Postnatal care of baby

For immediate care of baby after birth — see Newborn resuscitation, Newborn care

Related topic — see also Postnatal care of mother

Schedule of visits

• If worried that woman or baby are medically or socially at risk — keep regular contact with woman and review baby more than once a week
• Planned schedule of visits should consider individual woman and baby’s needs
• If difficult to see woman and baby as often as recommended — opportunistically assess wellbeing and provide care

• First visit within first 24 hours of birth THEN
• 2nd day following birth
• 3rd day following birth
• 4-7 days following birth
• 7-10 days following birth
• Weekly until 6 weeks following birth
• 8 weeks following birth

First postnatal visit

• First visit should be completed as soon as possible after mother and baby return to community
• First visit will be long. Spend time getting to know the woman and explaining what needs to be done
• Review discharge paperwork and take detailed history and examination. Check birth paperwork completed — if not, contact maternity unit

Ask

• If carer has any concerns
• Baby’s feeding, sleeping and alertness level
• Urine — should be 6 or more wet nappies every day
• Faeces — changes from dark green to yellow paste, frequency variable
• Breastfed baby may pass faeces several times a day or none for 5 days. Lack of faeces in breastfed baby is not a concern if no other signs of illness or distress
• Carefully monitor formula fed baby. If appears constipated — check how formula being prepared — see Postnatal nutrition for mother and baby (up to 6 months old)
• Social and emotional wellbeing, conditions at home — family support, housing finance and social issues
• Substance use including passive smoking

Check

• Weight, length, head circumference — plot on growth chart
• Immunisation status — medical consult if birth immunisations not given
• Head-to-toe exam — with attention to
  
• Alertness
• Interaction with carer 
• Any dysmorphic (odd) features
• Fontanelles — sunken or bulging
• Eyes — discharge, redness or jaundiced (white of eyes yellow)
• Mouth — thrush (white patches that don't wipe away with cotton bud)
• Ears — redness or discharge
• Chest and abdomen
• Umbilicus (belly button) — redness, infection, bleeding
• Skin — colour, skin folds, cleanliness, nappy area for rash
• Moves arms and legs equally on both sides

Do

• Newborn screening test ideally 48–72 hours after birth if not done
• Neonatal hearing test — medical consult if not done
• Enrol for Medicare and the shared electronic health record

Discuss

• Feeding methods — see Postnatal nutrition for mother and baby (up to 6 months old)
• Encourage and support breastfeeding
• If baby bottlefed talk with mother or carer about equipment, formula feeding and the need for frequent checks at clinic
• Growth
• Start growth chart — measure and plot every visit
• Show growth chart to carer and explain the purpose and current growth
• Medical consult if not gaining at least 150g a week or below birth weight after 7 days 
• Immunisation schedule
• Smoking, alcohol and other drugs
• Avoid smoking around baby and children
• Make home a smoke-free place
• Hygiene
• Talk with woman about cord care — put nothing on stump, fold nappy below stump, wash and dry stump if it gets soiled
• Hand hygiene when tending to baby
• Gently wash and keep face clean
• Change nappies regularly and wipe skin well to avoid nappy rash
• Bath baby at least every second day
• Safe sleeping
• Sleep baby on their back
• Do not cover head or face
• Do not smoke near baby
• Use a firm flat mattress and clean bedding
• If co-sleeping adults should not drink, smoke or take drugs. Baby should be between the edge of mattress and carer
• Injury prevention and use of car seats

Follow-up

• Advise carer to bring baby to clinic if any red flag signs
• Refer to multidisciplinary team as indicated — at minimum child health nurse and doctor
• Arrange medical follow-up

Follow-up visits

Ask

• About red flag items
• About feeding

Check

• Weight, length and head circumference — plot on growth chart and check trend of growth
• Head-to-toe exam — see first postnatal visit check
• Interaction between carer and baby — attentiveness of carer to baby

Do

• Discuss feeding, growth, sleeping, hygiene, injury prevention — see first postnatal visit

Follow-up

• Check any problems previously identified have resolved

6-8 week postnatal check

• Will be long. Spend time getting to know woman and explain what needs to be done
• Take detailed history and examination

Check

• History and examination as per first postnatal visit AND
• If mother had positive syphilis serology — check baby’s risk of congenital syphilis was assessed
• Baby’s development
• Looking at carer
• Starting to smile and vocalise (make noises)
• Holds head unsupported when sitting or lying

Do

• Offer 6-8 week immunisations
• Discuss feeding, growth, sleeping, hygiene, injury prevention — see first postnatal visit

Follow-up

• Advise carer to bring baby to clinic if any red flag signs
• If any concerns about growth — medical consult
• Medical/midwife/child health consult to check
• Developmental assessment (ASQ TRAK/ASQ 3)
• Eyes for red reflex
• Heart sounds for murmurs
• Femoral pulses
• Hips for developmental problems
• In boys testes in scrotum