Newborn Care at Home: Safe Sleep, Feeding, Jaundice, and Warning Signs
Teach the ABCs of safe sleep: alone, on the back, in a crib with a firm, flat mattress and no soft objects, with room-sharing but no bed-sharing. Teach feeding 8 to 12 times in 24 hours for breastfed newborns and at least 6 wet diapers daily by day 5. A temperature of 100.4 F (38 C) or higher in an infant younger than 3 months requires immediate evaluation; call 911 for cyanosis, apnea, limpness, or difficulty waking.
Who needs this teaching
Parents and every caregiver of a newborn, before discharge. Normal newborn values are a respiratory rate of 30 to 60/min and an axillary temperature of 97.7 to 99.5 F (36.5 to 37.5 C).
The priority teaching points
- Safe sleep. Place the infant on the back for every sleep, alone, in a crib or bassinet with a firm, flat mattress and a fitted sheet only. Keep pillows, bumpers, blankets, and toys out of the sleep space. Room-share without bed-sharing, ideally for at least the first 6 months. Never sleep with the infant on a sofa or armchair. Avoid inclined sleepers and overheating. Keep the home and car smoke-free.
- Feeding and output. Feed on early hunger cues: rooting, sucking on the hands, and lip smacking. Crying is a late cue. Breastfed newborns feed 8 to 12 times in 24 hours; formula-fed newborns usually feed every 3 to 4 hours. Give no water before 6 months and no honey before 12 months. Expect at least 6 wet diapers daily by day 5.
- Cord and bath care. Keep the cord clean and dry, and fold the diaper below it. The cord falls off in 1 to 3 weeks. Give sponge baths until then. Test bath water with the wrist or elbow, and never leave the infant alone in water.
- Jaundice. Jaundice progresses from head to toes. Check the skin and sclerae in daylight. Yellow skin spreading to the abdomen or legs, poor feeding, or difficulty waking requires a same-day call. Visual checks underestimate bilirubin, so keep the first newborn visit at 3 to 5 days of age.
- Car seat. Use a rear-facing car seat in the back seat for every ride. Keep the harness snug, with the chest clip at armpit level and no bulky clothing underneath.
- Crying and abusive head trauma. Crying increases from about 2 weeks and peaks around 6 to 8 weeks. Never shake an infant. If frustration rises, place the infant on the back in the crib, leave the room, and call a support person.
- Fever and illness. A rectal temperature of 100.4 F (38 C) or higher in an infant younger than 3 months requires an immediate call to the provider or an emergency department visit, day or night. Do not give fever medicine before the call. Call 911 for apnea (a breathing pause of 20 seconds or longer), cyanosis, limpness, or difficulty waking.
Red flags the client reports
| Call the provider the same day | Call 911 or the local emergency number |
|---|---|
| Fewer than 6 wet diapers daily after day 5, or fewer than 8 feedings in 24 hours | Blue or gray lips, face, or skin |
| Yellow skin spreading to the abdomen or legs | Apnea or severe difficulty breathing |
| Redness, foul odor, or drainage at the cord, or repeated vomiting: call promptly | Limp, floppy, or difficult to wake |
| Temperature of 100.4 F (38 C) or higher in an infant younger than 3 months: call immediately or go to the emergency department | Seizure |
Teach-back questions
- "Show me how you will lay your baby down to sleep."
- "How many times a day will your baby feed?"
- "How many wet diapers do you expect by day 5?"
- "What will you do if your baby's temperature is 100.4 or higher?"
- "What is your plan if the crying makes you frustrated?"
Teaching tips
- Observe the parent buckle the infant into the car seat before discharge.
- Teach rectal temperature measurement with a return demonstration.
- Include grandparents and babysitters in the safe sleep and crying plans.
Read more on NCLEXPace
- Newborn Assessment: APGAR, Reflexes, and Red Flags
- Pediatric Vital Signs by Age: The Only Table You Need
- Growth, Development, and Immunizations
Sources
- Moon RY, et al. Sleep-Related Infant Deaths: Updated 2022 Recommendations for Reducing Infant Deaths in the Sleep Environment. Pediatrics. 2022;150(1):e2022057990.
- Kemper AR, et al. Clinical Practice Guideline Revision: Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation. Pediatrics. 2022;150(3):e2022058859.
- Meek JY, et al. Policy Statement: Breastfeeding and the Use of Human Milk. Pediatrics. 2022;150(1):e2022057988.
- Durbin DR, et al. Child Passenger Safety. Pediatrics. 2018;142(5):e20182460.
- Pantell RH, et al. Evaluation and Management of Well-Appearing Febrile Infants 8 to 60 Days Old. Pediatrics. 2021;148(2):e2021052228.
Why this matters for the NCLEX
Teaching is effective when the parent states, "I will lay my baby on her back in her own crib with nothing else in it," and "I will call right away if my 4-week-old has a temperature of 100.4." Statements requiring further teaching include, "I will put a soft bumper in the crib so she does not hit her head," "She can sleep in our bed so I can watch her," and "I will give acetaminophen for a fever and wait to see if it goes down."
Frequently asked questions
Why does a fever in an infant younger than 3 months require immediate care?
Young infants have immature immune responses and show few specific signs of serious bacterial infection. A temperature of 100.4 F (38 C) or higher requires immediate evaluation.
Is room-sharing the same as bed-sharing?
No. Room-sharing places the infant in a separate crib or bassinet in the parents' room and reduces the risk of sleep-related death. Bed-sharing increases that risk.
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