Baby Care GUIDE

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Welcome to the world of baby care! If you are pregnant, congratulations!

You may already know, or might soon know, that taking care of your little one may seem overwhelming at first, with many new responsibilities to take care of. We at Vitality Kit are proud to offer you this guide on baby care that will help initiate you into the realms of parenthood. In this guide, you will find numerous tips and techniques that we hope will be helpful to calm your nerves during this

arduous, but rewarding road of parenthood. Using the latest and best-practice standards, you can rest assured that the information portrayed in the ‘Baby Care Guide’ has been consulted and recom-mended by leading physicians across the globe. So, fear not, new mommy! This

guide is designed to give any newbie a degree, in baby care!

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*This guide cannot replace your pediatrician’s advice.*Always refer to your doctor first.

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Index

Feeding

Sleeping

Swaddling

Diapering

Burping

Breast feedingBreast feeding positionFormula feedingForms of the formulasPrecautions

Positioning for sleepSleeping environmentUse a pacifier

Importance of swaddling

Changing your baby's diaper

Burping positions

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Diaper Rash

Common signs of diaper rashCommon causes of diaper rashPrevention of diaper rashTreatment of diaper rashConsulting the pediatrician

Before the stump of the umbilical cord falls off (sponge bath)After the stump of the umbilical cord falls off (water bath)

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Bathing 17

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Circumcised penisUncircumcised penis

Types of thermometersDifference of temperature between different routes

Finger nail careToenail care

Nail care

Checking your Baby’s Temperature

Vaccination

Care of Circumcised and Uncircumcised penis 19

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Importance of Vaccinations for your babyImportance of Vaccinations for the community Vaccination safetyThree things you must tell your pediatrician before vaccinating your baby

Nasal Aspirator

Car seats 25

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Choosing a car seatCar seats in winter

How to use the Nasal Aspirator

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Feeding

There are two ways to feed your baby:

1) Using breast milk - the natural milk produced by the mother.

2) Using formula milk - which could be a cow milk ba-sed formula, hydrolyzed formula, or a soy formula.

Most pediatricians agree that breastfeeding is the healthiest way for both the mother and the baby. The reasoning is that breastfeeding provides the infant with the ideal nutrition needed to grow, it protects them from infections (by the strengthening of the baby’s immune system) and creates an emotional bond between the baby and the mother. Additionally, breastfeeding has many posi-tive health benefits on the mother. Breastfeeding has a proven track record to burn extra calories, so it helps to shed that excess pregnancy weight faster. Studies have also found that breastfeeding releases the hormone oxytocin, which helps the uterus return to its’ pre-pregnancy size, whilst boasting anti-cancer benefits. Other studies show that breastfeeding can reduce the risk of developing diabetes type 2, cardiovascular diseases and rheumatoid arthritis.All-in-all breastfeeding is a win-win solution for both you and your little one!

*Reference: http://www.webmd.com/parenting/baby/nursing-basics#1

The American Association of Pediatrics (AAP) recommends exclusive breas-tfeeding for the first six months, and then gradually adding solid foods while continuing to breastfeeding until at least the baby’s first birthday.

Breast feeding

• A mother ideally should start breastfeeding her baby right away - usually an hour after giving birth.

• Breastfeed her for about eight to twelve times a day, she will often show you signs of hunger. Many signs, such as short, low pitched crying, or waking up and acting restless could be cues that your little one needs to be fed.

• For the first few days, changing four to eight wet diapers and three to four seedy stools per day, indicates that she is getting adequate milk.

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• Do not take any medications or any herbal substances during the breas-tfeeding stage unless you have been cleared to do so by your pediatrician.

• It is recommended that the mother does not consume alcohol as this may impact the amount/taste of milk produced. If alcohol is to be consumed please use the breast pump to store milk prior to consumption, limit your-self to 2 units of alcohol per day, and ensure there is a 2 hour gap between any alcohol consumed and the feeding session.

• Feel free to ask your pediatrician, nurse, or lactation consultant if you face any problem or discomfort.

• It is important to tell your pediatrician if you are on a diet that excludes all foods of animal origin i.e. vegetarian. A vegan diet for example limits the intake of vitamin B12, which is essential in breast milk.

Breast feeding positions

Start your first weeks of breastfeeding in a seated position, such as a bed or an armed chair.

Support your breast by your hand. You can place your thumb just above the areola, with your palm and fingers below it.

Your baby’s jaw should close around the areola, and not just the nipple. Her chin and nose must be resting on the breast.

Nipple

Areola

Keep your back straight and relaxed. Do not lean forward or backward as it will make it difficult for your baby to hold your breast properly.

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Her entire body, not just her head, should be facing your body.

To increase milk flow, taking a warm shower may help. An alternative would be to soak a cloth with warm water and apply it on your breast prior to feeding.

While you are still in the hospital, if possible try to practice different positions for breastfeeding such as sitting up or laying down, so that a nurse or a lacta-tion consultant can check your technique.

It is advisable to change your feeding positions periodically, as doing so may help in reducing milk clogging and nipple soreness.

Breastfeeding should not cause sustained pain. If the pain continues after few moments of breastfeeding, then you should consult a specialist to check your breastfeeding techniques.

Formula feeding

If you absolutely need to provide formula milk, then discuss with your pediatri-cian which type of formula milk is ideal, based on your baby’s needs.

As mentioned earlier, there are 3 types of formula milk:

*Fresh cow milk is not recommended for your baby. She will not be able to digest the milk easily, and it lacks the proper amount of vitamins that she needs. Cow milk baby formulas are often recommended since they have been modified to suit the baby’s nutritional needs.

1) The first is a cow’s milk-based formula. This is the most wide spread for-mula. The cow milk in this formula is well treated and altered to suit a human baby, the end product is made to resemble the mother’s milk.

Iron-fortified formulas are cow-milk based formulas with more iron added into them. These formulas exist to reduce the rate of iron-deficiency (anemia) in infants.

*The American Association of Pediatrics and American Academy of Family Physicians recommend the iron-fortified formula to be used with all non-breastfed or partially breastfed babies.

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2) The Hydrolyzed formula contain milk with predigested proteins. These types of formulas help your baby digest milk easily, and furthermore they aim to prevent a few types of skin allergies. Check with your doctor to see whether your child is a candidate for hydrolyzed formulas.

3) Soy formulas contain soy protein, and either glucose or sucrose as the base sugar. They are used in case your baby has an allergy to the cow-milk based formula. In a few cases, there are babies that have both cow milk, and soy protein allergies.

*If your baby has both these allergies, or other special needs, do not panic, your pediatrician will provide the best formula that is suitable for your little one.

Forms of the Formulas

Baby formulas come packaged in 3 forms: ready-to-feed liquids, concen-trates, and powders.

This table shows the characteristics of different types of formulas.

Ready-to-feed Concentrates Powders

Preparation

Cost

StorageConditions

Does not require any preparation

Follow the storage instructions on the label

Most expensive

Addition of water is required. Follow the manufacter’s instructions

The remaining prepared concentrate can be cove-red and stored in the refri-gerator for 48h.

Less expensive

Addition of water is required. Follow the manufacter’s instruc-tions. Make sure to mix well to dissolve lumps.

The prepared formulas can be stored in the re-frigerator for 24h.

Least expensive

1. Prepare the mixture to form the milk (If it is “ready to feed” jump straight to step 2).

Steps to feeding your baby (formula milk):

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2. Warm the milk. Either in a pan (on top of hot water) or by leaving it at room temperature for about one hour.

3. Test the temperature of the milk by placing a few drops on the inside of your wrist.

4. Wash your hands before feeding the baby.

5. Feed your baby. If you give your baby the bottle at bedtime, make sure to remove the bottle before she sleeps.

NOTE: Avoid feeding your baby cold milk. Your baby may prefer the milk to be warm or at least at room temperature. Try to mimic the natural temperature of breast milk.

Burping

Naturally, your baby may swallow some air during fee-dings. This occurs in both breastfed and bottle-fed babies; however, it is more pronounced in bottle-fed babies. If he is a bottle-fed baby, burp him after every 60-90 ml (2-3 oun-ces) that should be around the mid-way and at the end of feeding. If he is a breastfed baby, burp him when switching from one breast to another and then at the end of feeding.

Keep in mind that your baby might not burp every time. If your baby does not burp after a few minutes, continue feeding him.

*Precautions*

• Do not heat breast milk, formula milk, or the bottles in the microwave.

• Make sure that all the bottles, nipples, and other utilized items are clean and sterile.

• Wash your hands carefully before feeding your baby.

• If you give your baby a bottle at bedtime, make sure to remove it before she sleeps.

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Burping positions

On your lap, lay him on his stoma-ch whilst supporting his head by your hand. Pat gently on his back by using your other hand.

Seat him on your lap while leaning forward, supporting his head and chest with one hand. Pat gently on his back using your other hand.

Hold him upright, resting his head upon your shoulder. Pat gently on his back using your other hand.

Sleeping

Positioning for sleep

Throughout their first year, it is mandatory that a baby sleeps on their back at all times, unless there are specific needs and the doctor has recommended another sleeping positions.

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Sleeping environment

• Use a firm crib mattress covered with a fitted sheet.

• Never use soft objects such as pillows and other similar soft items, as that could cause suffocation.

• Keep all toys and stuffed animals away from the baby’s bed, these will also increase the chances of suffocation

• Keep the temperature of the room comfortable for your baby, and place the crib/bed/box away from any air-conditioning, heaters, open windows, and other sources of air current

• Always share the room with your baby without sharing the same bed. At no point should your infant be alone whilst asleep.

Using a pacifier

If you are breastfeeding wait 3 to 4 weeks to offer your baby the pacifier, since the suction mechanism is different. If you are not breastfeeding you can start using the pacifier as soon as you want. You may offer your baby a pacifier during nap time, however do not force the baby to take it. Make sure the pacifier does not have any accessories or ob-jects attached to it, which may cause suffocation or choking.

Sudden Infant Death Syndrome

Sudden infant death syndrome (SIDS) is a sudden, unexpected, and unexplai-ned death – which research has shown may occur in even fully healthy babies younger than a year. SIDS is also known as crib/cot death, since it often occurs while the baby is asleep. In 2010, more than 2000 infants died of SIDS, making it the leading cause of infant death in the United States.

Recommendations to reduce the risk of SIDS:

• Put your baby on his or her back when sleeping or napping.

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• Place your baby on a firm sleeping surface covered by a fitted sheet, such as the mattress provided in the Vitality Kit Baby Box, a crib, a portable crib, a bassinet or play yard that is approved by the Consumer Product Safety Commission (CPSC).

• If your baby fell asleep in a car seat, swing, stroller or any infant carrier, make sure to place your baby on his or her back on a firm sleeping surface as soon as possible.

• Do NOT place pillows or any soft objects such as quilts, comforters, sheepskins or any similar products that are placed underneath your baby.

• Keep all the stuffed animals and toys outside the box or crib.• Do not place your baby to sleep on an armchair or couch, as these are

extremely dangerous environments for your baby. • Ensure your baby is sleeping in the same room as you but on a different

surface that is ideally designed for infants. Babies who sleep in the same bed with their parents are more prone to SIDS, since parents may roll over on their baby, or the baby might get tangled in the blankets or sheets.

• If you are using the Vitality Kit Baby Box, make sure to place the box on the floor or a steady surface.

• It is recommended to offer your baby a pacifier. Make sure the pacifier does not have any accessories or objects attached to it, which may cause suffocation or choking.

• Keep the temperature in the room comfortable, so your baby won’t get too hot. Dress your baby in no more than one extra layer than an adult can bear. For instance, if an adult is comfortable with 1 layer, then do not dress the baby in more than 2 layers. SIDS is frequently associated with the child being exposed to overheating. Signs of overheating will appear in the form of sweating, and may also be noticed if the babies chest is warm upon touch.

• Breastfeed your baby as long as you can, since breastfeeding reduces the risk of SIDS.

• Avoid smoking or exposure to smoke during pregnancy and after birth. Keep your baby away from smoking environments. Similarly avoid alcohol and illicit drugs during pregnancy and after birth.

• During pregnancy, you should conduct regular prenatal doctor visits. After birth, your baby should attend all scheduled visits to the doctor and all the scheduled immunizations required.

• Avoid the use of positioners, wedges and other devices that are intended to separate the baby from others in the same bed.

• Under supervision, assigning “Tummy Time” is important for your baby. Place your baby on his stomach while he is awake and play with him in this position. It is important for your baby’s growth and muscles development.

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Swaddling

Diapering

Importance of Swaddling

Swaddling is an old technique of wrapping your baby with a blanket or cloth to keep them calm and warm. Swaddling resembles the mother’s uterus, so it helps your baby to feel secure and helps them to sleep better.

*Precaution*

• It is important to put your baby to sleep on her back especially when she is swaddled, or else she can suffocate.

• Keep the swaddle loose on the baby’s hips. Tightening the swaddle ex-cessively on the baby’s legs can lead to hip dislocation.

• The swaddle should not be too tight or else it makes it difficult for the baby to breath.

*The American Academy of Pediatrics recommends that parents stop swaddling their babies at the age of 2 months before the baby learns how to roll.

You should change your baby’s diaper as soon as he pees or poos. Make sure all the things you need for dia-pering are within hand’s reach. Never leave the baby alo-ne on the changing table, as he may roll over, leading to a potential situation where the baby may fall off the table – leading to injury.

Changing the baby's diaper

1. Wash your hands.

2. Remove the dirty diaper carefully as to not dirty the surrounding area.

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3. Wipe the genital area well using lukewarm water on a washcloth, soft paper towel, cotton ball, or gentle wet wipes. For girls, wipe the genital area from front to back.

4. Apply diaper rash ointment/baby powder if it was recommended by your pediatrician.

Diaper Rash

Diaper rash is an irritation of the skin in the area covered by the diaper. It is common in babies, and usually can be treated with ease.

Common signs of diaper rash

The first sign of diaper rash is redness and irritation that usually begins bet-ween your baby’s thighs. It may then spread to the lower abdomen, buttocks, genitals, and any surface that has been in direct contact with the diaper.

Common causes of diaper rash

• Leaving the wet or stool-solid diaper on for too long.• Too much moisture in the diaper area.• Rubbing and friction.• Allergic reaction to the diaper material, powders, creams, or wipes.

Prevention of diaper rash

• Change your baby’s diaper after urination / bowel movement as soon as you can.

• Air is important! Make sure you keep the diaper loose to allow some air to reach the skin covered by the diaper.

• Gently clean the diaper area with water and soft cloth. • Avoid using wipes that contain alcohol or perfume as these dry the skin.• If you use cloth diapers (reusable), make sure to wash them thoroughly

with very hot water.

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Treatment of diaper rash

• You may use an over-the-counter diaper rash ointment or cream, such as a zinc oxide ointment.

• If the rash is severe, change the diaper more often, as you consequently have to wake the baby to change their diaper at night.

*The rash should improve within two to three days after starting the treatment.

Consult the pediatrician

• If the rash does not improve after two to three days of treatment;• If your baby has a diaper rash accompanied with a fever, or seems to be

sick;• If the rash appears as itchy with painful blisters, sores, or has crusted

areas.

Bathing

Always prepare all the items required for bathing prior to placing your baby in the water. And make sure that everything you need is within hands reach. NEVER leave your baby unsupervised during the bathing process.Adjust your water heater to no more than 120 degrees Fahrenheit (48.9 degrees Celsius) to avoid burns.

Before the stump of the umbilical cord falls off (Sponge Bath)

1. Prepare a lukewarm bowl of water and a double-rinsed washcloth next to you.

2. Lay your baby in a comfortable and flat surface in a warm room.

3. Cover the surface with a blanket or fluffy towel.

4. Wrap your baby with a towel.

5. Expose only the parts of her body that you are instantly washing.

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6. Use a slightly wet washcloth without soap to wash her face.

7. Dip the washcloth in soapy water.

8. Wash the remainder of her body, keeping the diaper area as the last area to be washed.

9. Do not forget to wash under her arms, behind her ears, around the neck and the genital area.

After the stump of the umbilical cord falls off (Water Bath)

1. Prepare the items that you need ahead of time.

2. Undress the baby in a warm room and place her in the water directly.

3. Always test the temperature of the water by using your elbow prior to pla-cing your baby in the water.

4. Use one hand to support her head and the other hand to place her feet first and then slowly lowering the rest of her body in the water. If you are using a bath tub, fill it with 2 inches (5.08 cm) of water.

5. For safety reasons, most of her body and face should be above the water. So, you need to frequently pour water on her body to keep her warm.

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6. Wash her face and hair with a soft cloth, and massage her scalp gently.

7. Pour water by either using your hand or a cup to rinse the soap. Cup your hand across her forehead to prevent water from running to her eyes whilst washing her face.

8. Wash the rest of her body from top to bottom, leaving the diaper area till the end.

9. To lift the baby, support her head and neck with one hand and her body with the other hand. Make sure you have a firm hold so that the baby will not slide.

10. Cover the baby’s body and head with a dry towel and gently pat her to dry.

11. You do not need to routinely apply lotions and creams on your baby’s skin.

*An alternative would be to start washing the baby’s body first, keeping the head area for last.

*If some of the soap during bathing enters her eyes, get a damped washclo-th without soap, and wipe her eyes until all the soap is gone.

*Keep in mind that bathing your baby excessively, especially when soaps are used, may dry out her skin. Additionally, changing your baby’s diapers in a punctual manner means you will not need to bathe her as often. Three times a week during her first week will be enough.

Care of Circumcised and Uncircumcised Penis

It is your decision to circumcise your baby boys’ penis. Either way, it is impor-tant to keep it clean at all times.

Circumcised Penis

After your boy’s penis is circumcised, a light dressing will be applied. Later when he urinates, the dressing will usually take off on it is own. In every diaper change, make sure to gently wipe any stool particles that come in contact with his penis with soap and luke warm water. In the first few days after circumci-sion, you may notice redness and yellow secretions on the head of the penis, do not be alarmed, this means his penis is healing normally

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Consult your pediatrician if the following signs appear:

• Persistent bleeding.• Fever. • Crusted yellow sores or blisters that contain cloudy fluid.• Redness of the skin or on the head of his penis that persist more than a

few days.

After his penis is healed, a small piece of the fore-skin will remain. Make sure in every bath, to retract this skin gently and clean the area behind it.

Uncircumcised Penis

For the first months, clean your baby’s penis with soap and water as well as the rest of the diaper area. Do not try to pull back the foreskin to clean under-neath it, forcing it to retract may cause pain, bleeding and tear the skin. Your pediatrician will tell you when his foreskin is separated and it can be safely retracted. Afterwards pull his foreskin back, and rinse the area with water and soap.

Nail Care

Fingernail care

• At first your baby’s fingernails will grow quickly, and you may have to trim them twice a week.

• Use a soft board, baby nail clippers or blunt- nosed toenail scissors.

• Do not bite your baby’s nails with your mouth as that will be increasing her chance of getting an infection.

• The best times to trim your baby’s nails are either after bathing (she will be calm), or when she is asleep. The most important thing is for her to be still.

• Remember to keep her nails short and smooth as to prevent herself from scratching and harming herself.

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Toenail care

• In contrast, your baby’s toenails grow slower than her fingernails, you may have to trim them once or twice a month.

• Use a soft board, baby nail clippers or blunt- nosed toenail scissors.

Checking your Baby’s Temperature

To check your baby’s temperature, you should use a digital thermometer. Mer-cury thermometers are not recommended. To prevent any accidental exposure or poisoning, the American Academy of Pediatrics encourages parents to re-move any mercury thermometer from their homes.

Types of Digital Thermometers

• Digital Multiuse Thermometers

Reads the body temperature once the tip of the thermometer touches a part of the body. It can be used rectally (in the anus), orally (in the mouth), or axillary (under the arm).

Route Accuracy Age

Rectal

Oral

Axillary

Most accurate

Accurate

Not accurate

From birth till 3 years

From 4 to 5 years

Older children.Mainly used in schools

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Difference of Temperature Between Different Routes

• Temporal Artery

Reads the body temperature from the temporal artery in the forehead. It is accurate and used for babies greater than 3 months of age. However, some research show that it is not extremely reliable when used on babies less than 3 months old.

• Tympanic

Reads the body temperature from the eardrum. It is not reliable for babies aged less than 6 months. For accuracy purposes, it should be placed correctly in the baby’s ear canal. Earwax could cause the reading to be incorrect.

The average normal oral temperature is 37 °C (98.6°F)

Route Difference from the oral temperature

Rectal

Tympanic (Ear)

Axillary (under arm)

Temporal artery (forehead)

0.3°C (0.5°F) to 0.6° (1°F) higher than the oral temperature.

0.3°C (0.5°F) to 0.6° (1°F) higher than the oral temperature.

0.3°C (0.5°F) to 0.6° (1°F) usually lower than the oral temperature.

0.3°C (0.5°F) to 0.6° (1°F) usually lower than the oral temperature.

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Vaccination

Throughout history, vaccinations have helped us get rid of many diseases. They have helped our population grow, and increased our quality of life greatly. Therefore, vaccinations are essential to protect infants from many diseases. In the past, many children have been hospitalized or passed due to various infections. Many of these infections and disease are nowadays easily preven-table by vaccines. Therefore, always vaccinate your baby as the germs that cause these diseases are still around. However, we are mostly immune to them thanks to vaccinations and progress in health care.

Vaccinations are vital for your baby as it;

Vaccinations are important for your community as it;

Vaccinations and Safety

• Protects from many dangerous and fatal diseases caused by germs such as bacteria and viruses.

• Attenuates the disease if he catches the infection and reduces its severity, whilst protecting him from any disease complications.

• Eradicates and reduces many infections that may invade your community.

• Protect other babies who are unable to receive these vaccinations due to potential medical problems.

Vaccinations are one of the most safe and effective medicines. Yet vaccina-tions may cause side effects which are usually mild.

Mild and common side effects include:

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Redness, swelling and discomfort at the injection siteMild fever

Sleeping more than usual

Severe and uncommon side effects:

High fever Rash Seizures

*If he shows such side effects, you have to contact your pediatrician immediately AND go to the emergency room.

1. If he experienced a serious reaction during a previous vaccination.2. If he has a certain allergy3. If he is sick on the day of the appointment

Three things you must inform your pediatrician before your baby is vaccinated;

Some children cannot receive

the vaccines due to certain medical

conditions”

“Remember that getting mild side effects from the vaccines is much less dangerous than getting the preventable disease”

These side effects are common and should subside within two days.

“

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Car Seats

Thousands of young children are injured or killed each year in car accidents. Car seats play an important role in protecting your child from accidents. They act as the seatbelt and the air-bag for your little one. Therefore, it is mandatory - and in some countries, a legal responsibility - to have a car seat as soon as the baby is born. You should start by placing your baby in the car seat during the drive from the hospital back to your home.

Choosing the Car Seat

There are many types of car seats in the market. Choosing the type of car seat depends on your baby’s weight, height, and age. All children under 2 years should be in a rear-facing car seats, it is the ideal way to keep her safe. Do not switch from one type of car seat to another, unless your child has exceeded the height or weight limit allowed by the car seat manufacturer.

Car Seats in the ‘Winter’

AAP recommends a general rule that says: Bulky clothes including winter coats and snowsuits should not be worn underneath the harness of the car seat. Since bulky and fluffy clothing will flatten directly after a crash, allowing your baby to slip from the car seat. To keep your child safe and warm at the same time, dress her with a thin layer of clothes and cover her with a blanket over the straps of the harness.

Infant and ToddlerRear-facing car seats

Older childrenSeat belt

Toddler andPreschooler

Forward-facing car seats

School-agedchildren

Booster seats

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Nasal Aspirator

Nasal congestion is a common problem in newborns. A Nasal aspirator will help you clean your baby’s nose.

How to use a nasal aspirator

• Use saline nasal drops along with the nasal aspirator which help loosen and soften the mucus first.

• Compress the nasal aspirator as to remove the air (within) prior to inserting it in his nose.

• Once inside the nostril, release the nasal aspirator so the air will suck the mucus out.

• Make sure to remove all the mucus on a paper towel from the nasal aspi-rator before inserting it in the other nostril.

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References

www.healthychildren.org

“Caring for Your Baby and Young Child Birth to age 5” (6th edition)Steven P. Shelov, Tanya Remer Altmann

American Academy of Pediatrics Guidelines

American Family Physicians Guidelineswww.aafp.org

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