We discuss home safety teaching for parents. We are joined by Stephanie Nguyen, MD, Assistant Professor of Neonatal-Perinatal Medicine at the University of Texas Southwestern Medical Center.
Dr. Neeta Goli:
Welcome to Newborn News, a podcast where we discuss educational topics for medical professionals who care for newborns. I'm your host, Dr. Neeta Goli, a pediatrician in the UT Southwestern Newborn Nursery.
Dr. Neeta Goli:
Welcome back to the podcast. In today's episode we'll review newborn discharge teaching, which means what to teach families before they go home. We're joined again by Dr. Stephanie Nguyen. Thanks for joining us again.
Dr. Stephanie Nguyen:
Thanks for having me again.
Dr. Neeta Goli:
So before babies go home, there's some discharge teaching which needs to be completed with all our families, and for any of our residents listening at Parkland, you are expected to discuss this with your families. So, can you start off by telling us what things you usually tell families before they go home?
Dr. Stephanie Nguyen:
The first topic that I like to cover is safe sleep, and I like to phrase it as back to sleep, tummy for play. So whenever the baby is by himself and sleeping, the safest place for him to be is in his crib on his back by himself. And an ugly crib is a safe crib. Ugly meaning no extra blankets, pillows, or toys. Less in the crib is less than can cover his face and mouth and keep him from breathing.
Dr. Stephanie Nguyen:
I like the term back to sleep, tummy for play, because a lot of parents are really concerned about the flat head that babies can get on their back if they're always on their back. So things to do to prevent this is one, more tummy time, so tummy time is for play time, and then two, when babies are sleeping on their back you can turn their head side to side every couple hours to reduce pressure on just one area of the head.
Dr. Stephanie Nguyen:
The second thing to cover is car seat safety. I tell parents to look at the label on the car seat to make sure that the car seat has not expired and it is the appropriate weight guidelines for your baby, and then the car seat should be in the back seat facing backwards until the baby's at least two years old. The middle seat is the safest.
Dr. Stephanie Nguyen:
Third thing I talk about is cord care. I tell parents that the less you mess with the cord, the quicker it will fall off, and I tell parents it can happen anywhere from between three days and three weeks. And no baths for the baby, no soaking in water, until the cord has completely fallen off. I have a lot of parents asking me, "Hey, back in the day we did certain dyes or certain alcohol wipes for it." I tell them now the recommendations is just leave it alone. No alcohol wipes, no special purple dyes, just leave the cord alone.
Dr. Stephanie Nguyen:
The third thing I like to talk about is ER warnings for fever. I tell parents that if the baby's ever behaving abnormally, not waking up to feed at least every six hours, or crying for hours and you can't figure out why, take his temperature, and take this temperature rectally. A fever in a baby is 100.4. 100.4, and that is an emergency. You don't give the baby Tylenol or Motrin, you take the baby straight to a children's emergency room so that a doctor can evaluate them.
Dr. Stephanie Nguyen:
All babies cry. Some a little, some a lot. If your baby's crying, that is completely normal, but we don't want a frustrated parent and frustrated baby because that can lead to injuries. So if you need to take your breaks, you put the baby in the crib and you take the breaks that you need so that it doesn't lead to any injuries for the babies. Last thing we want is a shaken baby.
Dr. Neeta Goli:
And for our listeners, the fever warnings, those especially apply for infants who are younger than 28-days-old.
Dr. Stephanie Nguyen:
Yes.
Dr. Neeta Goli:
That if they have a fever, they need to go straight to the emergency room.
Dr. Neeta Goli:
That was a really great safety talk. I bet parents love hearing that from you. You mentioned no baths before the cord falls off. Once the cord falls off, how often can parents bathe their babies?
Dr. Stephanie Nguyen:
I say while the cord is still in place they don't need real baths because they don't really sweat or get dirty. Just give them sponge bath, kind of spot clean those areas. After the cord's fallen off, two to four times a week is okay. And you don't need soap, you just need warm water.
Dr. Neeta Goli:
So you don't need to be the baby every day. Some families, if they choose to bath the baby every day, that's okay, but it's not required or not necessary. And then, so Vitamin D for babies is something that we talk about a lot. So, which babies need vitamin D, and why?
Dr. Stephanie Nguyen:
They say technically just exclusively breastfeeding moms, but for me, I say all babies need Vitamin D because the amount of formula babies would have to take is 32 ounces a day to get sufficient vitamin D. I would say especially for the first few months of life all babies need Vitamin D, and the dose is 400 units per day. They come in some types where it's just one drop. Moms who are breastfeeding tend to like that form because they can do one drop on the nipple and then latch the baby. Other parents prefer the multivitamin forms, and I tell them more vitamins, great, not necessary, but if they do get the multivitamin form get the type without iron for now, and then at four to six months they get the type with iron.
Dr. Neeta Goli:
Why do they need to add in the type with iron when they're four to six months old?
Dr. Stephanie Nguyen:
Babies hit their physiologic anemic nadir at eight to 12 weeks, and so we tell them to wait on adding iron until after that point.
Dr. Stephanie Nguyen:
When babies are initially born, if you look at their cell counts, their hemoglobin hematocrit is way higher than ours. The reason for that is first, their fetal hemoglobin, they make much more of it, and then two, in utero they're in a hypoxic environment so their EPO is overstimulated to make more red blood cells. After they're born they're in an oxygen rich environment again, and so their body tells them, "Oh, I don't need all these red blood cells or all this EPO." So that kind of turns that off and it decreases production from the bone marrow, and they're having an increased breakdown due to the normal half-life of the red blood cells. It's usually for a term healthy infant. The physiologic nadir is at eight to 12 weeks. This would be different for a pre-term infant who may need iron supplementation earlier on, anywhere between four to eight weeks.
Dr. Neeta Goli:
That's great. That's a great little extra tidbit for our listeners to understand.
Dr. Neeta Goli:
I get this question a lot from parents. When babies are crying, they always ask me, "Is it baby's stomach? Is there something wrong with his tummy? Is it because he's gassy? Is it something to do with the breast milk or the formula?" What do you tell these families?
Dr. Stephanie Nguyen:
I tell parents that a fussy baby does not mean that they're necessarily hurting. That the movements that they're doing, if it looks like they're pushing or kind of grunting, that's normal of their intestines just learning how to do the movements. Something that's really benign to teach them is if they're concerned about it, to do bicycle kicks where they grab each leg and do little circular motions. That helps straighten out the rectum. And then after that, do 5-10 minutes of a soft belly massage to help release the gas.
Dr. Neeta Goli:
Sounds good. And then I get a lot of parents asking me about their baby's hiccupping, if that's normal.
Dr. Stephanie Nguyen:
For me, it's completely normal. I'm not worried about it at all.
Dr. Neeta Goli:
Yeah, agreed. Interestingly for our listeners, there was a recent study that showed that hiccupping might be a way that babies actually learn how to breathe. So I just give families lots of reassurance, tell them it's completely normal for babies as they're developing and growing.
Dr. Neeta Goli:
And then some families, especially if they're first-time parents, might not know when to change a diaper. Can you tell us a little bit more about what you tell families?
Dr. Stephanie Nguyen:
So if it's wet, change it. If it's dirty, change it. Diapers nowadays have that yellow line that turns blue when it's wet. So I tell them that's an easy way to know if it's wet, but letting them know that dirty diapers will not turn that stripe blue.
Dr. Neeta Goli:
Okay.
Dr. Stephanie Nguyen:
There are no set guidelines of how often to change diapers, but we typically see diaper changes every three to four hours. It is okay if the baby is sleeping, let the baby sleep and wake them up to change them later.
Dr. Neeta Goli:
Yeah. So, never wake a sleeping baby is a pretty good rule of thumb for parents. That being said, make sure that families talk to their pediatrician and babies are gaining weight well, they're back up to their birth weight, and the pediatrician agrees with this. But as long as everything's moving on track, there's no need to wake a sleeping baby just to change their diaper.
Dr. Neeta Goli:
So while we're talking about diapers, they can get really expensive. We're talking about changing diapers every three to four hours. That comes out to about six or eight new diapers a day. So each diaper, depending on whether you get the store brand or the name brand diapers, they can be between 10 to 20 cents each or about 20 to 30 cents each, and that can come out to about a thousand dollars a year, and that's a big expense for families. So for some families, they might not change the diapers as often because they can't afford that many diapers. What are some risks that you might worry about for babies if their diapers aren't being changed often enough?
Dr. Stephanie Nguyen:
If parents aren't changing the diapers often enough the baby's at risk of diaper rashes and urinary tract infections.
Dr. Neeta Goli:
And then studies have also shown that parents who have diaper need, which means that they're not able to afford the diapers, also have increased rates of parental stress. Sometimes it actually leads to them not participating in the workforce, because if parents are going to work, then their babies need a childcare setting, and childcare requires diaper changes with a certain frequency. So if parents can't afford that, then that might actually keep them from working. If families are having diaper need, if they can't afford these diapers, what kind of resources do we have for them?
Dr. Stephanie Nguyen:
Unfortunately, neither WIC nor SNAP provide diapers, but you can try to find your local diaper banks which may be able to help. Some examples of this is the Hope Supply Co., and the North Dallas Shared Ministries.
Dr. Neeta Goli:
So, diapers can be a big cost for families. If some families are formula feeding their babies, that can also get really expensive too. I have a lot of parents that before they go home ask me what kind of formula to buy.
Dr. Stephanie Nguyen:
I would say buy generic. The FDA mandates that all formulas have the same nutritional content, so I say go to one of those big box stores and buy the generic formula in bulk, and that will definitely help you save money.
Dr. Neeta Goli:
Absolutely. And then, how often is it that families can't afford their formula?
Dr. Stephanie Nguyen:
Unfortunately in the area that we live in, in Dallas County, one in four children live in a household that experiences food insecurity and have done so in the last year.
Dr. Neeta Goli:
So what do you mean by food insecurity?
Dr. Stephanie Nguyen:
So the AAP defines food insecurity as either not having access to food, or even having the concern of not having adequate access to food. For our patient population, transportation is a major issue, along with a lot of our family live in areas considered food deserts. Especially after having a baby, transportation becomes even a bigger issue as you're less mobile.
Dr. Neeta Goli:
So for families who have food insecurity, who can't afford to buy the formula out of pocket from the store, what kind of resources can we offer them?
Dr. Stephanie Nguyen:
So if they qualify for WIC services, depending on how they've chosen to feed their child, they have certain food allotments for mom. In addition, SNAP is available for families with low income.
Dr. Neeta Goli:
Okay. So what if the family is being discharged on Friday and they can't make it to WIC until Monday? What can they do over the weekend?
Dr. Stephanie Nguyen:
Food pantries are an option. And if you had to buy anything out of pocket, again, go generic.
Dr. Neeta Goli:
Okay. Thanks so much for all this useful, really practical information, and for joining us again. So to end today's episode, do you have any other tips for our listeners while they're taking care of newborns?
Dr. Stephanie Nguyen:
Unfortunately, we can't cover all the questions parents are going to have, so I tell them the best website is healthychildren.org. It's a website written by the American Academy of Pediatrics, and it covers all the topics. Like “how often is my baby supposed to poop” and a lot of safety tips for parents at home.
Dr. Neeta Goli:
So many poop questions.
Dr. Stephanie Nguyen:
Always with the poop questions.
Dr. Neeta Goli:
Okay. All right, thanks Stephanie.
Dr. Neeta Goli:
Thanks for listening to Newborn News. We hope you join us next time. If you like what you hear, make sure to subscribe and leave us a review. If you have questions, comments, feedback, or suggestions for future episodes, please email me at NewbornNews@utsouthwestern.edu. As a reminder, this content is educational and is not meant to be used as medical advice. Views or opinions expressed in this podcast are those of myself and my guests and do not necessarily reflect the views of the university.