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A Guide for First-Time Parents

You've survived 9 months of pregnancy. You've made it through the excitement of labor and delivery, and now you're ready to head through the hospital or birthing-center doors and begin your life at home with your baby. But as those doors close behind you, you frantically realize you have no idea what you're doing! If you're a first-time parent, get the basics about burping, bathing, bonding, and other baby-care concerns.

Getting Help After Birth
You may want to recruit help from friends and family to get through this time, which can be very hectic and overwhelming. While in the hospital, use the expertise around you. Many hospitals have feeding specialists or lactation consultants who can help you get started nursing or bottle-feeding. In addition, nurses are a great resource to show you how to hold, burp, change, and care for your baby.

For in-home help, you might want to hire a baby nurse, or a responsible neighborhood teenager to help you for a short time after the birth. In addition, relatives and friends can be a great resource. They may be more than eager to help, and although you may disagree on certain things, don't dismiss their experience. But if you don't feel up to having guests or you have other concerns, don't feel guilty about placing restrictions on visitors.

Handling a Newborn
If you haven't spent a lot of time around newborns, their fragility may be intimidating. Here are a few basics to remember:

• Be careful to support your baby's head and neck. Cradle the head when carrying your baby and support the head when carrying him or her upright or when you lay him or her down.
• Be careful not to shake your newborn, whether in play or in frustration. Shaking that is vigorous can cause bleeding in the brain and even death. If you need to wake your infant, don't shake him or her - instead, tickle his or her feet or blow gently on his or her cheek.
• Make sure your baby is securely fastened into the carrier, stroller, or car seat. Limit car rides and any other activity that would be too rough or bouncy.

Remember that your newborn is not ready for rough play such as being jiggled on the knee or thrown in the air.

Bonding and Soothing Techniques
Bonding with your baby is probably one of the most pleasurable aspects of infant care. "Bonding" is a concept that was introduced in the late 1970's by two pediatricians, Klaus and Kennell. They suggested that there is a sensitive time in the first hours to days after birth in which it's important for parents to make a connection with their infant. This physical connection promotes an emotional connection between parent and infant (bonding). The attachment that's then formed allows the parents to make the necessary sacrifices to be able to take care of their child.

For infants, the attachment contributes to their emotional growth, which also impacts their development in other areas like physical growth. Another way to think of bonding is "falling in love" with your baby. Children who don't have a parent or adult in their life that unconditionally love them will potentially have greater problems as they mature.

Begin bonding by cradling your baby in your lap and gently stroking him or her in different patterns. If you and your partner both hold and touch your infant frequently, he or she will soon come to know the difference between your touches. Each of you should also take the opportunity to be "skin-to-skin" with your newborn, holding him or her against your own skin when feeding or cradling.

Babies, especially premature babies and those with medical problems, may respond to infant massage. Research has shown that certain types of massage can relax and increase bonding between both infant and parent as well as help with infant digestion and growth. Infant massage was introduced to the United States in the 1970's by Vimala Schneider McClure from India who saw firsthand the benefits it provided. Many books and videos cover the subject; talk to your child's doctor about which one you think might work for you and your baby. Be careful, however - babies are not as strong as adults, so massage your baby gently.

Babies usually love vocal sounds, such as talking, babbling, singing, and cooing. Your baby will probably also love listening to music. Try a variety of types to find your baby's preference. Baby rattles and musical mobiles are other good ways to stimulate your infant's hearing. If your baby is being fussy, try singing, reciting poetry and nursery rhymes, or reading to him or her as you sway or rock gently in a chair.

Some babies may be unusually sensitive to touch, light, or sound. Such babies may startle and cry easily, sleep less than you might expect, or turn their faces away when you speak or sing to them. Keep noise and light levels moderate.

Swaddling is another soothing technique first-time parents should learn. Swaddling keeps your baby's arms close to his or her body and his or her legs securely bound. Not only does this keep your baby warm, but the surrounding pressure seems to give most newborns a sense of security and comfort. Here's how to swaddle a baby:

• Spread out the receiving blanket, with one corner folded over slightly.
• Lay the baby face up on the blanket with his or her head at the folded corner.
• Wrap the left corner over his or her body and tuck it beneath him or her.
• Bring the bottom corner up over his or her feet.
• Wrap the right corner around him or her, leaving only the neck and head exposed.

Diapering Dos and Don'ts

You'll probably decide before you bring your baby home whether you are going to use cloth or disposable diapers. Whichever you use, you will need about 10 diapers a day, or about 70 a week.

Before diapering a baby, make sure you have all supplies within reach so you won't have to leave your baby unattended on the changing table. You'll need:

• a clean diaper
• a fastener (if cloth is used)
• diaper ointment if the baby has a rash
• a container of warm water
• cotton balls
• clean washcloth or diaper wipes

After each bowel movement, or if your baby's diaper is wet, lay your baby on his or her back and remove the dirty diaper. Use the water, cotton balls, and washcloth or the wipes to gently wipe your baby's genital area clean. When removing a boy's diaper, do so carefully because exposure to the air may make him urinate. When wiping a girl, wipe her bottom from front to back to avoid a urinary tract infection. If your baby has a rash, apply ointment. Always remember to wash your hands thoroughly after changing a diaper.

Diaper rash is a common concern. Typically the rash is red and bumpy and will go away with a warm bath, some diaper cream, and a little time out of the diaper. Most of the time rashes occur because the baby's skin is sensitive and becomes irritated by the wet diaper. If your baby has had juice, their poop can become acidic and give them a rash. To prevent or heal diaper rash, try these tips:

• Change your baby's diaper frequently, especially soon after bowel movements.
• After cleaning the area with mild soap and water or a wipe, apply a diaper rash or "barrier" cream. Creams with zinc oxide are preferable because they form a barrier against moisture.
• If you use cloth diapers, wash them in dye- and fragrance-free detergents.
• Let the baby go undiapered for part of the day. This gives their skin a chance to "air-out".

If the diaper rash continues for more than 3 days, call your child's doctor - it may be caused by a fungal infection that requires a prescription.

Bathing Basics

You should give your baby a sponge bath until:

• the umbilical cord falls off (1-4 weeks)
• the circumcision heals (1-2 weeks)
• the naval heals completely(1-4 weeks)

A bath two or three times a week in the first year is sufficient. More frequent bathing may be drying to the skin.

You'll need the following items before you give your baby a bath:

• a soft, clean washcloth
• mild, unscented baby soap and shampoo
• a soft brush to stimulate the baby's scalp
• towels or blankets
• an infant tub filled with warm - not hot! - water (to test the water temperature, feel the water with your elbow or wrist). An infant tub is a plastic tub that can fit in the bathtub and is better fitted for the infant and makes bath time easier to manage.
• a clean diaper
• clean clothes

For a sponge bath, pick a warm room and a flat surface, such as a changing table, floor, or counter. Undress your baby down to his or her shirt and diaper. Wipe your infant's eyes with a washcloth dampened with water only, starting with one eye and wiping from the inner corner to the outer corner. Use a clean corner of the washcloth to wash the other eye. Clean your baby's nose and ears with the washcloth. Then wet the cloth again, and using soap, wash his or her face gently and pat it dry. Next, using baby shampoo, create a lather and gently wash your baby's head and rinse. Pay special attention to creases under the arms, behind the ears, around the neck, and the genital area. Once you have washed those areas, make sure they are dry and diaper and dress your baby.

When your baby is ready for tub baths, the first baths should be gentle and brief. If he or she becomes upset, go back to sponge baths for a week or two, then try the bath again.

Once you've undressed your baby for the tub bath, place him or her in the water immediately so he or she doesn't become chilled. Use one of your hands to support the head and the other hand to guide him or her in, feet first. Talk gently to the baby and slowly lower the rest of his or her body until he or she is in the tub. Use a washcloth to wash his or her face and hair. Gently massage your baby's scalp with the pads of your fingers or a soft baby hairbrush, including the area over the fontanelles (soft spots) on the top of the head. When you rinse the soap or shampoo from your baby's head, cup your hand across the forehead so the suds run toward the sides and soap doesn't get into his or her eyes. After the bath, wrap your baby in a towel immediately, making sure to cover his or her head. Baby towels with hoods are great for keeping a freshly washed baby warm.

While bathing your infant, never leave the baby alone. If you need to leave the bathroom, wrap the baby in a towel and take him or her with you.

Circumcision and Umbilical Cord Care

Immediately after circumcision, the tip of the penis is usually covered with gauze coated with petroleum jelly to keep the wound from sticking to the diaper. Gently wipe the tip clean with warm water after a diaper change. Redness or irritation of the penis should heal within a few days, but if the redness or swelling increases or if pus-filled blisters form, infection may be present and you should call your baby's doctor immediately.

Umbilical cord care in newborns is also important. To help prevent infection, some doctors suggest swabbing the area with rubbing alcohol after each diaper change until the cord stump dries up and falls off, usually in 10 days to 3 weeks. The infant's navel area shouldn't be submerged in water until this happens. Until it falls off, the cord stump will change color from yellow to brown or black - this is normal. You should consult your baby's doctor if the navel area becomes reddened or if a foul odor or discharge develops.

Feeding and Burping Your Baby

Your first feeding decision is to choose whether you want to feed your child with a breast or a bottle. Once you've made that decision, you may be stumped as to how often your baby should be fed. Generally, it's recommended that you feed your baby whenever he or she seems hungry, which is called demand feeding. Your baby may cue you to his or her hunger by crying, putting his or her fingers in his or her mouth, or making sucking noises.

A newborn baby may need to be fed as often as every 2 hours or perhaps more frequently. If you're breast-feeding, give your baby the chance to nurse about 10 to 15 minutes at each breast. If you're feeding your infant with a bottle, he or she will most likely take about 2 to 3 ounces of infant formula at each feeding.

Some newborns may need to be awakened every few hours to make sure they get enough to eat. Call your baby's doctor if you need to awaken your newborn frequently or if your baby doesn't seem to take an interest in eating or sucking.

If you are formula-feeding your child, you can more easily monitor if he or she is getting enough to eat - after all, what goes in must come out. However, if you're breast-feeding, you may wonder if your baby is eating enough. If he or she seems satisfied, produces about six wet diapers and several stools a day, sleeps well, and is gaining weight regularly, then your baby is probably eating enough. Talk to your child's doctor if you have concerns about your child's growth or feeding schedule.

Babies often swallow air during feedings, which can cause them to become fussy. You can prevent this fussiness by burping your baby frequently. If you are bottle-feeding, burp your baby every 2 to 3 ounces. If you are breast-feeding, burp your baby each time he or she switches breasts with one of the following burping strategies:

• Hold your baby upright with his or her head on your shoulder. Support your baby's head and back while you gently pat his or her back with your other hand.
• Sit your baby on your lap. Support your baby's chest and head with one hand and gently rub his or her back with the other.
• Lay your baby on your lap with his or her back facing up. Support your baby's head in the crook of your arm and gently pat or rub his or her back.

If your baby hasn't burped after several minutes, finish the feeding you've started. Afterward, burp your baby again and keep him or her in an upright position for 10 to 15 minutes to avoid spitting up.

Sleeping Basics

As a new parent, you may be surprised to learn that your newborn, who seems to need you every minute of the day, actually sleeps about 16 hours or more! Usually a newborn will sleep for periods of 3 to 4 hours. Don't expect your newborn to sleep through the night - because your baby's digestive system is so small, he or she needs nourishment every few hours and should be awakened if he or she hasn't been fed for 5 hours.

When can you expect your baby to sleep through the night? About 90% of babies sleep through the night (between 6 and 8 hours) at 3 months of age, but if your infant doesn't, it's not a cause for worry. Like adults, babies must develop their own sleep patterns and cycles, so if your newborn is gaining weight as your baby's doctor recommends and appears healthy, don't despair if he or she hasn't slept through the night at 3 months.

It's important to place your infant on his or her back to sleep to reduce the risk of sudden infant death syndrome (SIDS). In addition, you should remove all fluffy bedding, quilts, sheepskins, stuffed animals, and pillows from the crib to ensure that your baby doesn't get tangled in them. You should also be sure to alternate the position of your baby's head from night to night (first right, then left, and so on) so that he or she doesn't develop a flat spot on one side of his or her head.

Even though you may feel anxious at handling a newborn now, in a few short weeks you'll develop a routine and will be parenting your newborn like a pro! If you have a lot of questions or concerns, call your baby's doctor - he or she can provide you with a list of possible local resources to help you and your baby grow together.