Mother andNew Baby Care

Mother andNew Baby Care

Visitation PolicyOur hospital has an open visitation policy as part of our patient- and family-centered care. Visitors who plan to stay past 9 p.m. must receive a visitor tag from the patient’s nurse.

The first hour after birth is a very special time for parents and other siblings. If you and your newborn are adjusting well, we encourage you to spend this time together as a family.

When siblings are with the baby, a responsible adult, other than you, must be with them at all times. Other friends, neighbors and siblings who may be sick should delay their visit until you and your baby are at home. If you are too tired to receive visitors, or want your visitors limited, please inform your nurse.

Welcome to our UnitCongratulations on the upcoming birth of your baby! Thank you for selecting the Birthing Spa at Ephraim McDowell Fort Logan Hospital for this wonderful experience. Our highly-skilled physicians and nursing staff are committed to providing excellence as they meet your health care needs.

During your labor process, please let your nurse or physician know of any special activity you and your support person may like to try – such as walking in early labor or sitting in a rocking chair – unless there are reasons you shouldn’t do them. We are able to monitor your baby during this activity.

Please refer to this booklet during your hospital stay and after you are discharged home for important information on caring for yourself and your baby.

The HUGS Infant Protection SystemAs part of our HUGS Infant Protection System, we will place a band/tag on your baby’s ankle soon after delivery. It will stay on your baby the entire time the baby is in the hospital. Please do not remove the HUGS tag for any reason. An alarm will sound if the HUGS tag is removed from your baby or if the baby is taken off the Birthing Spa Unit. If necessary, a nurse will make adjustments with the fit of the tag on your baby’s ankle.

Corresponding Numbered Bracelets These bracelets are applied in the delivery room to the baby, the mother and the father (or designated significant other). Each must wear their matching I.D. bracelet during the entire hospital stay. The bracelets will be checked every shift by a nurse for accuracy and proper fitting.

If your baby is in the nursery, your baby will not be released from the nursery to anyone who is not wearing its corresponding number I.D. bracelet.

If the mother or father (or the designated significant other wearing the I.D. bracelet) is unable to come for the baby at the nursery door, please press the NURSE CALL button in your room and request a nurse to bring your baby. Be sure both you and the nurse check I.D. bracelet numbers to ensure you receive the correct baby.

All authorized personnel who work on the Birthing Spa wear a LAVENDER I.D. badge as a means of identification. Feel free to question anyone requesting to take your baby. Insist on knowing where the baby is going and when to expect its return. Never permit ANYONE to take your baby out of the room if they do not show you their LAVENDER I.D. badge.

Other Guidelines to Protect Your Baby • Never leave your baby alone or unsupervised

in the room. Return your baby to the nursery when you are showering, sleeping, walking in the hallway or leaving the Birthing Spa Unit.

• Never carry your baby in the hallway. Always place the infant in the crib for transport.

• Only authorized personnel are permitted in the locked nursery at any time. Your baby’s nurse may request you to come into the nursery on various occasions (for example: breastfeeding assistance, infant care class or discharge instructions).

Currently Ephraim McDowell Health does not have a routine home visiting nurse practice for newborns. However, special medical conditions may require follow-up home care, or certain health insurance programs may include home visiting nurses as a part of their practice. DO NOT allow anyone into your home who is claiming to be a health care representative without knowledge of a pre-arranged visit and without requiring them to present their authorizing identification.

Infant SecurityThe Ephraim McDowell Fort Logan Birthing Spa has established guidelines to assure the security and well-being of your baby. Our Infant Identification/Security System is based on two different means of security.

Pain Associated with Labor and DeliveryLabor can be very painful. It is important to understand your options for pain management and to remain flexible on your choices. We use a “pain scale” to help identify your level of pain. This scale is defined as 0 to 10; 0 = no pain, 10 = most severe pain.

Types of Analgesia – Anesthesia Systemic Analgesia – relief without total loss of feeling. IV medications such as Stadol may be given if you choose not to have an epidural.

Local Anesthesia – Lidocaine or Xylocaine are injected into perineum to numb the area for episiotomy and repair.

Pudendal Block – injected through the vaginal wall, blocking the pudendal nerve that runs alongside the cervix. This allows you to actively push and is effective for episiotomy repair.

Epidural – medicine injected into the lower back. This flexible catheter inserted into the epidural space allows for a continuous drip of medicine for continuous, evenly-distributed pain control with no sedation throughout labor and delivery.

Spinal – used for Cesarean births – injected into spinal canal. This gives complete pain relief from nipple line down, allowing you to be awake and alert for the birth of your baby and allowing your significant other to be present.

General Anesthesia – not administered to laboring patients. Anesthesiologist administers the general anesthetic through the IV. You are unconscious, asleep, and feel no pain. Your significant other may be with the infant in the nursery but will not be permitted in the Operating Room.

Relaxation/Comfort MeasuresDuring labor and birth, relaxation can be used to help set the mood, provide adequate oxygen to mother and baby and decrease tension, pain and fatigue. To aid in relaxation, consider these:

• Comfort – Choose a comfortable position and use plenty of pillows for support. May use rocking

chair, warm or cold compresses or ice chips. A bath or shower, birthing ball or squatting bar may also provide comfort.

• Environment – Adjust surroundings by closing the door, taking the phone off the hook, dimming lights and playing soothing music.

• Focus – Focus inwardly with eyes closed to decrease distractions.

• Imagery – Visualize your “special place” or a favorite memory.

• Breathing – Try to mimic your style of breathing done while sleeping.

• Touch – Use touch with light and/or heavy massage to enhance the relaxation response.

Nitrous Oxide for Pain ReliefNitrous oxide use for labor pain is a mixture of 50% nitrous gas and 50% oxygen that is inhaled through a mask that you hold and self-administer, as you wish. It can help to lessen both pain and anxiety when used during induction, natural labor and childbirth.

Paced Breathing Start breathing techniques when you feel the need for anxiety, pain or tension release. Begin and end with a deep breath to “cleanse” your body and mind. Try to relax all muscles before, during and after a contraction. Choose an internal (eyes closed) or external (eyes open) focal point.

You determine pace, depth and use of nose/mouth for all techniques.

If there is a difficult situation:

1. Take some cleansing breaths and relax.

2. Realize what is happening and stay calm.

3. Focus on the options, not the problem.

4. Consider all choices and weigh the benefits and risks of each.

5. Ask questions and get any information you need.

6. Make the best decision you can.

Pre-Epidural Information A labor epidural/spinal is a method of injecting pain medicine alongside or into the central nervous system to achieve excellent pain control with minimal effect on the baby. The most common complication is popping into the spinal envelope with the epidural needle. This often happens if the patient moves or bears down when the needle tip is in the epidural space. It results in a headache, which may require treatment to manage. Very uncommon, but devastating complications include an infection, a blood collection, a medication intolerance, all of which could cause paralysis or death. This requires sterile conditions, reviewing pre-epidural laboratory results, and care in the selection and use of the medications, which your anesthetist will do. No precautions take away all the risks and, though severe complications are very rare, they are always possible. If you have questions, ask your provider who can refer you to one of the anesthesia providers.

Post-Partum Pain after having a baby may be caused by stitches, tears, “afterbirth cramps,” incisions, hemorrhoids and breast soreness. Each person feels pain differently. Some assessments performed by nursing may be uncomfortable. Some things can be done to reduce the level of discomfort as pain can cause stress and interfere with your ability to care for your infant. You will be asked to rate your pain on a scale of 0 – 10. Your abdomen may be rubbed to assess the firmness of your uterus and prevent too much bleeding. Ice will be applied to the stitches for six hours after delivery. Sitz baths three times a day for a week after delivery are recommended.

If a Cesarean-section birth, we will provide you with oral pain medication to help keep your pain score to 2 or below. Comfort measures such as walking, rocking

in a rocking chair and avoiding gas-forming foods and carbonated beverages will help prevent excessive discomfort. Any headache should be reported to the nurse.

The epidural needle tip is placed on top of the envelope. It does not pop through on purpose. The epidural catheter is a thin tube that gets passed through the needle. The needle is threaded off and thrown away, but the thin tube stays in the patient’s back. Pain medicine is injected into the thin tube.

A “spinal” needle pops through the envelope and Cerebral Spinal Fluid drips out. Medication for pain can be injected into the Cerebral Spinal Fluid. The spinal needle can also be passed through an epidural needle, which makes the procedure a Combined Spinal/Epidural.

The envelope surrounding thebrain and spinal cord is called the “dura”.

The brain and the spinal cord “float” in the spinal fluid.

Cerebral Spinal Fluid

“Epi” means “on top of,” so “epidural” means puttingmedicine on top of the dura (the envelope).

Back bones called “Vertebrae”

The Spinal Cord ends at a certain vertebral (back bone) level, which your anesthetist will identify and avoid when placing the Spinal and/or Epidural needles. This may include briefly using an Ultrasound Machine.

Spinal Cord Envelope

EpiduralNeedle

SpinalNeedle

Mother/Baby CareMother/Baby Care is a nationally-recognized concept that provides a new mother with the opportunity to learn all she can about how to take care of herself and her baby. Just after delivery, you and your support person will have the chance to begin early bonding with your baby. You may also begin breastfeeding at this time.

You and your baby will be cared for and taught by the Mother/Baby Caregivers. You will learn many caregiving skills from observing your nurse and from watching videos for new mothers and will be encouraged to begin to care for your baby yourself as you feel able to do so. If you are breastfeeding your baby, your nurse can give you personalized instruction to get you and your baby off to a good start. A Certified Lactation Consultant and Certified Breastfeeding Consultants are available for further assistance.

Newborn PhotosDiscretionary use of cameras is welcome except during the actual delivery. A picture of your baby will be taken by digital camera within the first few hours after birth (with a signed consent form from you as parent) and kept for security purposes until your discharge.

Kangaroo CareKangaroo Care is a special way to hold your baby for skin-to-skin contact. Immediately after birth, unless medical reasons prevent it, your baby will be dried off and placed on your bare chest wearing only a diaper and hat. Both you and your baby will be covered with blankets. The baby snuggles on your chest in this position the first 60 to 90 minutes of life or until the first breastfeeding.

If you can’t begin Kangaroo Care immediately after birth, your nurse will help you start as soon as possible. Even if you do not plan to breastfeed, you can hold your baby in Kangaroo Care. Dads can also Kangaroo Care to bond with the baby. We encourage you to continue Kangaroo Care when you return home.

Doctors say that holding a baby skin-to-skin is the “best care” for your baby because it:

Delayed bathing is the common practice in the Birthing Spa. If you choose to have your newborn bathed soon after delivery, please let your nurse know.

• Helps your baby adjust to the outside world more easily because he can hear your heartbeat and feel your warmth.

• Helps to keep your baby warm.

• Helps baby maintain a good heart rate and breathing rate.

• Helps to better develop your baby’s brain.

• Helps your baby to cry less and sleep more.

Voluntary Acknowledgement of PaternityAfter your baby’s delivery, we can help you to complete a Voluntary Acknowledgement Paternity form if you are not married to your baby’s father. Completing a voluntary paternity form allows the father’s name to be listed on the birth certificate, and he will be established as the legal father. This may entitle your child to benefits such as insurance, social security, veteran’s benefits and more. The process is easy, convenient and free if you complete the form at the hospital before you leave. Call the Kentucky Paternity Acknowledgment Program toll-free at 1-888-675-7425 for more information.

What is Paternity Acknowledgement? Paternity acknowledgement is the process that makes a man a legal father and establishes a parent-child relationship under the law.

What does Paternity Acknowledgement involve and how is it done? The process involves a legal document that must be signed by both parents in front of a notary provided by the hospital. This service is offered at Ephraim McDowell Fort Logan Hospital. There is no DNA testing involved. The father of the baby must have a picture ID. If interested, please call the nurse’s station at (606) 365-4767. They will be happy to assist you.

For additional information or questions regarding paternity, please contact your nurse. If you are discharged and would like to complete the affidavit, please call your local health department or child support office.

If either parent is under the age of 18, the affidavit must be completed at a health department, child support office or county attorney office. Contact your local health department for more information.

Rights and Responsibilities of the Unmarried Parent In accordance with KRS 213.046, when a birth occurs in a hospital, or en route to the hospital, to a woman who is unmarried, the hospital representative shall present to the mother, and father, if available, except when either parent is a minor, information regarding the establishment of paternity. If the parents agree, the hospital representative shall provide the Voluntary Acknowledgement of Paternity form for the parents

to complete in front of a notary. The Voluntary Acknowledgement of Paternity form shall accompany the birth certificate to the Office of Vital Statistics where the father’s name will be added to the birth certificate. A copy of the Voluntary Acknowledgment of Paternity form will then be forwarded to Child Support Enforcement.

All unmarried parents should review the following rights and responsibilities before completing a Voluntary Acknowledgement of Paternity form.

Rights and Responsibilities of the ParentsI understand:

• If I have questions regarding the legal effect of signing this form, I should seek legal advice.

• That I have the right to request genetic testing prior to signing this form if I have any doubts concerning the paternity of the child whose name appears on the affidavit.

• I have read the paternity acknowledgement information. I have also been given an oral explanation of the voluntary acknowledgement

Frequently Asked QuestionsQ. We know that he is the father, why should we

establish paternity?

A. Paternity acknowledgment is not a DNA test or a question of who the father is. It is a legal document that makes the father a LEGAL father and allows Vital Statistics to enter his information on the legal birth certificate.

Q. If we sign the Acknowledgement of Paternity, can we still do a DNA test?

A. Yes, however, it is HIGHLY recommended that if there is a question of who the father is, that a DNA test be done prior to signing the paternity acknowledgement form. This is a legally binding document.

Q. I am a mother who is still legally married and my husband is not the father of my baby. Can we sign the paternity acknowledgement form?

A. Yes, as long as you have been separated from your

husband for at least 10 months prior to the birth of your child.

Q. One or both parents are under the age of 18; can we sign the paternity acknowledgement?

A. Yes, however due to Kentucky state law, the form cannot be signed in the hospital. You must contact your local health department, child support division or county attorney office.

Q. How do we sign the Acknowledgement of Paternity in the hospital?

A. On your clipboard on your baby’s bassinet, you will find a four-page purple birth certificate worksheet. Complete the information. We need a picture ID from the father of the baby (mother’s ID is on file). Tell your nurse that you would like to sign a paternity acknowledgement. A notary public will be contacted for you.

* Neither parent may sign the form until a hospital notary is present!

process and alternative available to me or I have heard an audio tape or seen a video providing this information.

• I have the right and have been given the opportunity to ask questions before signing this form. “Opportunity to ask questions” includes contacting the child support agency at the toll free number, even if this means delaying my signing this form.

• The information that I have given on this form is true.

• I may be responsible to provide child support and medical insurance for this child at least until said child reaches the age of emancipation, or is otherwise legally emancipated.

• That if this child receives public assistance, I may be required to make child support payments to the State.

• That I may be responsible for hospital and doctor’s fees for the birth of this child.

• That this signed acknowledgement may be rescinded (taken back) by either parent signing the form the earlier of

1) 60 days, or

2) administrative or judicial proceedings relating to the child including setting support. Afterwards the acknowledgement may be contested in court only on the grounds of duress, fraud or material mistake of fact.

• That I do not automatically have custody or visitation rights by signing this form. I must go to court for those issues to be decided.

• This form will be sent to the Office of Vital Statistics. If all items are correctly completed and the affidavit is notarized, my name will be placed on the child’s birth certificate as the father.

• If this form is not SIGNED IN FRONT OF A NOTARY my name cannot be placed on the birth certificate as the father.

I understand this is a legally-binding document. It has the same weight and authority as court-ordered paternity.

I understand that any changes to the birth certificate after this form has been filed with the Office of Vital Statistics shall require a court order.

A Bigger Part for New Dads There was a time when dad’s role in the birth and infant-rearing process was limited to getting the prospective mother to the hospital, pacing in the waiting room, and providing the proverbial cigars. Today, however, fathers attend childbirth classes with the mother and are present for the baby’s birth.

This active involvement of fathers in the birthing process has done much to dispel some deeply entrenched notions that nurturing a baby is a mother’s exclusive domain. It’s possible, and quite natural, for you to have concerns that too much involvement in caring for an infant is out of sync with your traditional role.

You may want to do more for your baby, including tasks that have traditionally been the mother’s. According to leading child development experts, you “should go with these feelings,” for the mutual benefit of the entire family.

With the exceptions of giving birth and breastfeeding, there’s nothing a mother can do for a child that you can’t. Even if you won’t be staying home to care for your child, it is not unusual for today’s dad to take a short leave of absence after the birth of a child. This is not only a great help to your wife, who needs your assistance and support, but also a good opportunity for you and your baby to develop deep, lasting bonds.

State Newborn Screenings Kentucky law requires that all newborns have a screening test to identify hidden disorders that can cause serious problems for your baby if not treated soon after birth. Babies are tested for 48 rare but serious medical conditions. Babies with these conditions may look healthy at birth. If not treated, these conditions can cause problems such as intellectual disability, slow growth and even death.

Babies are tested 24 to 48 hours after birth by hospital staff. It is a blood test, and the risk of infection is low. The test is sent to the Kentucky State Lab for processing.

Disorders identified by newborn screening

• Congenital Hypothyroidism • Phenylketonuria (PKU) • Cystic Fibrosis (CF) • Galactosemia • Biotinidase Deficiency • Congenital Adrenal Hyperplasia • Hemoglobinopathies • Amino Acid Disorders • Organic Acid Disorders

Your baby’s health care provider will have a copy of the test results. You can ask about these results when you take your baby for a check-up. Your baby’s doctor will be contacted if there are any positive or unusual test results, and will talk to you about the test results. This is a screening test, which finds those babies who may be at risk. A positive or unusual result does not always mean that a disorder is present.

If your baby is found to have a disorder, his or her health care provider will discuss with you the treatment options. The early diagnosis and treatment of the disorder will allow your baby the best chance of normal growth and development.

If you need additional information, please talk with your child’s health care provider, call the Kentucky Newborn Screening Program or go to http://chfs.ky.gov/dph/mch/ecd/newbornscreening.htm.

How Will I Measure Up?At some time during your wife’s pregnancy you probably started wondering what kind of father you would be. This soul-searching is likely to continue after the birth of your child.

Will you be the type of father your father was? Much of what we bring to our own concept of parenting comes from what we ourselves experienced as children.

New fathers frequently experience doubts about their ability to provide substantial financial security for their families. These doubts may stem from a real, increased need to provide for “another mouth to feed,” or they may arise as the result of very high goals you may have set to give your child “the best of everything.”

Quality TimeThe term “quality time” has become popular over the last several years although some people may not be clear what it means. Quality time is any time spent with your child in which your child knows that he or she has your complete attention. This may include feeding time, bath time, or the few minutes it takes to tuck your child into bed and read him or her a story.

If you really must be away from home much of the time, make sure the moments you share with your family are memorable ones. Take time to plan weekly outings, especially with toddlers and older children. Make sure they know that this is their special time, and tell them how much you look forward to it. If your wife works, expect to share not only the household chores, but also daycare activities.

Pulse Oximetry Testing for Critical Congenital Heart Disease (CCHD)Critical congenital heart disease (CCHD) is the most common of all birth defects. They can affect 1 in every 100 babies born in the U.S. each year and account for nearly 30% of infant deaths due to birth defects. About half of these are found after birth when a normal infant has life-threatening problems and requires emergency care.

Newborn screening using Pulse Oximetry Testing can

identify some infants with a CCHD before they show signs of a CCHD. Kentucky is now doing this simple test before the baby is sent home from the hospital after birth. This test is done by putting a sensor on your baby’s foot and arm to read the oxygen percentage in his or her blood. The procedure is not painful to the baby and only takes minutes to perform.

Once identified, babies with a CCHD can be seen by cardiologists and can receive specialized care and treatment that could prevent death or disability early in life.

Hearing ScreeningKentucky law requires that every baby born receive a hearing test. Studies show that about six of every 1,000 babies born have significant hearing impairment. Without newborn testing, hearing loss often goes undetected until age 2 or later.

The first two years of a baby’s life are the most important for speech and language development. Even mild hearing loss, if untreated, can cause learning disabilities that may not be overcome.

The screening itself is painless and is performed by specially-trained nurses in the newborn nursery. It involves placing three small electrodes on your baby’s head and neck. The electrodes record your baby’s responses to the clicks and send them to an instrument that analyzes the responses. Most babies sleep throughout the test.

If your baby’s hearing test shows that further evaluation is needed, your baby’s physician will discuss this with you and you will receive a list of clinics to contact for follow-up hearing testing from Kentucky’s Universal Newborn Hearing Screening Program. Follow-up testing is very important. If your baby has a hearing loss, you will want to find out early.

Some babies may need further hearing testing even if they passed a hearing screening at birth. It is important to talk with your child’s doctor and make an

appointment for further testing if:

• You have a family member with permanent hearing loss since childhood.

• Your baby was exposed to an infection before birth.

• Your baby or you had an infection at birth such as sepsis or cytomegalovirus.

• Your baby had an infection of the brain after birth such as meningitis.

• Your baby had severe “yellow jaundice.”

• Your baby’s head, face, or ears have an unusual shape or form.

• Your baby had breathing difficulty at birth or immediately following birth.

• Your baby had a head injury.

• Your baby was given medications that can harm hearing.

• Your baby had to stay in the Neonatal Intensive Care Unit for more than five days.

Kentucky’s Early Hearing Detection & Intervention Program helps families get the services they need. Please call them at (877) 757-4327 if you have questions or want to know where to get a hearing test.

(WIC) ParticipantsWIC is a special supplemental nutrition program for Women, Infants and Children. As soon as possible after your baby’s birth, you or your baby’s father should contact your local health department for your WIC voucher. The birth data can then be processed so that you or your baby’s father receives the voucher. You or he will need to show your hospital I.D. bracelet to the WIC representative.

Redeem the voucher at your pharmacy, grocery or retail store. Upon your discharge, the formula for your infant will be ready for your use.

A major goal of the WIC program is to improve the nutrition of infants. Mothers who participate in the WIC program are encouraged to breastfeed their infants and may be eligible to receive a breast pump to help support the initiation and continuation of breastfeeding. WIC mothers who choose to breastfeed exclusively receive an enhanced food package.

Hepatitis B Vaccine Hepatitis B is a serious disease that affects the liver, caused by the hepatitis B virus. It can cause mild illness lasting a few weeks or lead to severe illness, liver cancer and even death. Many people who get hepatitis B do not look or feel sick. Others may have fever, fatigue, loss of appetite, nausea and/or vomiting, jaundice (yellow skin or eyes, dark urine, clay-colored bowel movements) or pain in the muscles, joints and stomach.

Babies are less able to fight hepatitis B virus infection than older children or adults. About 90% of infants who get hepatitis B become chronically infected and about 1 out of 4 of them dies.

You may not know if your baby is exposed. Many people with hepatitis B virus do not know they have it because they do not look or feel sick, but they can still spread the virus to others. A baby whose mother is infected can be infected at or after birth. People can also become infected when they have contact with the blood or open sores of an infected person.

Each year about 2,000 people in the United States die from hepatitis B-related liver disease. Hepatitis B vaccine can prevent hepatitis B and its consequences,

including liver cancer and cirrhosis.

Hepatitis B vaccine is made from parts of the hepatitis B virus and is usually given as three or four shots over a six-month period. Infants should receive their first dose of hepatitis B vaccine at birth and then complete the series at 6 months of age.

The most common reactions to the vaccine are soreness where the shot is given and mild to moderate fever. These side effects may last one to two days.

For additional information on the hepatitis B vaccine, contact your health care provider, your local or state health department or you may visit www.cdc.gov/vaccines or call (800) 232-4636.

Circumcision Care Circumcision is the removal of the foreskin of the penis. This can be done surgically using a special clamp, or non-surgically using a plastic ring, which places pressure on the foreskin, causing it to fall off in five to eight days. The infant will experience mild pain during the circumcision and may be uncomfortable until the penis heals.

Keeping your baby on his side and off his abdomen for the first 12 hours can minimize pain and pressure. Check for bleeding with diaper changes and apply a gauze pad with Vaseline on it over the tip of the penis to prevent sticking to the diaper. Report any bleeding to the baby’s nurse or doctor immediately.

Continue sponge baths until the circumcision is healed. Clean area gently with soap and water at bath time. If there is no swelling, gently and without force, pull back any remaining foreskin. Clean around the base of glands to remove any visible white secretions. Again, gently pull the foreskin forward.

A circumcision usually takes 7 to 10 days to heal. During this time it may have an irritated or yellowish appearance. Report any reddening, pus, excessive swelling or foul odor to your baby’s doctor.

If your son has a plastic ring used in non-surgical circumcisions, no special care is required. However, if at any time, the head of the penis protrudes through the plastic ring, you should:

• Apply a small amount of Vaseline.

• Secure the ring with the forefinger and thumb, grasping each side of the ring.

• Gently slide the head of the penis back through the ring with your other forefinger.

If you are unable to push the head of the penis back through the ring, contact your baby’s doctor before swelling occurs. If the ring has not fallen off within two weeks, notify the doctor.

Your baby’s nurse can answer any questions you may have concerning circumcision, its care, or need for personal assistance with your baby before going home. Please ask her.

Caring for Your Newborn 1. Keep the area around your baby’s umbilical cord stump clean, using plain water if it becomes dirty or sticky.

Expose the stump to air to help it dry out.

2. Sponge bathe your baby until the navel cord and circumcision are healed.

3. Use the bulb syringe and/or saline drops to clear your baby’s nostril from secretions.

4. Call your baby’s doctor when you notice any of the following:

• Behavioral change • Refuses food • Persistent crying

• Vomiting and/or diarrhea • Difficulty breathing • Fever (greater than 101 under arm)

Breastfeeding Your BabyWe encourage you to consider breastfeeding your baby. Breastfeeding provides your newborn with necessary minerals and many important antibodies to help protect your baby from infections caused by viruses and bacteria. Breastfeeding benefits your baby because breast milk is easy for your baby’s immature digestive system to digest and it helps to reduce the possibility that your baby will have allergic reactions. Breastfeeding also creates a special bond between you and your baby.

Benefits of Breastfeeding Breastfeeding reduces your baby’s risk for ear infections, skin infections, stomach infections, respiratory infections, diarrhea, SIDS (Sudden Infant Death Syndrome) and bowel problems. It also reduces your baby’s risk for obesity, Type I and II diabetes, asthma and childhood leukemia. Breastfeeding is also important to you, as it reduces your risk for breast cancer, ovarian cancer, Type II diabetes and postpartum depression.

Breastfeeding FactsThe first milk your baby receives is called colostrum. (You may have been leaking this while you were pregnant). Colostrum is replaced by milk three to five days after delivery. At this time, you may have a brief period (24 to 48 hours) of engorgement, which may cause your breasts to feel firm and tender.

This is different from the fullness you may feel before a feeding. When your baby nurses, your body responds by sending milk from the glands in your breast through your nipples (known as the “let down”). This may feel like pins and needles or a tingling sensation. Some women do not notice it at all.

What to do in Case of Uncomfortable EngorgementEngorgement is known as the “coming in” of milk. It occurs three to five days after delivery. Symptoms are an increase in the size, temperature and firmness of your breasts. Treatment options include massaging the breast before feeding, softening the areola by expressing milk,

nursing often, applying ice packs (15-20 minutes each breast) after feeding, pumping for comfort and using a mild pain reliever (Tylenol/Ibuprofen).

Sore Nipples

• Check the baby’s latch. • Break suction appropriately. • Alternate feeding positions. • Offer the least sore breast first. • Provide shorter or more frequent feedings. • Air-dry the breast. • Place breast milk on nipples. • Use lanolin cream and/or comfort gel pads.

Blocked Milk Duct A blocked milk duct is a tender lump in the breast or possibly a white bump on the nipple. Treatment options include applying moist heat before feeding, nursing frequently, massaging the area before and during feeding and getting plenty of rest.

MastitisThis is an infection of the breast tissue. It is most common during the early months of breastfeeding but can happen at any time during the course of nursing your baby. Symptoms include breast pain, swelling, warmth, redness, fever and chills (flu-like symptoms). If you notice any of these symptoms, call your health care provider.

Breastfeeding Tips Breastfeeding is a learning process for both mother and baby. If you plan to breastfeed, let your labor team know as they can help you right after delivery. If possible, it’s important to try to nurse within the first hour after birth.

When you are ready to begin nursing, cup your breast in your hand and stroke your baby’s lower lip with your nipple. Your baby’s chin should be off the chest.

When your baby opens his or her mouth big (like a yawn), quickly point your nipple toward the roof of the baby’s mouth – making sure the baby’s tongue is down – and pull the baby close to your breast. It may take several attempts to get the baby to latch on correctly. Use your clean finger to break the suction and try the latch again.

Feed your baby on demand. The average feeding time is 10 to 20 minutes on each breast. Watch for hunger cues to know when to feed (rapid sucking motions, nuzzling on bed linens or your breast).

You should nurse eight to 12 times in a 24-hour period (every one and one-half to three hours). Alternate which breast you begin nursing with each feeding. The baby may or may not take both breasts each feeding.

Avoid bottles and pacifiers the first three weeks. Once a baby is latching effectively and gaining weight, a pacifier may be used or a bottle with breast milk may be introduced. Never let a pacifier substitute for a feeding.

Breastfeeding PositionsCradle Hold – Sit up straight and cradle your baby in the crook of your arm, with your baby’s belly against your belly. Support your baby’s head in the bend of your elbow.

Football Hold – Tuck your baby under your arm like a football, supporting your baby’s back with your upper arm and holding baby’s head level with your breast.

Cross-Cradle Hold – With your baby’s belly against your belly, hold your baby with your other arm so that baby’s bottom rests in the crook of your arm and your hand supports baby’s head.

Lying Down – Lie on your side and nestle your baby against you. Place your fingers beneath your breast and lift it up to help your baby reach your nipple.

Baby BelliesA newborn’s small stomach is adequately filled by frequent breastfeeding. Baby’s stomach grows as mom’s milk increases.

Birth ControlTalk with your health care provider about what form of birth control is right for you. Good choices for hormonal birth control are the progestin-only pill, implants or injections. These options rely on the hormone progestin and do not contain estrogen, which may decrease your milk supply.

ShooterMarble5-7 ml

Ping PongBall

22-27 ml

LargeChicken Egg

60-81 ml

Day 3 Day 10Day 1

Nutritional Needs While BreastfeedingYour nutritional needs are very important if you are breastfeeding your baby. Please consider these guidelines for your diet while you are breastfeeding:

The following tips can help you cope with the discomfort of engorgement:

• After delivery, wear a well-fitting bra that covers the breasts completely. You should wear your bra day and night,

removing it only for bath time. • Avoid direct heat or warm

water to your breasts as they will stimulate your milk

production. When showering, do not let warm water directly hit your breasts. Avoid any nipple stimulation.

Management of Breast Engorgement for Non-Breastfeeding Mothers

Even if you do not breastfeed your baby, you still may experience breast engorgement. Between the third and fifth day after delivery, your breasts may feel very hard, hot, lumpy and tender to touch. You may even notice a slight rise in your temperature and a headache. Sometimes the skin covering the breast area may be red and shiny. This is a normal response to the sudden change in hormones, the presence of milk and an increase in blood flow to your breasts. The degree of engorgement and discomfort varies greatly among mothers. Although the discomfort usually lasts only a few days, it can be very painful.

BeveragesConsume at least eight cups daily of water, decaffeinated coffee or tea, low-fat milk, juices and decaffeinated soft drinks. Avoid alcohol, which passes through into breast milk. Use herbal teas with caution. Limit caffeine to two servings per 24 hours.

Grains/StarchesEat at least six to 11 servings every day of whole grain breads, whole grain or bran cereals, brown rice, whole wheat pasta and whole grain crackers.

Fruits/VegetablesEat at least five servings daily of fresh, frozen, canned or dried fruit and/or vegetables, especially those high in Vitamin A and C. These include oranges, tomatoes, kiwi fruit, sweet potatoes, green peppers, blueberries, cantaloupe, apricots, spinach and strawberries.

Meat/ProteinEat seven to eight ounces of lean meat, poultry, eggs, peanut butter or fish. The best protein sources of

calcium are sardines, low-fat cheeses, low-fat cottage cheese and yogurt.

Sweets/TreatsUse sparingly as these have very little nutritional value for you or your baby.

Dairy FoodsConsume four to five servings daily of cheese, cottage cheese, milk and yogurt. Women who are nursing more than one infant may need six or more servings daily.

Miscellaneous • Stevia has been proven safe for both pregnant

and nursing women in amounts under twenty 12-ounce cans of diet soft drinks or 97 packets of tabletop sweetener daily.

• If any foods appear to cause baby to be fussy, avoid them for at least 72 hours and slowly reintroduce the food.

• Continue taking prenatal vitamins or any over-the-counter multivitamins.

• Use ice compresses for comfort and pain relief. Place ice chips in a bag, wrap in small towels and place on areas of the breast that hurt. You can also dampen a washcloth, place it in a bag and freeze it. Use clean towels and washcloths after each treatment to prevent infection.

• Use nursing pads or a clean, ironed handkerchief inside

your bra to absorb any milk that may leak from your breasts. Change the pads frequently to prevent irritation and soreness to your nipples.

• Take a mild analgesic (such as two Tylenol pills every four hours as needed) to relieve pain and fever.

• Drink only when thirsty as excess fluids will encourage

your body to produce more milk.

• Call your doctor if you develop a hard, swollen, hot, red and very tender area that does not improve with ice compresses. Flu-like symptoms such as aching joints, severe headache, nausea, exhaustion and/or fever that appears suddenly may indicate a breast infection.

Taking Your Baby Home Kentucky law requires that all children under 40 inches in height be placed in a car seat when riding in a vehicle. You will not be allowed to take your baby home from the hospital without a car seat. An Infant Car Seat

Training Class is available for all parents, taught by the Stanford Fire Department. Call (606) 365-4501 for an appointment to take this class.

Is Your Baby Feeding Enough?During your baby’s first few weeks, he or she will spend most of the time sleeping and feeding. The number of wet and dirty diapers that your baby has each day will let you know if your baby is getting enough to eat. During the first two days after your baby’s birth, the stool will be black, thick and sticky. It will turn green and pasty on the following two days and then be yellow, seedy and runny after that. If your baby has black stools on day three, green stools on day five or fewer than three stools a day after the first day, contact your baby’s health care provider.

Formula Feeding Your BabyAlthough breastfeeding is the best choice for baby, it may not be possible for all women. In those cases, infant formula is a healthy alternative to provide baby with the nutrients needed to grow and thrive. If you choose to formula feed your baby, you will need to sterilize the equipment used and prepare the formula for feeding.

Sterilization:If you have city water, you do not need to sterilize the bottles, nipples and caps. Wash them well in hot, soapy water and rinse well in hot water. If you are using cistern or well water, the bottles, nipples and caps must be sterilized according to a booklet that will be provided to you before you leave the hospital.

Preparation:You may use ready-to-feed formula or concentrated liquid. The ready-to-feed formula does not have

to be mixed with water before giving to your baby. Concentrated liquid must be mixed with an equal amount of water. If you have city water, you may use cold tap water. Otherwise, the water must be boiled according to directions found in the formula booklet.Formula should be stored in the refrigerator, and will be good for 48 hours. When it is time to feed your baby, warm the bottle in a pan of warm water for a few minutes. Sprinkle a drop or two of formula on the inside of your wrist. If it feels neutral or cooler, it is fine for your baby.

Selecting the Appropriate Safety Seat for Your Child 1. Keep your baby facing the rear of the car as

long as possible (one year minimum; two years recommended).

2. Keep your child in a safety seat with a harness as long as possible (three years minimum; four years recommended).

3. Keep your older child in a booster seat until he or she fits properly in the lap and shoulder belts in the car. To find out if your child is ready to wear just a safety belt, try the 5-Step Test at the bottom of this chart.

Type of Seat Child’s Age Child’s Weight(check mfg. inst.)

Child’s Height Comments

Convertible (may be used rear facing or forward facing)

Birth to about 3 to 4 years

Most models fit birth to 30-35 lbs. rear facing, and up to 40 lbs. forward facing. Some models fit larger children.

Rear facing: child’s head must be at least one inch below top edge of seat. Forward facing: shoulders must be at or below top strap slots.

5-point harness without shield preferred. Use rear facing as long as possible (one year minimum; two years recommended).

Forward facing only with harness

Age 1-2 to 4 years

Most models fit 20-40 lbs. Some models for larger children.

Shoulders must be at or below top strap slots.

May not be used when baby outgrows infant-only seat unless baby is at least 1 year.

Combination(forward facing only; harness is removable)

Age 1 to 8 years or more (use harness as long as possible, at least until 3-4)

20-30 lbs. up to 40-50 lbs. with harness; 30-40 lbs. up to 50-100 lbs. with lap and shoulder belt. Check instructions.

Remove harness if child’s shoulders are above top strap slots. Child’s head must be supported up to top of ears.

Some models have higher strap slots than those of convertible seats. When used as booster, make sure lap belt is not positioned too high.

Belt positioning booster (no harness included)

3 to 4 years until vehicle belt fits properly (see 5-Step Test)

30-40 lbs. up to 80-100 lbs. Weight limits vary; check instructions.

Child’s head must be supported up to top of ears. If vehicle seatback is low, use booster with backrest.

Must be used with lap and shoulder belt. Recommend booster with removable back and adjustable headrest.

Special products Birth to adult Birth to 160 lbs. Various Car beds, harnesses, large seats for children with special needs

Vehicle safety belt only

For children who pass the 5-Step Test; depends on vehicle, child’s size, and behavior.

SafetyBeltSafe U.S.A. P.O. Box 553, Altadena, CA 91003 www.carseat.org310/222-6860, 800/745-SAFE (English) 310/222-6862, 800/747-SANO (Spanish)

The 5-Step TestThe child is ready for a safety belt if the answer to every question is “yes.” 1. Does the child sit all the way back against the auto seat?2. Do the child’s knees bend comfortably at the edge of the auto seat?3. Does the belt cross the shoulder between the neck and arm?4. Is the lap belt as low as possible, touching the thighs?5. Can the child stay seated like this for the whole trip?

Birth to about 6 to 9 months

Birth to 20-22 lbs. Child’s head must be at least one inch below top edge of seat.

Smaller and lighter than a convertible seat. Most models have detachable base that stays in the car. May be sold as part of a stroller system.

Infant-only(must face rear of car)

Normal Developmental Milestones – Birth to 8 Weeks

Motor Control • Shows strong suck and gag

reflex (after first week of life)

• Makes crawling movements when prone on a flat surface; pushes with toes and holds hands in fists

• May lift head when held against shoulder; otherwise, head sags

• Lifts head intermittently, though unsteadily, when in prone position; by 8 weeks has better head control

• Turns head to side when prone

• Stares at surroundings

• Notices faces and bright objects but only in line of vision

Communication • Utters throaty noises; smacks

lips

• Smiles randomly; reduces activity in response to sounds; begins to smile by 6-8 weeks

• Responds to human face

• Cry is strong and lusty when hungry or uncomfortable

Play • Music boxes, soft radio music,

singing, mobiles

• Rocking

Safety • Requires car seat for safe travel

in automobile (until reaches 40 pounds)

• Place baby on side or back for sleeping

• Avoid placing baby on waterbeds

• Avoid drawstrings in hoods on clothing

• Do not leave unattended on beds, changing table, counter tops, etc.

Socialization • Enjoys being held, cuddled,

touched, talked to and smiled at

Physical • Weight: gains 5-7 ounces per

week during each month

• Height: grows approximately 1 inch during each month

• Pulse: 100-160 beats per minute

• Respirations: 30-60 beats per minute

• Temperature: rectal 97.7 degrees – 100.2 degrees

• Head circumference: 13-15½; generally ¾ inches larger than chest

• Immunizations: Hepatitis B virus (HBV) recommended

• Fontanels: soft and flat

• Feeding pattern: Breast every 2-3 hours; Bottle 3-4 ounces every 3-4 hours

• Stools: 2-6 per day. Breast fed - yellow, soft, runny, seedy; Bottle fed - yellow and soft

• Abdomen: soft and flat

• Urine: voids at least 6 times/day

• Color: lips, palms or hands, and soles of feet - pink

• Skin: generally clear without rash; small, profuse, yellow - white papules may frequently be found on face.

• Cord: Umbilicus clean, non-irritated; should dry and fall off during first or second week

• Eyes: Free of drainage or irritation

• Mouth: Clean, non-irritated

• Perineum: Non-irritated

• Circumcision site: Clean, non-irritated

Jaundice in Healthy Newborn BabiesWhat is Jaundice? Jaundice is a common condition in newborns that often appears shortly after birth. Most of the time it goes away on its own. If not, it is easily treated. Jaundice occurs when bilirubin, a product in the newborn’s blood that is broken down in the liver and exits in the baby’s stool, builds up to excess amounts.

Excess bilirubin makes a baby’s skin look yellow,

beginning on the face and then downward to the chest, stomach and legs. Some reasons for this build-up are: 1) baby’s liver is too newly developed to clear

bilirubin, 2) more bilirubin is being made than the liver can

break down, 3) too much of the bilirubin is reabsorbed from

the intestine before baby can pass it through the stool.

What is Bilirubin? Hemoglobin is found in all red blood cells. Red blood cells live only a short time and when they die, they change into yellow bilirubin. Adults and older children get rid of these blood products quickly, usually through excess bowel movements. Newborns have more bilirubin because their liver is too immature to clear excess amounts.

Is it Dangerous?If the level of bilirubin in the blood becomes too high, it can be dangerous. This level varies according to the newborn’s age and if other medical conditions are present. A small sample of the baby’s blood can be tested for the bilirubin level. Other tests can tell if other reasons are causing the level to be too high.

How to Know?Be alert of any changes in your baby’s skin color, especially in the whites of the eyes. Check your baby’s color in a room with fluorescent

light or in the natural daylight. An easy and quick way to check is by pressing lightly with your finger on the tip of the baby’s forehead or nose. If the skin looks white, there is no jaundice. This applies to babies of all colors. If you see a yellow color, contact the baby’s doctor to check if the level is too high.

How to Treat Jaundice?Mild and moderate levels of bilirubin do not need medical treatment. If high levels do not clear up without treatment, special lights can help with the breakdown of the bilirubin in your baby’s liver.

This may require a hospital stay for a few days. Some doctors treat babies with light therapy at home. Another way to treat high levels is to increase feedings of either breast milk or formula to help clear the bilirubin through the stools.

Water is not helpful since it does not bind with the stool as milk does. In rare cases, a baby may need to have a blood exchange to get rid of levels that will not clear using light

therapy. Once the bilirubin level falls, it is unlikely that it will climb again. If after 3 weeks of age your baby still looks yellow, contact your doctor.

Breastfeeding and JaundiceIt is not often that breastfed infants will need to stop nursing to treat jaundice. Often frequent nursing (10 to 12 times a day) can prevent high bilirubin levels by frequent stooling to rid excess amounts.

However, if the jaundice lasts more than a week, your doctor may ask you to stop nursing one to two days. You can pump your breasts to keep up your supply until time to restart nursing.

REMEMBER that jaundice in the healthy baby is seldom serious and usually clears up easily. A newborn with high levels of bilirubin needs to be checked by a doctor to prevent further medical problems. Talk to your baby’s doctor about your baby’s treatment of jaundice.

What Does a Safe Sleep Environment Look LikeYou can lower your baby’s risk of Sudden Infant Death Syndrome (SIDS) by doing the following:

• Use a firm mattress in a safety-approved crib covered by a fitted sheet. (For more information on crib safety guidelines, call the Consumer Product Safety Commission at 1-800-638-2772 or visit their website at http://www.cpsc.gov).

• Place your baby on his or her back to sleep for naps and at night until age 1.

• Use sleep clothing, such as a one-piece sleeper, instead of a blanket and keep the room at a temperature that is comfortable for an adult.

• Do not let anyone smoke near your baby.

• Avoid alcohol and illicit drug use.

• Keep soft objects, stuffed toys, and loose bedding out of your baby’s sleep area.

• Do not use pillows, blankets, sheepskins, or pillow-like bumpers in your baby’s sleep area.

• Make sure nothing covers the baby’s head.

• Keep your baby in the same room that you sleep in for at least six months but ideally for the first year. Your baby should sleep close to your bed but on a separate surface.

• Think about using a clean, dry pacifier when placing your baby down to sleep, but don’t force the baby to take it. (If you are breastfeeding your baby, wait until your child is 1 month old or is used to breastfeeding before using a pacifier).

• Avoid products that claim to reduce the risk of SIDS because most have not been tested for effectiveness or safety.

• Do not use sleep and breathing monitors to reduce the risk of SIDS. If you have questions about using monitors for other conditions talk to your health care provider.

Don’t Smoke Around Your BabyIf you smoke, your baby is more likely to have ear infections, asthma, allergies, colds, flu, pneumonia and bronchitis. Even if you reduce the number of cigarettes you smoke or use cigarettes with low levels of tar and nicotine, your baby will still breathe harmful chemicals.

You can reduce the amount of smoke your child inhales by smoking outside. There is no safe way to smoke indoors. Blowing smoke away from children, going into another room or opening a window will not protect children from all of the dangers of smoke. Air flow systems in homes cannot filter and move air well enough to get rid of smoke in the air.

The best choice is not smoking at all. If you smoke, stop. It’s not easy, but it’s the best thing you can do for your child. Call your local health department for help or more information on ways to stop smoking.

Poison Control If you suspect your baby has ingested something harmful, call the local Poison Control Center at (800) 222-1222.

If you suspect your infant is not breathing, tap him or her on the shoulder to check for responsiveness. If baby is not breathing, yell for someone to call 9-1-1 and then begin administering CPR following the steps below. If you are alone, start CPR immediately and call 9-1-1 if you do not get a response from your baby after two minutes of CPR. 1. Place baby on his back on a firm, flat surface. 2. Place two fingers of one hand in space between

baby’s nipples.

3. Gently compress the chest 30 times. 4. Tip baby’s head back with one hand and lift his

chin slightly with the other. 5. Cover baby’s mouth and nose with your mouth. 6. Give two breaths and watch to see if his chest

rises. 7. Repeat the sets of 30 compressions and two

breaths until your baby begins breathing on his own or until medical help arrives.

How to Perform Infant CPR

Remember Tummy Time! To reduce the chance that flat spots will develop on your baby’s head, it’s important that you place babies on their stomachs when they are awake and someone is watching.

Tummy Time helps your baby’s head, neck, and shoulder muscles to get stronger. You should also change the direction that your baby lies in the crib from one week to the next and avoid too much time in car seats, carriers and bouncers.

Never Shake a Baby!Taking care of a small child is a BIG job, and sometimes a parent can feel frustrated, overwhelmed and alone. These are normal feelings to have while taking care of a baby. Many times the stresses of day-to-day life – fatigue, family problems, financial strain and overworking – can make someone reach a breaking point, especially if a baby is fussy and crying for a long period of time. Unfortunately, babies and small children are the victims when feelings of frustration result in violent shaking to stop the child from crying.

What is Shaken Baby Syndrome? When a baby is vigorously shaken, the head moves back and forth. This sudden whiplash motion can cause bleeding inside the head and increased pressure on the brain, causing the brain to pull apart, resulting in injury to the baby.

This is known as Shaken Baby Syndrome. Head trauma is the leading cause of disability among abused infants and children.

Shaken Baby Syndrome occurs most frequently in infants younger than 6 months old, yet can occur up to the age of 3. Often there are no obvious outward signs of inside injury, particularly in the head or behind the eyes. In reality, shaking a baby, if only for a few seconds, can injure the baby for life.

These injuries can include brain swelling and damage, cerebral palsy, mental retardation, developmental delays, blindness, hearing loss, paralysis and death.

How Does it Happen?Often, frustrated parents and other persons responsible for a child’s care feel that shaking a baby is a harmless way to make a child stop crying.

Other times, children become victims when a parent or caretaker, not realizing how seriously this behavior can harm, throws a small child vigorously into the air, plays too rough or hits an infant too hard on the back.

What Can You do to Prevent a Tragedy? • Never shake or throw a baby around.

• Always provide support for the baby’s head and neck.

• Educate parents, grandparents, caregivers, new parents, baby sitters, teenagers, siblings and licensed childcare providers about the dangers of shaking a baby.

• Choose childcare providers and baby sitters carefully. Know how they play with children and how they will react when the children are upset.

• If you or someone else shakes a baby, either accidentally or on purpose, call 911 or take the child to the emergency room immediately. Bleeding inside the brain can be treated. Immediate medical attention will save your baby many future problems … and possibly save the baby’s life.

You Can Cope!If you feel overwhelmed and frustrated by your baby’s crying, practice these non-violent ways to calm yourself:

• Place the baby in a safe place, like a crib, and leave the room for a few minutes.

• Sit down, close your eyes and take 20 deep breaths.

Use of Saline Nose Drops and Bulb Syringe Babies breathe only through their noses during the first few months of life. It is important that their nasal passages do not become blocked. When their breathing is affected they become cranky and feed poorly. If you notice that your baby is sneezing frequently (Mother Nature’s way to clean out the nose) or seems to be breathing through one nostril only, realize he/she probably has nasal congestion and needs assistance to clear out the secretions.

• The bulb syringe and saline drops, which you will receive when you go home, are for clearing his/her nostrils of congestion.

• It is best to clear the nostrils before, not during or after, a feeding and only if he/she needs it.

• With your baby lying on his/her back, place two to four of the saline drops into each nostril. The drops moisten and loosen secretions in the back of the nose.

• Next, gently draw out the secretions with the bulb syringe. To avoid forcing air into the baby’s nostril, squeeze the bulb before inserting it. When you release your “squeeze,” a suction is created that pulls out the congestion.

• Clear out the syringe by squeezing its contents into a tissue, then suction out the other nostril.

• If congestion persists, instill the drops again and use the syringe in each nostril a second time. Now, allow your baby to rest.

Your baby may be unhappy during the procedure, but remember you are doing him/her a favor and are not endangering them.

If you do not feel comfortable using the bulb syringe, have your Mother/Baby Nurse demonstrate it to you, and then practice before you leave the hospital.

Pet Safety and Your NewbornNo matter how much you plan ahead, the addition of a new family member may be difficult for your pet. Below are some helpful tips to minimize stress of the new baby’s arrival for your pet and how to keep your new baby safe around your pet(s).

• Before you bring your baby home from the hospital, have your partner or friend take home something with the baby’s scent (such as a blanket) for your pet to investigate.

• When you first return home from the hospital your pet may be eager to greet you and receive your attention. Have someone else take the baby into another room while you give your pet a warm but calm welcome (it may be a good idea to keep some treats handy to distract your pet).

• Begin gradual introductions of the pet to the baby over a period of four to eight weeks. Never force your pet to get near the baby.

• NEVER LEAVE THE PET AND BABY ALONE. Always supervise any interaction.

• Do not allow pets in baby’s sleep area.

• Try to maintain regular routines as much as possible to help your pet adjust.

• Make sure pet food and the litter box are out of reach of children.

• Be cautious of certain dog breeds (Rottweilers, pit bulls, German Shepherds) that account for more than 50 percent of fatal dog bites.

• Be very careful with exotic pets around babies; their actions and reactions are not as predictable as a dog or cat.

• Pet reptiles, including turtles, snakes, and lizards, are a common source of infection from Salmonella in children. You should keep pet reptiles away from children under 5 years old, and teach older children to wash their hands after handling them.

• Discuss specific questions with your veterinarian or pediatrician.

Please remember that this is not an all-inclusive list of tips but only a guide to help you find what works for you to keep your newborn baby safe. We also cannot guarantee that the above tips will work. We do feel that they will be very helpful to you and are a starting point to a happy and healthy relationship between your baby and pet.

Respiratory Syncytial Virus (RSV)Help Protect Your Baby Respiratory Syncytial Virus (RSV) is a common virus that most children get before they are 2 years old. In some babies, RSV can be very serious. It is important to know your baby’s risk and what you can do to help protect your baby. RSV causes mild cold-like symptoms in adults and children. It can make premature babies very sick because it can become a serious infection and require hospitalization. Each year, 124,000 babies are hospitalized with severe RSV infections. RSV may also cause more long-term health problems, such as asthma. RSV season usually starts in the fall and runs through the spring.

What are the Symptoms?Usually RSV causes mild, cold-like symptoms such as a runny nose and fever. But in some babies symptoms can quickly get worse.

How Does a Baby Get RSV?A baby can get RSV through personal contact such as touching and kissing with an infected person. It is also spread by sneezing and coughing. Nearly all babies get RSV by the age of 2.

What are the Risk Factors? • Premature birth

• Born with a lung and/or heart disease

• Low birth weight

• Family history of asthma

• Tobacco smoke and other air pollutants

• Older brothers and sisters (being in contact with other children)

• Multiple births

• Going to daycare

How Can You Prevent RSV? • A person can be exposed to RSV and give it to

others without knowing it.

• Wash your hands before touching your baby and ask others to do the same.

• Keep your baby away from crowds, especially young children.

• Keep your baby away from people with colds.

• Wash your baby’s toys and bed linens often.

• Do not smoke near your baby.

Is There Any Other Way to Prevent RSV for High-risk Babies?Your baby’s doctor may prescribe a shot to be given each month during RSV season if he or she is identified as high risk.

Notify Your Doctor Right Away if Your Baby is:Coughing, wheezing (a whistling sound when breathing), breathing rapidly, has problems breathing or is gasping for breath.

Caring for Yourself When You Go Home

NUTRITION & VITAMINS: Eat regular meals with nutritious snacks. This is not a good time to try to diet, especially if you are nursing your baby. Be sure to eat plenty of protein such as meat and cheese and to drink milk. Drink at least six to eight glasses of fluids a day. Continue to take your prenatal vitamins once a day. If you need a refill, call your physician’s office. If you have been instructed to take iron pills, take them as directed with meals.

POST-PARTUM BLEEDING: The vaginal discharge varies in amount and appearance. For the first few days it may be very bloody and in a large amount. It gradually tapers off to brown, pink and finally light yellow and white. This discharge may last three to four weeks. If you have persistent or excessive bright red bleeding, call your physician. Your next menstrual period may occur between four to eight weeks after delivery or even longer if you are breastfeeding your baby. Your first menstrual period may be unusually long and heavy.

FAMILY PLANNING: You are free to choose the form of birth control you may want to use. Discuss this with your physician. If you are breastfeeding, and taking birth control pills, notify your doctor if you stop breastfeeding as the type of pill you take may need to be changed. Remember that breastfeeding is not a form of birth control. You may use foam and condoms for contraception until your check-up.

LAXATIVES: Use any stool softeners for constipation. Avoid Ex-Lax or other cascara type laxatives if breastfeeding. If no bowel movement 24 hours after discharge, take a laxative such as Milk of Magnesia.

RHOGAM INJECTION: If you are RH negative and your baby is RH positive, you will receive a Rhogam injection prior to discharge.

If You Had a Vaginal DeliveryFor follow-up appointments/referrals and medications to continue at home, please refer to your discharge instructions. If no follow-up appointment is indicated, call your doctor to schedule an appointment three to five days after discharge.

SAFETY/ACTIVITY: You may do light housework after the first 14 days at home. You may climb stairs if you have no discomfort, but restrict stair climbing to necessary trips only. If you feel comfortable, you may drive a car anytime but no long trips for two weeks. Avoid lifting anything heavier than the baby for two weeks. Increase your activities gradually. Try to rest in the afternoon while the baby sleeps.

EXERCISES: You may do exercises starting two weeks after delivery. Until that time walking is recommended.

PERI CARE: Your stitches, if present, will not be removed, as they will dissolve in about two weeks. Keep your perineum (the area between the vagina and rectum) clean and dry in order to prevent infection. You may continue to use the spray or ointment you received in the hospital for discomfort. Use pads for any bleeding the first month after delivery.

SITZ BATHS: Continue to take the sitz baths three times a day for one week or until the stitches feel comfortable. Dry off well afterwards.

INTERCOURSE: You should not have intercourse until after your first post-partum visit or until your physician says it is OK.

DOUCHES: No douching until after your checkup.

BATHS: You may take a shower or tub bath unless otherwise instructed.

If You Had a Cesarean DeliveryYou will need to return to your physician for a check-up in two weeks. Please call in advance to make an appointment.

SAFETY/ACTIVITY: You may do light housework after 14 days. Avoid pushing or pulling activities such as mopping and vacuuming for four weeks. For the first two weeks, restrict stair climbing to necessary trips. You may drive a car after two weeks. Avoid lifting anything heavier than the baby for two weeks. You may become tired easily so increase your activities gradually. You may feel stronger day by day. Give yourself six to eight weeks to build up to your normal activity schedule. Frequent rest breaks are advised. Sleep in the afternoon while the baby sleeps.

EXERCISES: After your scheduled check-up, it is usually safe to begin an exercise program, but ask your physician. Walking is recommended, until exercise is approved by physician.

ABDOMINAL INCISION CARE: Your abdominal incision is healing by the time you go home. You cannot see the stitches holding the incision together. These will not have to be removed as they will dissolve. The clips or suture on the outside of your abdomen are removed before you go home. No special care is needed with this area other than to keep it clean. Some mild pain and itching may be experienced during the healing process. If you have any problems at home with the incision – such as drainage, redness, inflammation, or severe pain – notify your physician. Remember HAND WASHING prevents infection. Wash your hands with soap and water before eating, after using the bathroom and when your hands are dirty.

INTERCOURSE: You should not have intercourse until four weeks after delivery or until your physician says it is OK. Do not put anything in your vagina for four weeks. You may use sanitary pads, but do not use tampons.

BATHS: You may take a shower or tub bath in about four inches of water. You should put off a full tub bath until four weeks after delivery.

PAIN: You may take a mild over-the-counter analgesia such as Tylenol or Ibuprofen (Advil) for cramping or incisional pain. If pain persists, call your physician.

Postpartum DepressionHaving a baby can be a joyous occasion, but being a new mother can also be stressful and difficult. You may feel depressed a week or so after the birth of your baby. Your mood may change from happy to sad for no apparent reason and you may cry at times. This is not uncommon for a new mother and usually ends in two to three days. If depression persists or you have feelings of harm to yourself or your baby, notify your physician.

Symptoms of postpartum depression include:

• Severe sadness or emptiness, emotional numbness, or crying a lot

• Withdrawal from family, friends, or activities that are pleasurable

• A strong sense of failure or inadequacy

• Constant fatigue, trouble sleeping, overeating, or loss of appetite

• Intense concern and worry about the baby or a lack of interest in the baby

• Thoughts about suicide, fears of harming the baby

Postpartum Psychosis This is a more rare disorder that usually occurs as a severe form of postpartum depression. Symptoms include:

• Delusions (false beliefs)

• Hallucinations (hearing voices or seeing things that are not real)

• Thoughts of harming the baby

TreatmentAlthough the exact cause of postpartum emotional changes is unknown, they can be treated. If you are feeling a mild case of the blues after having your baby, you can help yourself by getting plenty of rest, napping when your baby naps, asking for help from family and friends, showering and dressing each day, getting out for a walk, and getting a babysitter to watch your baby when you need a break.

More severe depressive symptoms require medical

evaluation. Types of interventions may include:

• Biological: Complete medical examination to rule out medical conditions that may cause depression; antidepressant or antipsychotic medication if appropriate

• Psychological: Individual or group therapy; counseling of both parents if possible

• Social: Development of social networks with involvement of a partner, family, friends, and support groups

For More Information • The National Women’s Health Information Center

(U.S. Department of Health and Human Services) www.womenshealth.gov/faq/depression-pregnancy.cfm

• American Psychiatric Association www.healthyminds.org/MainTopic/ PostpartumDepression.aspx

Post-Partum Bilateral Tubal LigationFor follow-up appointments/referrals and medications to continue at home, please refer to your discharge instructions. If no follow-up appointment is indicated, call your doctor to schedule an appointment three to five days after discharge.

Care Instructions • Diet as ordered.

• You may shower.

• You may use Tylenol for discomfort.

• You may drive after 24 hours, but no long trips for two weeks.

• No intercourse for three to four weeks.

• Consult your vaginal delivery discharge sheet.

Call Your Doctor if You Experience: • Increased vaginal bleeding

• Abdominal pain that worsens over time

• Fever over 101 degrees

Call 911 if you have:

q Pain in chest

q Obstructed breathing or shortness of breath

q Seizures

q Thoughts of hurting yourself or someone else

Call your healthcare provider if you have:

(If you can’t reach your healthcare provider, call 911 or go to an emergency room)

q Bleeding, soaking through one pad/hour, or blood clots, the size of an egg or bigger

q Incision that is not healing

q Red or swollen leg, that is painful or warm to touch

q Temperature of 100.4°F or higher

q Headache that does not get better, even after taking medicine, or bad headache with vision changes

These post-birth warning signs can become life-threatening if you don’t receive medical care right away because:• Pain in chest, obstructed breathing or shortness of breath (trouble

catching your breath) may mean you have a blood clot in your lung or a heart problem

• Seizures may mean you have a condition called eclampsia• Thoughts or feelings of wanting to hurt yourself or someone else may

mean you have postpartum depression• Bleeding (heavy), soaking more than one pad in an hour or passing an

egg-sized clot or bigger may mean you have an obstetric hemorrhage

• Incision that is not healing, increased redness or any pus from episiotomy or C-section site may mean you have an infection

• Redness, swelling, warmth, or pain in the calf area of your leg may mean you have a blood clot

• Temperature of 100.4°F or higher, bad smelling vaginal blood or discharge may mean you have an infection

• Headache (very painful), vision changes, or pain in the upper right area of your belly may mean you have high blood pressure or post birth preeclampsia

My Healthcare Provider/Clinic: ______________________________________ Phone Number: ________________________Hospital Closest To Me: __________________________________________________________________________________

GETHELP

16004 ©2018 Association of Women’s Health, Obstetric, and Neonatal Nurses. All rights reserved. Unlimited print

copies permitted for patient education only. For all other requests to reproduce, please contact permissions@awhonn.org.

Tell 911 or your healthcare provider:

“I gave birth on ________________ and

I am having ____________________.”

(Date)

(Specific warning signs)

SAVE YOUR LIFE:

Get Care for These POST-BIRTH Warning SignsMost women who give birth recover without problems. But any woman can have complications after giving birth. Learning to recognize these POST-BIRTH warning signs and knowing what to do can save your life.

Trust

your instincts.

ALWAYS get medical

care if you are not

feeling well or

have questions or

concerns.

POST- BIRTH

WARNINGSIGNS

This program is supported by funding from Merck, through Merck for Mothers, the company’s 10-year, $500 million initiative to help create a world where no woman dies giving life. Merck for Mothers is known as MSD for Mothers outside the United States and Canada.

Post-Partum Exercise ProgramThe sooner a regular post-partum exercise program is initiated, the quicker you will notice positive changes in terms of improved muscle tone, proper posture and increased comfort. After doing all of the following exercises daily for one month, begin increasing the number of repetitions by five weekly until achieving 20 to 30 repetitions. Each exercise should be performed weekly for the next four to six months.

Ankle Circles and Pumps Purpose: To improve circulation in legs

1. Sitting or lying, rotate your ankle. Change directions.

2. Lying on your back or sitting, bend and straighten your ankles briskly.

Kegel Exercise/Pelvic Floor ExercisePurpose: To restore tone to the muscles of the pelvic floor, increase blood supply to the pelvic floor region to promote healing, prevent stress incontinence

1. Lie on back with knees straight and ankles crossed. Tighten or squeeze the muscles around the bladder and anal openings as if you were trying to stop your bladder from emptying. Hold for five seconds and relax. (10 repeats)

2. When urinating, stop and start flow of urine.

Pelvic TiltsPurpose: To improve the tone of the lower abdominal muscles, help reduce excessive curve in low back

1. Lie on your back with knees bent and arms by your side. Tighten your stomach muscles and press the small of your back against the floor. Hold five seconds then relax.

2. Begin exercise with both knees bent. Progress gradually over several weeks to perform pelvic tilt with legs straight. (10 repeats)

Standing Pelvic TiltPurpose: To strengthen abdominal muscles and improve postural tone

1. Stand against a wall with your heels about three inches from wall and your feet four inches apart.

2. Flatten the small of your back against the wall by tightening your abdominal and buttock muscles. Hold this position for the count of 5. (10 repeats)

Partial Sit-upPurpose: To improve tone in upper abdominals

1. First Week – Lying on your back with arms at your sides, lift your head up until your chin touches your chest. Hold three seconds. (10 repeats)

2. Second Week – Lift your arms toward your knees, raising your head and shoulder blades off the floor. Hold three seconds. (10 repeats)

Chest and Arm TonerPurpose: To improve muscle tone in arms and pectoralis muscle

1. Place the palms of your hands together, keeping your elbows at shoulder level.

2. Press palms together and hold for a count of 5. (10 repeats)

Resting Positions 1. Lying with pillow under your knees

2. Lying with one leg straight and the other leg bent and supported by a cushion

Iron-Deficiency AnemiaIron-deficiency anemia is characterized by a decrease in the number of red blood cells, or in the amount of hemoglobin in the blood, or both. Red blood cells and hemoglobin carry oxygen from the lungs to body cells. The less hemoglobin/red blood cells, the less oxygen available, resulting in extreme fatigue and pale skin.

Iron-deficiency occurs due to a variety of reasons:

• Inadequate intake of iron in the diet

• Poor absorption of iron, from a lack of acid in the stomach or presence of inhibitors like phytic acid

• Absence of ingredients for the formation of hemoglobin, such as B-12

• Increased need, as in the case of pregnancy

The average pre-menopausal woman needs 18 mg of iron per day, and the average pregnant or lactating woman needs 30 mg a day. Given that the typical American diet contains 6 mg of iron for every 1,000 calories, a woman would have to eat 3,000 calories to get enough iron. Therefore, women must make careful food choices in order to consume enough iron without overeating.

Consider the following choices to add iron to your diet:

• Hot oats (c.) 0.8 mg

• Bagel (1) 1.8 mg

• Wheat bread (1 sl.) 1.0 mg

• Cornflakes (¾ c.) 1.8 mg

• Total cereal (¾ c.) 18.0 mg

• Potato w/skin (1) 2.7 mg

• Peas (c.) 1.2 mg

• Spinach, raw (c.) 0.7 mg

• Carrot, raw (1 med.) 0.4 mg

• Kidney beans (c.) 1.5 mg

• Baked beans (c.) 0.4 mg

• Tofu (c.) 2.3 mg

• Molasses (1 tbsp.) 5.0 mg

• Apricots, dry (7) 1.1 mg

• Raisins (2 tbsp.) 0.4 mg

• Prunes (3 med.) 0.8 mg

• Corn (c.) 0.2 mg

Posture GuidelinesDo:

• Maintain ear, shoulder, hip and ankles in a line.

• Lift with your legs. Hold objects close to you.

• If nursing, roll shoulders back and tuck chin after nursing.

Don’t:

• Stand with weight distributed unevenly through legs.

• Lift anything heavier than your baby for two weeks.

• Bend over from your waist.

Other Services AvailableEphraim McDowell MedSourceEphraim McDowell MedSource, a home medical equipment store, carries a variety of products suitable for women after they deliver. Women who choose to breastfeed their baby can find breast pumps, extra pumping kits and breastfeeding supplies and accessories. Breast pumps can be billed to most insurance

companies prior to delivery and up to one year after delivery for rental or purchase. Ephraim McDowell MedSource will bill your insurance for you. For more information, please contact one of our convenient locations: Danville - (859) 239-1691Stanford - (606) 365-4632Liberty - (606) 787-0468Harrodsburg - (859) 733-4880

B-12 Deficiency Anemia/Folic Acid Deficiency Anemia

Both B-12 and folic acid are vitamins necessary to make red blood cells. Sometimes, anemia is due to a poor intake of one or both of these vitamins rather than a poor intake of iron. B-12 is found only in animal foods. Therefore, a person who eats very little meat or dairy foods may develop anemia due to lack of B-12. Adults need 2 mcg of B-12 a day. In addition, some people lose the ability to absorb B-12 as they grow older and must take B-12 by injection. Folic acid is found in dark green foods like kale, broccoli, and spinach as well as dried beans like kidney beans, chickpeas, and black-eyed peas. Adults need 400 mcg a day.

$20 Gift VoucherTo be used only with the purchase or rental of a breast pump at Ephraim McDowell MedSource. Voucher good only toward the purchase of breastfeeding supplies and accessories at the time of purchase or rental.

STAGE 3: Ride in a booster with a lap-shoulder belt (E)— School-aged children who have outgrown a harness need a booster until the seat belt fits correctly, usually between ages 10 to 12. Always use a lap-shoulder belt with a booster, never a lap-only belt.

If the car has only lap-only belts, a booster cannot be used. Learn about safe options from a resource, listed below.

❑ Is your child using the right car seat?STAGE 1: Ride rear facing—the safest way to ride! Child’s first year: Rear-facing-only car

seats (A) are small and can be carried. Make sure baby’s head is at least an inch below the top of the car seat.

Convertible car seats face the rear for babies up to 30 to 50 pounds (B) (check label), then can be changed to face forward. (C, below).

Child’s second year: Continue facing the rear until the child is at the car seat’s rear-facing weight limit or the child’s head is less than an inch from top of the car seat. Most children use a convertible car seat to ride rear facing after about age one.

STAGE 2: Ride forward facing with a harness (C, D)—Use when a car seat that faces the rear is outgrown. Use a convertible car seat, combination car seat (forward-facing seat/booster), built-in car seat, or vest.

❑ Is the car seat second-hand? • Avoid second-hand car seats. If one is used, check it

carefully. Make sure it is not recalled and has all parts and instructions. Make sure it has not been in a crash. Follow a car seat’s “do not use after” date—many may not be used longer than 6 years. If you are not sure it’s safe, don’t use it!

❑ Does your child ride in back? • The back seat is much safer than the front. Children

under 13 might be big and tall, but their bodies are still different from an adults. They should ride in the back.

• Air bag safety: Never put a child in a rear-facing car seat in front with an air bag. The force of the air bag can kill a child sitting too close to it. If a truck or car has an air bag on-off switch, turn it off if a child must ride in the front seat.

❑ Are you following instructions and laws? • Always follow instructions for your child’s car seat. • Also, read the car owner’s manual on car seats and air bags.• Know and follow the child passenger laws of your state.

❑ Is the car seat tightly installed?• Car seats can be installed with either a seat belt or LATCH.

Use whichever gives the tightest fit. Do not use both, unless the car seat and car instructions say it is okay. Check car seat labels for weight limits for using LATCH.

• Put the seat belt or LATCH strap through the correct path on the car seat (check labels).

• If using LATCH, connect the car seat hooks to the correct anchor bars in the car. Check the car manual.

• Important: Attach the tether strap, if forward facing. • Tighten the seat belt or LATCH. A car seat should move less

than 1 inch if pushed while holding it near the belt/LATCH. ❑ Are the harness straps the right height?

Are they snug on your child? • Position the straps at the child’s shoulders. If there is not a

position right at the shoulder: –When rear facing, use the next spot below the shoulders. –When forward facing, use the next spot above the shoulders.• Make harness straps snug, so you cannot pinch any slack.• Make sure

straps are flat, not twisted.

• Put the chest clip at armpit level.

FACT SHEETS © 2018 Safe Ride News Publications, 800-403-1424 • www.saferidenews.com A5 Revised 1/18 Reproducible by SRN Fact Sheet purchasers only. For noncommercial distribution only.

Resources Nat’l. Vehicle Safety Hotline: 888-327-4236, www.safercar.govSafetyBeltSafe U.S.A.: 800-745-7233, www.carseat.orgFind someone to help: 866-732-8243, or look online:

• www.seatcheck.org (see Inspection under Installation Help) • http://cert.safekids.org (see Find a Tech)

E

Tether strap

C Convertible car seat

A

Tether strap

C h i l d Safety F a c t s2 0 1 8

Make Every RideA Safe Ride

D Combination car seat/booster

B

✔Check Your Child’s Car Seat! Choosing and Using Car Seats Correctly

This Is the Way Baby RidesPrepare to Ride Safely With Your New Baby

Car seat basics• Your baby is safest riding in a rear-

facing car safety seat (car seat) as long as possible. Being rear facing protects babies from head and neck injury. Stay rear facing as long as the child still fits the car seat’s height and weight limits. Also, check state laws.

• Baby always rides in the back seat. It is much safer than the front seat. Use the center rear if the car seat fits there.

• Be sure the air bag is off if baby must ride in the front seat. (See page 2.)

• Be sure the seat belt or LATCH holds the car seat tightly.

• Buckle and tighten the harness snugly over your baby’s body.

• ALWAYS follow the car seat instructions and the car manual to install and use the car seat correctly.

Choosing a car seat for a new babyWhat is the best car seat? The “best car seat” is one that fits your child and your car. For a baby, it must face the rear of the car. Read all instructions and try the car seat out. Make sure it is easy for you to use. Be sure you can install it properly in all the cars you will use.

What kinds of car seats fit a new baby? Use a car seat that fits the baby’s length, weight, and health. Types include: • Rear-facing-only car seats (1): These are small, have a

handle, and fit most babies well. If a baby becomes too tall for this type before reaching the weight limit, she can keep riding rear facing by moving to a convertible car seat.

• Convertible car seats (2): These are larger, but many fit new babies well. (See page two for how the harness must fit.) Convertibles face the rear for babies and toddlers. Later, they can be changed to face forward.

• Car beds (3): Use a car bed (not shown) only if a doctor says your baby must ride lying flat for a medical reason.

What features should I look for?Consider your car’s features and the needs of other

riders. It is helpful to have many shoulder strap positions, so you can make it fit when baby is small and also as he grows. For snugging a harness, a pull-strap at the front of the car seat is usually easier than straps in the back.

FACT SHEET © 2018 Safe Ride News Publications, 800-403-1424 • www.saferidenews.com A3 Revised 1/18This is copyrighted material. These sheets cannot be reproduced or copied.

ResourcesSafetyBeltSafe U.S.A.: 800-745-7233, www.carseat.orgNational Vehicle Safety Hotline, recalls:

888-327-4236, 800-424-9153 (tty), www.safercar.gov

2) Convertible car seats can face the rear for children up to 30 to 50 pounds

1) Rear-facing-only car seats are for babies up to 22 to 40 pounds

Find someone to help: 866-732-8243, www.seatcheck.org (select Inspection under Installation Help) or http://cert.safekids.org (select Find a Tech)

Others: www.chop.edu/carseat, www.healthychildren.org

Make Every RideA Safe Ride

Warning: Car seats are not cribs!Being in a car seat for long periods of time is not healthy for babies. Outside the car, baby should spend little time in a car seat. Always buckle the harness.

C h i l d Safety F a c t s2 0 1 8

Can I use a second-hand car seat? If possible, use a new car seat. They are often easier to use, safer, and can be used longer. If you do use a second-hand seat, make sure it has all its parts and instructions. Ask the car seat maker if there are recalls.

Never use a car seat that has been in a crash. Also, follow a car seat’s “do not use after” date. If you can’t find this on the label, do not use the car seat if it was made over six years ago.

Pack for baby’s first ride:

√ Car seat

√ Remember instructions

for car seat and car

√ Small baby clothes

with legs

√ Small blankets to pad

around baby (but never

under the harness)

How else can I plan for baby?• Go to a car seat safety class. Call your

hospital or clinic to find one. • Practice installing the car seat and

adjusting the straps. Learn more from someone trained to help with car seats. (See Resources.)

• If your car seat has a base, it can be left installed in the car, ready to use, while at the hospital or birth center.

Steps to install a rear-facing car seat1. Place the car seat in the back seat, facing the rear window. The back seat is safer than the front in all cars, especially cars with front air bags.

2. Use the seat belt or LATCH strap to attach the car seat. Make it tight. If the seat belt or LATCH strap does not hold the car seat tightly, your child could be seriously hurt in a crash. Always read the instructions that come with the car seat. Also read the sections on seat belts, LATCH, air bags, and car seats in your car manual. Do not use the lower anchors and seat belts at the same time unless both instructions say it is okay. To check for a tight fit, hold the car seat near where the LATCH strap or seat belt goes through the car seat. Pull forward and side to side. The car seat should not move more than one inch. (Do not grab near the top of the car seat to check for tightness. The movement there is okay.)

3. Make sure your baby is reclined enough so his head does not fall forward. Always follow any recline guide on the car seat. Also, look for instructions that say how to adjust the car seat to make it recline. For some car seats, a firmly rolled towel or foam roll placed under the car seat may be needed to help it recline (A).

Bringing your new baby home Dress baby in clothes with legs so the buckle strap can go between the legs.

Put the shoulder straps in a low position that is at or below the shoulders. Put the chest clip at armpit level.

If baby tends to slide downward, re-check the instructions to make sure the harness is set up for a small baby. You may need to add a small, rolled cloth between her crotch and the buckle strap (C).

Any support pad or insert that came with your car seat should be used, following instructions. Do not put other padding, like a blanket or add-on cushion, under or behind baby.

Tuck blankets along baby’s sides to support her (C), if needed. Roll them firmly so they are not near the face.

Adjust the harness straps to fit snugly. You should not be able to pinch any slack (D). Do not use thick blan-kets or dress baby in heavy clothes. This makes it impossible to get the har-ness snug enough to hold the baby in a crash. Buckle the harness first, and then put a blanket over baby.Sometimes babies cry. However, NEVER take baby out of the car seat while the car is moving. If you need to hold baby, park in a safe place first.

As your baby grows biggerFollow instructions to make the car seat fit as baby grows.

Move the harness straps up when baby’s shoulders are as high as the next position. A rear-facing car seat is outgrown when: • Baby’s head is less than 1 inch from the top of the seat, or• Baby reaches the weight limit of the car seat.

Keep baby rear facing as long as possible. This is the best way to protect a child’s head and spine from injury. A baby should NEVER be faced forward when under 20 pounds or 1 year old.

This Is the Way Baby Rides 2

FACT SHEET © 2018 Safe Ride News Publications, 800-403-1424 • www.saferidenews.com A3 Revised 1/18Reproducible by SRN Fact Sheet purchasers only. For noncommercial distribution only.

Air bag danger: Put baby in back!A baby riding in front with an air bag (B) is in great

danger. In even a minor crash, the air bag may open with great force—enough to kill a child. The back seat is safer for all children.

A baby’s car seat must face the rear and should be in the back seat. If baby does ride in front, the air bag MUST be off. Look for an on-off switch or air bag light on the dashboard.

Learn about your car’s air bags in the owner’s manual. Also, read the air bag warning labels in your car.

B. Warning: A baby can be killed by an opening air bag!

D. Use the pinch test. If you can pinch a strap, it is not snug enough.

A. Baby should ride reclined. Follow car seat instruc-tions and labels.

Rolled towel

C. Parts of a car seat. Add padding (shown) along baby‘s sides and at the crotch only if needed.

Optional padding,

for support

Padding, if needed to

prevent slumping

Shoulder strap

Top of car seat shell

Chest clip

Harness buckle

What to Do About Recalls? Fixing Recalled Car Seats and Vehicles

Information used to look up recalls......on my child’s car seat:Car seat maker_____________ Contact info______________Model name _______________________________________ Model number ______________ Date made______________Date of recall_______________ Date fixed ______________

...on my car:Car maker _________________Contact info ______________Model _____________________ Year made ______________Date of recall________________ Date fixed ______________

Fix your recalled item. It’s free!

Car seat: A repair kit will be sent to you. Fix the car seat right away. If you need help with the repair, find someone trained to help with car seats. (See Resources on page 2.) Sometimes the car seat maker will send you a new car seat instead of a repair kit.

Vehicle: Take it to the nearest car dealer that sells your vehicle make or brand.

FACT SHEET © 2018 Safe Ride News Publications, 800-403-1424 • www.saferidenews.com C5 Revised 1/18Reproducible by SRN Fact Sheet purchasers only. For noncommercial distribution only.

Make Every RideA Safe Ride

RECALL NOTICE

Car Seat Maker

Your Name

StreetCity, State, Zip

C h i l d Safety F a c t s2 0 1 8

Recalls help keep your family safe When a product has a safety problem, the manufacturer (the maker) must recall it. By law, the maker must give a free repair or a replacement to owners of that product. Some recalls may not seem important, but all should be fixed. Too many people ignore them. Their families are not as safe as they could be.

Has your child’s car seat been recalled?• If you have registered the car seat to let the maker know you are the owner, the

company will send you a notice and a repair kit. (You must act to register your car seat(s); it is not automatic. See the back of this sheet for more about how to do this.)

• Whether you have registered your car seat or not, you can do one of these things to find out if a car seat has been recalled: • Call the maker by telephone (use the number on the label) or check its website, or• Call the National Vehicle Safety Hotline (1-888-327-4236), or• Check a car seat recall list online (see Resources).

• Have this information ready before you check: the maker’s name, the model number, and the date when your child’s car seat was made. You will find this information on labels on the car seat. (Write the information in the box below so you have it when you call.) This information is needed to tell if the car seat you own is part of a recall. The car seat maker might also ask about other details of your car seat.

Has some part of your car been recalled?• The car maker must send a recall notice to all car owners registered in the U.S.

(Owners are registered when the license plates are given. No extra step is needed.)• Car makers require their dealerships to fix the problem at no charge to the owner.• Some vehicle recalls are for parts that affect children’s safety—parts like LATCH

anchors, seat belts, or air bags. These types of recalls might affect the safe installation of car seats and/or the use of boosters or seat belts alone.

Reporting Safety Problems If you have found that your car seat or vehicle has a safety problem, it is important that you report it to BOTH the manufacturer and the government. To report a possible problem to the car seat or vehicle manufacturer, contact the manufacturer’s customer service department or go to its website. To report it to the government, call the National Vehicle Safety Hotline (888-327-4236) or use the reporting form found at www-odi.nhtsa.dot.gov (look under Report Safety Problem). This form can be sent online. Be sure to print copies of the form for your records and to send to the car seat or vehicle manufacturer.

ResourcesTo register a car seat, call the maker or

go to its website, or contact the National Highway Traffic Safety

Adminstration (NHTSA): 888-327-4236, 800-424-9153 (tty)

www.nhtsa.gov or www.safercar.govTo find out if your car seat has been

recalled or to make a safety complaint about a car seat or vehicle, contact the National Vehicle Safety Hotline: 888-327-4236, 800-424-9153 (tty), or www.safercar.gov

Car seat recall lists: Highway Safety Research Center: www.buckleupnc.org SafetyBeltSafe U.S.A.: www.carseat.org

(includes product problems that are not recalls and some vehicle recalls due to problems related to child safety)

Car seat safety information: American Academy of Pediatrics,

www.healthychildren.orgNational Highway Traffic Safety

Administration: www.nhtsa.gov SafetyBeltSafe U.S.A: 800-745-7233, 800-

747-7266 (Spanish), www.carseat.org The Children’s Hospital of Philadelphia:

www.chop.edu/carseatInsurance Institute for Highway Safety:

www.iihs.orgFind someone to help: 866-732-8243,

www.seatcheck.org (select Inspection under Installation Help) or http://cert.safekids.org (select Find a Tech)

FACT SHEET © 2018 Safe Ride News Publications, 800-403-1424 • www.saferidenews.com C5 Revised 1/18Reproducible by SRN Fact Sheet purchasers only. For noncommercial distribution only.

Recalls on Car Seats and Vehicles 2

No stamp is needed! Just fill out and mail the card on your new car seat to register it.

Car seat recall tips• How can I register a car seat? Every new seat comes with a registration card

attached. It is best to fill out the card and mail it right away, but it is never too late to register. If you do not have the card, you can call the maker or go to its website. Another way to register is by contacting the National Vehicle Safety Hotline by phone or online (see Resources). If you move, contact the car seat maker to update your address.

• You will need the car seat maker’s name, and also the seat’s model number and manufacture date. Look on labels on the back, side, or base of the seat. Some labels may be under the seat cover. Some dates may be in number codes (year-month-day).

In case labels peel or fade, you can write the model name, number, and manufacture date on the car seat with a marker that will not wash off. Also, write it on the instruction booklet or in the box on the other side of this sheet. (Always keep the instructions with the car seat.)

• Can I use the car seat while I am waiting for the repair kit? If you have another car seat the right size for the child, use it instead. If not, you can use the recalled car seat, unless the recall notice says not to. Using the recalled seat is much safer than letting your child ride without any car seat. The car seat maker will often tell how to use the seat safely until it is fixed. Be sure to repair the seat as soon as you can.

If the car seat has a very dangerous problem, the recall notice will warn NOT to use the seat until after it is fixed. Sometimes, the maker will replace the seat and destroy the recalled one. However, this rarely happens. Remember: A recall is never a reason to let your child ride unbuckled.

• What should I do if there is no label on the car seat showing the model number and date? It is safest not to use the car seat. It is not possible to know whether it has a recall. You also will not know if the car seat is too old to use. To throw it away, destroy it by cutting up the pad and straps. Recycle the plastic parts, if possible. Do this so nobody else will take it and use a car seat that may be unsafe.

Vehicle recall tips• Car ownership is tracked by registration in all the states. This is done using

vehicle ID numbers (VINs) found inside the windshield on the driver side. You can enter the VIN at www.safercar.gov to check any car for recalls.

• Pay attention to any mail from the car maker. You also can contact the dealer or the vehicle maker’s customer service to ask about recall information.

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