Getting to know your baby

When can my baby go home from the hospital?

When your baby is ready to go home depends on many factors. Every baby must be individually evaluated for readiness and your family must be prepared to provide any special care that is needed.

The American Academy of Pediatrics (AAP) has proposed discharge guidelines for high-risk newborn babies. Generally, babies may be ready for discharge when they:

• are steadily gaining weight
• have a stable temperature in a regular crib
• can feed from a bottle or the breast without difficulty breathing or other problems
• have mature and stable heart and breathing ability

Your baby should also be:

• given any required immunizations or screening tests, including vision and hearing
• checked for risks for additional complications
• evaluated for treatment of on-going medical problems, and a follow-up care plan should be discussed with your baby's doctor

The follow-up care plan for your baby includes identifying a primary care pediatrician and specialists for any special needs your baby may have, as well as readying your home for your baby's arrival. This may include arranging for special home care services or equipment.

What do I need to know before taking my baby home?

As a new parent or caregiver, you'll need instruction in:

• feeding
• basic infant care (baths, skin care, taking temperature, etc.)
• infant CPR (cardiopulmonary resuscitation)
• symptoms of illness
• sleep positioning and car seat safety
• use and care of special medical devices or equipment
• giving medications
• performing special procedures or care such as suctioning or special dressings

What kind of new furniture will my baby need?

Safety is the most important issue when choosing your baby's new furniture. The U.S. Consumer Product Safety Commission (CPSC) offers recommendations for many of these items.

• Cribs must meet Federal safety standards which include the following:
  • Slats should be spaced no more than 2-3/8 inches (60 mm) apart.
  • All slats should be intact, not missing or cracked.
  • The mattress should fit snugly on all four sides - less than the width of two fingers between the edge of the mattress and the side of the crib.
  • Mattress supports should be securely attached to the head and foot boards.
  • Corner posts should be no higher than 1/16 inch (1.5 mm) to prevent entanglement of clothing or other objects worn by your baby.
  • The head and foot boards should have no cutouts which would allow your baby's head to get trapped.
  • Make sure that your baby can't easily release drop-side latches.
  • Make sure that drop-side latches hold the sides in raised position securely.
  • Check that all screws or bolts which secure components of crib are present and tight.
  • Don't place a crib near draperies or blinds where your child could become entangled and strangle on the cords. When your child reaches 35 inches in height, or can climb or fall over the sides, the crib should be replaced with a bed.
• Crib mattress and bedding:  According to the American Academy of Pediatrics (AAP), soft bedding may be a major contributor to sudden infant death syndrome (SIDS). They offer the following recommendations for infant bedding:
  • Place your baby on his or her back on a firm, tight-fitting mattress in a crib that meets current safety standards.
  • Remove pillows, quilts, comforters, sheepskins, stuffed toys and other soft products from the crib.
  • Consider using a sleeper as an alternative to blankets, with no other covering.
  • If using a blanket, put your baby with his or her feet at the foot of the crib. Tuck a thin blanket around the crib mattress, only as high as your baby's chest.
  • Make sure your baby's head remains uncovered during sleep.
  • Do not place your baby on a waterbed, sofa, soft mattress, pillow or other soft surface to sleep.
• Bassinet or cradle: These small beds are helpful and portable in the first few months.
• Changing tables offer a convenient place to change your baby's diaper. The CPSC recommends not leaving a baby on the table unattended. For safety reasons, be sure to look for a changing table with the following:
  • safety straps to prevent falls
  • drawers or shelves that are easily accessible without leaving your baby unattended
• Rocking chair or glider: For comfort, look for a chair with arms that are wide enough for you to hold your baby, especially when breastfeeding.
• Playpens are large enclosed beds where a baby can nap or play safely away from pets or other children.
• The CPSC recommends never leaving your baby in a mesh playpen or crib with the drop-side down.
• Even a very young infant can roll into the space between the mattress and loose mesh side and suffocate.
• Only playpens that meet federal safety standards should be used. These include:
  • Drop-side mesh playpens or cribs with warning labels to never to leave the side in the down position.
  • Mesh with small weave (less than 1/4 inch openings).
  • Mesh with no tears, holes, or loose threads.
  • Mesh securely attached to top rail and floor plate.
  • A top rail cover has no tears or holes.
  • A wooden playpen with slats spaced no more than 2 inches (60 mm) apart.
  • If staples are used in construction, make sure they are firmly installed and none are missing or loose.
• Strollers and carriages are helpful in transporting your baby on outings.
  • The CPSC recommends always securing the seat belts with the stroller or carriage is in use.
  • Never leave your child unattended in a stroller.
  • Keep your child's hands away from pinching areas when stroller is being folded or unfolded, or the seat back is being reclined.
  • For safety reasons, be sure to look for a stroller or carriage with:
    • a wide base to prevent tipping.
    • the seat belt and crotch strap attached securely to the frames.
    • a seat belt buckle which is easy to use.
    • brakes that securely lock the wheels.
    • a shopping basket which is low on the back and directly over or in front of rear wheels for stability.
    • leg hole openings which can be closed when being used in the carriage position
• Car seat: All states have laws requiring babies and children to travel in an approved car safety seat. The National Highway Traffic Safety Administration offers recommendations for choosing a car safety seat, which include:
  • Purchase the car seat well in advance of your due date.
  • Choose a seat that you find easy to use and that fits in your vehicle.
  • If you buy an infant-only seat, you will need a convertible seat later. Most babies outgrow their infant-only seats before age 1, then need to use rear-facing convertible seats as they get larger.
  • If you choose a convertible seat, try it facing both toward the front and rear.
  • Look for a seat you can use as long as possible that faces the rear. Read the labels to check weight limits, as some are made to carry a baby over 20 pounds facing the rear.
  • When you purchase a car seat, be sure to receive instructions on proper installation. Most local police departments will instruct you in proper car seat installation at no charge.

What other supplies should I get before bringing my baby home?

The following items are recommended to have on hand before you bring your newborn home. You can always start with the minimum and add more as needed.

• Linens:
  • three to four fitted crib sheets
  • two waterproof crib pads
  • two lightweight cotton crib-size blankets (no fringe)
  • three to six receiving blankets
  • four waterproof pads
• Diapers:
  • about 10 to 11 disposable diapers per day for the first few weeks, or 48 cloth diapers (plus three to five diaper covers or wraps)
  • diaper stacker
  • a diaper pail at each changing area
  • diaper wipes
• Bath items:
  • baby bathtub
  • four to six baby washcloths
  • two to four hooded towels
  • mild bath soap
  • "no tears" baby shampoo
• Clothing:
  • Choose simple clothing that is easy to get on and off, without long strings or ties that might be a choking hazard.
  • Make sure sleepwear is flame retardant.
  • You may want to buy a mainly 6 to 9 month size clothing and a few newborn items, including:
    • four to six receiving gowns
    • two to three one-piece footed sleepers
    • four to six undershirts
    •  two to three pairs of booties or socks
    • one to two blanket sleepers (depending on the season)
    • one to two dress up/special occasion outfits
    • bonnet with brim
    • bibs
    • a sweater
• Miscellaneous:
  • Pacifier
  • baby brush and comb
  • baby nail clippers or scissors
  • baby acetaminophen drops (given as advised by your baby's physician)
  • bulb syringe for cleaning baby's nose
  • humidifier
  • rectal or digital thermometer
  • crib mobile
  • decorations for your baby's room
  • a front baby carrier or backpack
  • laundry hamper

As you prepare your home for your new baby, look for sturdy furnishings and equipment. Be sure that all products meet current safety standards. This is especially important if you are borrowing or buying items second-hand.

Getting to know your baby

After all the months of waiting, it's amazing when your baby is finally born. But it takes time and effort for parents to get to know their newborn, and time for the newborn to adjust to the new world.

Getting to know your new baby is part of a fascinating but relatively simple process called bonding, in which you essentially "fall in love" with each other. Although bonding is a natural process, it takes effort. Some ways to help make this process easier include rooming-in at the hospital with your baby and techniques such as infant massage.

Bonding:

This is an ongoing process of intimacy, understanding and nurturing that is all part of falling in love with your baby.

• It was once thought that bonding occurred as a distinct time frame immediately after birth, when your baby was held in the mother's arms and eye contact was established.
• However, bonding has been identified more as a process, not an event. With more frequent use of ultrasound examinations, parents are actually seeing their babies earlier than ever before. This seems to enhance bonding during pregnancy.
• Bonding continues when your baby is born and the parents and baby spend time getting to know each other. As a process, bonding isn't "missed out on" if a baby needs to leave the mother's side for special care.
• Bonding may be different for mothers and fathers. And some mothers feel an immediate deep emotional bond at first sight, while others find their feelings develop more slowly, as they spend time with your baby. Babies don't "forget" parents if they are separated from them at first. Babies show a unique preference for a mother's smell and her voice.

There are several ways to help you and your baby continue the process of bonding:

• Breastfeeding is one of the best ways to bond with your baby. In addition to the nourishment it provides, breastfeeding gives mother and baby closeness and skin-to-skin contact on a constant basis. This helps both get to know each other more intimately.
• Carrying a baby in a sling is another method of continuing to bond. This is often a helpful technique for fussy or high-need babies.

Rooming-in:

Many hospitals now encourage mothers to keep their babies with them throughout the hospital stay - called "rooming-in." This can be full-time-24 hours, or a partial rooming-in, when your baby is with you the majority of the time.

• Many mothers find that having their baby with them throughout the day and night allows them to learn your baby's needs and how to respond to them. Mother-baby nurses work with new mothers in their hospital rooms helping them learn to breastfeed and care for their babies.

If you are rooming-in, it is a good idea to have someone stay with you at night. This is especially important after a cesarean delivery, when you may not be able to get up right away to care for your baby.

Infant massage:

Parents have always loved touching and stroking their babies, and babies love to be soothed and cuddled. Part of a baby's emotional and neurologic development comes from the interactions of touch and feelings of security it offers.

Other cultures have long practiced infant massage - a technique of stroking and gently rubbing your baby's limbs. Proponents of infant massage believe it:

• relieves stress for parents and babies, which can help with sleep
• provides one-on-one time for bonding and communication
• increases parent confidence and sensitivity to a baby's signals and cues
• stimulates growth and development
• helps with gas and symptoms of colic

Some evidence shows that massage of premature infants may increase weight-gain and help with neurological development.

Certified infant massage therapists often offer classes to teach techniques in infant massage. However, many parents find that spending time with their baby helps them learn how to stroke and cuddle in ways that baby and parents both prefer.