Decreased urination: Fewer than six to eight wet diapers per day after 3 to 4 days of age

9. Breathing difficulties: Labored breathing with flared nostrils or absence of breathing for more than 15 seconds (Note: A newborn’s breathing is normally irregular and between 30 and 60 breaths/min. Count the breaths for a full minute.)

10. Cyanosis (bluish skin color), whether accompanying a feeding or not

11. Lethargy: Sleepiness, difficulty waking, or periods of sleep longer than six hours (Most newborns sleep for short periods, usually 1–4 hours, and wake to be fed.)

12. Inconsolable crying (attempts to quiet not effective) or continuous high-pitched cry

13. Bleeding or purulent (yellowish) drainage from umbilical cord or circumcision; foul odor or redness at the site

14. Drainage from the eyes