Hesperian Health Guides
What to do for the baby
HealthWiki > A Book for Midwives > Chapter 14: The first few hours after the birth > What to do for the baby
Wash your hands, just as you did for the birth, and put on clean gloves. It is easy for a new baby to get an infection, so everything that touches the baby must be as clean as possible. But there is no need to bathe the baby right away. Bathing, even in warm water, will make her cold. You can safely wait a few hours or even a few days. Wear gloves until the baby is clean and dry to help protect you from getting an infection.
While you examine the baby, keep her warm. Cover her head and the parts of her body you are not examining. If possible, you should warm up the room. Be gentle with the new baby. Babies feel as much as adults do and gentle care will help them feel strong and safe.
The most important things to check for a new baby are her general appearance and other physical signs. Check these as soon as you can after the birth. The other parts of the newborn exam can wait a few hours.
If you can, write down what you find on a chart. A chart will help you remember to do each step, and notice changes that happen over time. Here is an example of a chart you can use:
Click here for a print quality version of this record of the new baby's health.
Contents
- 1 General appearance
- 2 Physical signs: breathing, heartbeat, temperature
- 3 The baby's body
- 4 Immunizations given at birth
- 5 Clean up and answer the family’s questions
General appearance
The way a baby looks and sounds can tell you a lot about her health. Notice everything! Is the baby small or large? Fat or thin? Do her arms, legs, feet, hands, body, and head seem to be the right size? Is the baby tense or relaxed? Active or still? Listen to the baby's cry. Every baby's cry is a little different, but a strange, high, piercing cry can be a sign of illness.
Baby is limp, weak, or does not wake up
Many babies are very sleepy for the first few days after birth. They should wake up from time to time to breastfeed. When awake, the baby should respond to noise and touch. If the baby does not respond, or seems unusually weak, slow, or limp in the first few hours, she may have one of these problems:
- difficulty breathing
- not enough sugar in the blood
- infection
- sleepiness from drugs or herbs given to the mother during labor
Not enough sugar in the blood
A very weak baby may need more sugar in her blood. This is especially likely if the baby is very big or very small, if the birth was very hard or long, or if the mother has diabetes. The baby may stay cold or tremble.
Breastfeed the baby as much as possible — there is sugar in breast milk.
Keep the baby warm and close to the mother's body. If the baby does not seem more awake and alert in 12 hours, get medical help.
Physical signs: breathing, heartbeat, temperature
Check the baby's physical signs every hour for 2 to 6 hours after the birth, and more often if the baby is having problems.
Breathing rate
Count the baby’s breaths for one full minute by watching her belly rise and fall. A new baby should take between 30 and 60 breaths in a minute while she is resting, and her breathing may slow down and speed up from moment to moment. This is OK
A baby who is breathing too fast, too slow, or with difficulty may be having trouble getting enough air, or may be having other problems.
Baby has trouble breathing, or takes more than 60 breaths a minute
If a baby has trouble breathing, or if she takes more than 60 breaths a minute, it is a warning sign. It could mean that the baby has an infection, has breathed in her own stool, has drugs in her blood from the mother, or has other problems.
What to do
- Keep the baby warm.
- Check for signs of infection.
- Lay the baby with her head lower than her bottom to help fluids drain. Suction the baby — especially if you think she might have breathed stool into her nose or throat.
- Encourage the baby to breastfeed.
- If the baby stops breathing — do rescue breathing.
- Get medical help.
Heartbeat
A new baby's heart should beat between 120 and 160 times a minute. It may beat as slow as 100 beats a minute or as fast as 180 beats a minute.
If the baby's heartbeat is too fast, she may have an infection.
If the heartbeat is too slow, give rescue breathing. If the heart rate does not come back up, get medical help.
Temperature
Keep the baby warm
Babies must stay warm to stay healthy. But they cannot keep themselves warm as easily as adults can. The easiest way to keep a baby warm is to put her next to her mother's skin. The mother is exactly the right temperature for the baby. Cover them both with blankets and be sure to cover the baby's head.
If the mother cannot hold her baby for a bit (for example, if she gets up to urinate), someone else can hold the baby. This person should wash their hands well before handling the baby.
Temperature and health
A healthy baby's temperature is around 37°C (98.6°F).
To check the baby's temperature, gently put the silver end of the thermometer into her armpit. Then hold the baby's arm against her body for 3 minutes if it is a glass thermometer or until the digital thermometer beeps. If you do not have a thermometer, feel the back of the baby's neck while you touch a healthy person. If the baby does not feel as warm as the healthy person, her temperature is too low.
A baby whose temperature is 36.5°C (97.7°F) or less should be warmed quickly. Do not wait. Place her skin to skin, between the mother’s breasts, wearing only a diaper and hat. If she will not warm, try using hot water bottles.
Fill hot water bottles (or jars) with hot water, wrap them in cloths so they do not burn the baby, and put the bottles next to the baby's body.
If the baby does not get warmer after 1 or 2 hours, she may need medical attention.
Infection
Infection can cause a baby's temperature to be too low or too high (fever). Too low is below 35.5°C (96°F). Too high is above 38°C (100.4°F). Other signs of infection are:
- the baby cannot keep warm even wrapped in blankets
- fever lasting more than 4 hours
- breathing more than 60 breaths a minute
- baby who seems ill
- baby sucks poorly or stops feeding
- weak, fast heartbeat
If the baby shows any of these signs of infection, get medical help. If the nearest medical help is more than 2 hours away, give the baby antibiotics on the way. See about the kind and amount of medicine to give.
Get medical help if the baby cannot warm up after several hours — even if
she has no other signs of infection.
Baby does not urinate or pass stool within the first 24 hours
The baby should urinate and pass stool within the first day of birth. If the baby does not do so, her urethra or intestines may be blocked. Get medical help right away.
The baby's body
Weight
Every baby is different, but most healthy babies weigh between 2.5 and 4 kilograms (between 5.5 and 9 pounds).
You may be able to get a scale from the local health authority, buy a hanging fish scale, or make a homemade scales. But you do not need a scale to have an idea of what a healthy baby should weigh. Every time you hold a baby, think whether that baby weighs more than most babies, or less, or about the same. This way, you will know when a baby is very small (underweight) — even without a scale.
Very small babies
Very small babies who are less than 2.5 kilograms (5.5 pounds) have a higher risk of infection, breathing problems, and jaundice. The smaller the baby, the greater the risk. Small babies also may have trouble breastfeeding and digesting their food. Some babies are small because they were born early, and some are just small.
If there is a well-equipped medical center nearby, it may be best to take very small babies there to be cared for. But if you are going to care for a small baby at home, there are some things you can do to help him stay healthy.
What to do
- Keep the baby warm. The best way to warm him is against his mother's skin. Place the naked baby, with a hat and a diaper, inside the mother's clothing, against her skin and between her breasts. Keep this skin-to-skin contact day and night. The mother will have to change the baby's position to breastfeed. If the mother needs to put the baby down, another family member can put the baby next to their skin.
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Give breast milk. Breast is best for all babies, but it is even more important if the baby is very small. Breast milk is easiest for the baby to digest, it gives the best nourishment, and it protects the baby from illnesses. A small baby may not be able to eat much. Keeping him close to the mother's body will help him to breastfeed often. In this way, he will get enough to eat.
If the baby is not able to breastfeed, the mother should remove milk from her breasts by hand. The mother should feed the baby the breast milk with a very clean cup or spoon until he is strong enough to breastfeed. Give the baby as much breast milk as he will take and as often as he will take it. He must eat to grow. - Visit the baby every day for the first few weeks, to check for warning signs. Be sure the mother knows the signs of jaundice, breathing problems, and other signs of infection. If the baby develops any warning signs, get medical help.
Causes of small babies
Babies come in all sizes — just like people are many sizes. But small, underweight babies are much more likely to have problems than bigger babies.
And the size of a baby is not just a matter of chance. Mothers who get enough food and care in pregnancy usually have bigger, stronger babies. Mothers who did not get enough food and care usually have smaller, weaker babies.
Small babies are often born to:
- mothers who did not get enough to eat in pregnancy.
- mothers who had to do very hard work during pregnancy.
- mothers who did not get good medical care in pregnancy.
- mothers who smoke cigarettes, drink alcohol or use drugs.
- mothers who were exposed to pesticides or toxic chemicals in pregnancy.
- mothers who have had many babies before.
Baby weighs more than 4 kilograms (9 pounds)
Watch all big babies carefully for the first 2 days. If they seem tired, weak, or sick, they may not have enough sugar in the blood. Get medical help.
Some babies are big because their mothers had diabetes. These babies may have problems with the amount of sugar in their blood. Make sure these babies breastfeed often and stay warm.
Weighing a baby with a scale
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Adjust the scale to 0 or weigh the cloth. |
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If you have a scale, you can find out exactly how much a baby weighs. (See how to make your own scale.)
If you have a hanging scale, follow these steps:
- Attach a cloth to the scale.
- Adjust the scale so that it is at 0. If there is no knob to adjust the scale, write down how much the cloth weighs (the number that the scale is at when the cloth is attached).
- Put the naked baby into the cloth to weigh him.
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If you were able to adjust the scale, it will tell you the weight of the baby.
If there is no knob to adjust the scale, you must subtract the weight of the cloth to find out the weight of the baby.
| For example: | ||
| Baby and cloth together weigh | 3.25 kilograms | |
| Cloth alone weighed | - 0.25 kilograms | |
| So baby alone weighs |  | |
If you have a scale that you stand on, follow these steps:
- Weigh yourself, and write down the weight.
- Get off the scale.
- Get back on the scale holding the baby without his clothes or blankets. Write down the weight.
- Subtract your weight from the combined weight of you and the baby.
| For example: | ||
| You and the baby together weigh | 62 kilograms | |
| You weighed | - 59 kilograms | |
| So baby alone weighs |  3 kilograms | |
Length
If you have a tape measure, measure the baby from the top of her head to the bottom of her heel. Most babies are between 45 and 53 centimeters (18 to 21 inches). Babies who are not within this range may have problems.
Head
If you have a tape measure, measure around the baby’s head, just above the ears. For most babies, this measurement is about 35 centimeters (13 to 14 inches). A very large or small head can be a sign of illness or disability in the child.
Head shape, sutures, and fontanels
The skulls (head bones) of children and adults are solid, but a new baby's skull is made of 5 separate pieces. The spaces between these 5 pieces are called sutures or suture lines. The baby's skull also has 2 larger soft areas called fontanels or soft spots.
These spaces between the skull bones allow the skull pieces to move during birth. This helps the baby's head squeeze through the mother's vagina.
Sometimes the skull bones have to overlap for the head to be born. This is called molding. When the baby is first born, his head may be be in a pointed or flattened shape. It will usually become more round in 1 to 3 days. Molding is common, and does not last.
Here are some of the different shapes you
might see at birth.
Gently feel the sutures and soft spots with your fingers. The front suture should stop at or near the top of the forehead. Notice if the other sutures are where you expect, or if the soft spots are unusually wide. Are the soft spots soft, or tense and bulging? Do not push on the soft spots — this could hurt the baby.
If the soft spots are unusually wide, if the front suture goes down to the middle of the forehead, or if the soft spots are tense or bulging, the baby may have hydrocephalus (water on the brain). Hydrocephalus can cause disabilities or other serious problems. If there are no soft spots, this can also cause problems as the baby's head grows. In either case, get medical advice.
Caputs and hematomas
Some babies have a swelling called a caput in the area that was pressed against the cervix during labor and birth. A caput usually crosses a suture line. It will go away in 1 or 2 days.
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| Caput (crosses suture line): not a problem | Hematoma (not across suture lines): might cause problems |
If you find a swelling on the head that does not cross a suture line, it may be a hematoma (bleeding under the skin). Hematoma can cause the baby to get jaundice as she heals. If you find a hematoma, check the baby every day for signs of jaundice until the hematoma is gone. If possible, get medical advice
Ears
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| Ears are usually above the eyes. | Ears below the eyes can be a sign of a medical problem. |
To check the baby’s hearing, softly clap near the baby’s ear. Most babies will move when they hear a sound. If the baby does not seem to hear, get medical advice.
Also check how high or low the baby’s ears are on her head. To do this, look straight into her face and imagine a line across her eyes. Some part of each ear should be above this line. Low or uneven ears can be a sign of other problems inside the body, including cognitive delay and kidney problems. If one or both ears is below the line, get medical advice.
Eyes
Look at the baby’s eyes. Notice if they look like other babies' eyes, and if they move together. A little bit of blood under the surface of the white part of the eye is common. The blood should go away in a few days.
Put medicine in the baby's eyes to prevent blindness
If a mother has chlamydia or gonorrhea, she may pass it to her baby during birth. The infection gets into the baby's eyes and can cause blindness. Many, many women have chlamydia or gonorrhea and do not know they have it. Unless the mother has had a test to show that she does not have these infections, give the baby medicine in the eyes to prevent blindness.
| To prevent blindness |  |
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| Erythromycin, tetracycline, and povidone iodine are safer and work better than silver nitrate at preventing blindness caused by gonorrhea and chlamydia. Silver nitrate also irritates the baby's eyes for a few days. If you can get erythromycin or tetracycline ointment, or povidone iodine, use one of these. But use silver nitrate if that is all you have. | ||||
Nose and mouth
First check if the baby can breathe easily through his nose. If not, try suctioning the baby.
Then, gently stroke the baby's cheek. He should turn his head toward your finger. This is called the rooting reflex. Put a very clean finger inside the baby's mouth. The baby should suck on your finger. If there is no rooting reflex, and if the baby does not suck, he may be very weak or sick. Get medical help.
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| cleft lip | cleft palate |
Babies with cleft lip and cleft palate
A cleft lip is an opening or gap on the baby's upper lip, often connecting to the nose. A cleft palate is a split in the roof of the baby's mouth. These problems can be fixed by an operation when the baby is older. Cleft lip is often repaired when the baby is 4 to 6 months old. Cleft palate is often repaired when the baby is about 1½ years old.
Babies with cleft lip or cleft palate may need some help breastfeeding. For babies with cleft lip, the nipple should go deep into the baby's mouth, so the breast fills up the cleft. If there is still a space in the lip, the mother can put her finger over it.
For babies with cleft palate, the nipple should go as far back into the baby's mouth as possible. Point the nipple to the side of the cleft. The baby should drink with his head up so that milk does not go into his nose. If the baby cannot breastfeed, the mother can remove milk from her breasts by hand and feed the baby with a very clean spoon.
Babies with cleft lip or cleft palate may also have more ear infections and other health problems as they get older. Be sure the mother knows this. Also, a baby with a cleft lip may look unusual, and some parents feel upset when they first see their child. It is important to listen to how these parents feel, and also to remind them of the beauty of their children.
Neck
Check the neck for swelling and lumps. Also, the baby's head should move freely. If you find any problems, get medical advice.
Chest
Breathing
Watch the baby breathe. If the skin between and under the baby's ribs sucks in when he takes a breath, the baby is having trouble breathing.
Listen to the baby's breathing. Use a stethoscope or fetoscope if you have one. If not, just use your ear. You should hear breathing sounds on both sides of the chest, and on both sides of the back. If you do not hear breathing sounds on both sides, one lung may not be working. Get medical help immediately.
Count the baby's breaths when she is quiet, not breastfeeding or crying. If the baby breathes more than 60 breaths a minute, she may have an infection and need medical help.
Heart sounds
If you have a stethoscope or fetoscope, use it to listen to the baby's heart sounds too.
It is hard to describe heart sounds in a book. If possible, someone should teach you how a baby's heart usually sounds. But listen to the baby’s heart sounds even if you are not experienced. Over time you will learn what sounds a healthy baby's heart makes, and what sounds are unusual. If the heart sounds are unusual, get medical advice.
Shoulders, arms, and hands
Look at the baby’s arms and hands. Do they look like most other babies? Can the baby move them without difficulty?
Sometimes a baby’s shoulder, collarbone, or arm breaks during the birth. Feel those parts of the body to see if there are any odd lumps or breaks. A baby with a broken bone may cry in pain, but he may not. Simple breaks will usually heal on their own, but if possible, get medical help. Use a cloth to wrap the arm across the front of the body so it moves as little as possible and is not injured more when you go to get help.
Belly
Look at the belly. Does it look how you expect? ? What happens to the area around the cord when the baby cries? If some of the baby's insides push the skin out, this means the belly muscles are not connected. This is called an umbilical hernia. Get medical advice.
Next, feel the belly. When the baby is not crying, the belly should be soft. Check for lumps, cysts (round sacs of fluid), or other odd shapes under the skin. If you find anything unusual, get medical advice.
Genitals and anus
Look at the baby's genitals. All babies' genitals look swollen after birth. If the baby was breech, the genitals may be very swollen.
Make sure that the anus is really an opening, and not covered over with skin. If the baby has had a bowel movement, you know that this part of the body works. If the baby has no anus, or if it is closed, get medical help right away.
For a boy
First look at the baby’s scrotum. The scrotum is the sac under the penis. Inside the sac, there are 2 smooth, firm balls called testicles which will make sperm when the boy is older. Testicles form inside the baby's body during pregnancy and they usually drop down (descend) into the scrotum before birth. You should be able to feel the testicles and move them with your fingers.
 Feel the testicles.
penis
scrotum |
 If you could see through the scrotum, the testicles would look like this. |
Some boys are born with testicles still high in their bodies that did not descend into the sac. If you cannot find one or both testicles, check again in a month or so. In most of these babies, the testicles will move into the sac by 3 to 4 months after birth. If they do not, the baby should be evaluated in a hospital before age 2 for possible surgery.
Next, check to see if the hole at the end of the penis seems in the right place. If the penis looks very unusual, get medical advice.
Male circumcision
Circumcision is an operation to remove the skin around the tip of the penis (foreskin). A baby may be circumcised right after birth, or after a few months, and sometimes men are circumcised later. Some are not circumcised at all.
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| uncircumcised penis |
circumcised penis |
Circumcision is important in some cultures and religions. It is not medically necessary but it may provide some protection for a man against sexually transmitted infections, including HIV. For a baby, it can help prevent infections of the bladder and kidneys. The risks of circumcision are infection, bleeding, injury or less sensitivity of the penis, and pain and trauma to the baby. Only a skilled person with sterile tools should circumcise a baby.
Teach families with uncircumcised babies to clean their baby’s penis as they do the rest of the baby’s body. They should not pull back the foreskin to clean under it until it pulls back easily, usually after a few years.
lips
lips
For a girl
Make sure that the girl has both outer and inner “lips” of her genitals and a small opening to her vagina. If she does not have an opening, she may need an operation. Get medical help right away. Tell the family that it is common for girls to have a small amount of blood from the vagina for 1 to 2 days after birth.
Hips and legs
First, look at the baby's hips. Compare the two legs. If one hip is dislocated, that side may show these signs:
- the upper leg partly covers part of the body
- there are not as many skin folds
- the leg may seem shorter, or the knee and foot are pointing outwards
| Also, Hold both legs with the knees bent, like this: |
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Then, open them wide, like this: |
 click
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If you feel or hear clicking, the hip is dislocated — get medical advice. |
To treat a dislocated hip
The family will need to keep the baby’s knees high and open. There are several ways to do this.
| The best is a Pavlik Harness, which is only removed for bathing. | If they do not have this, they can use 2 to 3 diapers at the same time to hold the hips in position. | They can also carry the baby with legs apart like this: |
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Also, try to feel the baby's pulse in the place where the leg and genitals come together. A skilled person may have to teach you. If a skilled person cannot find this pulse, the baby may not have good blood flow to the legs. Get medical advice.
foot
Feet
Look at the baby’s feet. If one foot turns inward and cannot be straightened, it may be a club foot. This can usually be fixed with a cast if the baby gets help in the first few days. Chapter 11 of Disabled Village Children has more on treating club foot.
Back
Turn the baby over and look at her spine. Look for holes, sores, cysts, growths,
or tufts of hair.
Gently move your fingers down the baby's spine to feel the bumps of her spinal bones. Can you feel a flat spot in the spine? Are there any holes in the skin at the bottom of the spine where the baby's buttocks begin?
If you find any holes, sores, growths, or tufts of hair, get medical advice.
Skin
Look carefully at the baby's skin. Some babies have spots on their skin. For example, the baby might have large, dark patches on the lower back or bottom. Other babies have red patches on their faces. These spots are not harmful. Other spots, like small red rashes, can be a sign of infection. If you are not sure, get medical advice.
Color
The baby should have a healthy color within a few hours of the birth.
If the baby stays blue
- If a baby's hands and feet are still blue, but the baby is warm, there is probably not a problem. Some babies' hands and feet stay blue for 1 or 2 days after birth.
- If the baby's lips or face are still blue one hour after birth, the baby may have a problem with his heart or lungs. He may also need oxygen. Place the baby skin to skin with the mother, and cover them to stay warm. Go to the hospital now.
If the baby looks yellow
If the baby seems yellow less than a full day and night after the birth, he may have jaundice or an infection Get medical help.
If the baby is pale
A pale, limp baby may be anemic or have other problems. Get medical help now.
If the baby is very red
A very red baby may be OK. Watch him carefully for a week for signs of jaundice. Get medical help as soon as possible if the baby becomes yellow, starts breathing fast, or has trouble breastfeeding.
Baby has disabilities
When you look a baby over from head to toe, you may see signs that she has an illness or disability. Or you may see that the baby is somehow different from other babies. These differences or disabilities are sometimes small and not dangerous, like cleft lip. Or they may be very serious and life threatening, like a large opening in the spine (spina bifida). If you find anything unusual, get medical help.
If the baby has a disability, the parents may be very accepting, or they may not. Some people think that disabilities are caused by curses or bad luck. Some families feel sad that their child is not the way they imagined, or not like other children. They may feel overwhelmed by the extra help that they may need to give a child with disabilities. Parents of children with disabilities often need extra support.
Help these parents:
- find good medical care for their child.
- learn about the child's specific needs.
- learn about the child’s strengths and help the child learn to use these to navigate their world. For example, a child who will not walk because of a disability in her legs may have very strong arms and hands and a clever mind.
There are many helpful books for parents and caregivers of children with disabilities. Disabled Village Children, Helping Children Who Are Blind, and Helping Children Who Are Deaf are all available from the Hesperian Health Guides.
Immunizations given at birth
Hepatitis B vaccine Hepatitis B is a serious infection that can cause fatal liver disease. Hepatitis B can be passed from an infected mother to a baby during birth. The vaccine is very effective for prevention. For best protection the first of 3 injections (sometimes 4) should be given at birth.
BCG vaccine In places with a lot of tuberculosis (TB), a vaccine called BCG may be given to all babies at birth to prevent TB. Elsewhere, it only is given at birth if the mother has TB. BCG vaccination does not always work, so people who have been vaccinated should still be careful not to be exposed. Babies who are HIV positive and have any signs of illness should not be given the BCG vaccine.
If you do not give these vaccines yourself, help the mother have the baby immunized as soon as possible. For a complete listing of childhood immunizations, see Where There Is No Doctor, page 147.
HIV medicines While not a vaccination, babies who have HIV or were exposed to HIV during pregnancy because their mothers had it should be started on antiretroviral treatment as soon as possible. See here for more information.
Clean up and answer the family’s questions
Clean up the birth area. Anything that has blood on it, including the placenta, must be disposed of so it does not spread germs. Learn how to safely dispose of tools and wastes.
Make sure the family has all of their questions answered before you leave.