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

  • Calculate age-appropriate REWS — AVPU, respiratory distress, RR, O2 sats, pulse, central capillary refill time, Temp
  • Weight, BGL
  • 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

  • Calculate age-appropriate REWS — AVPU, respiratory distress, RR, O2 sats, pulse, central capillary refill time, Temp
  • Weight, BGL
  • 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