Babies cannot protect themselves. They need to feel safe and secure. They feel secure when warm and when wrapped and held snugly. Babies cry to communicate. They cry when wet, hungry, hot or cold, tired, uncomfortable, or in pain. To promote safety and security, respond to their cries—feed them, change diapers as needed, comfort them, talk to them, and so on.

Follow the infant safety measures in Box 52-1. Follow the measures in Chapters 13 and 14 to protect children from burns, poisoning, choking and suffocation, and falls. Also see Appendix D, p. 877.

Box 52-1

Infant Safety

General Safety

• Keep the baby warm. Check windows for drafts. Close windows securely.

• Keep your fingernails short. Do not wear fake nails. Long nails can scratch the baby.

• Do not wear rings or bracelets. Jewelry can scratch the baby.

• Respond to the baby’s crying. They communicate by crying. Responding to their cries helps them feel safe and secure.

• Keep 1 hand on a child lying in a crib or on a scale, bed, table, or other surface or furniture (Fig. 52-1).

FIGURE 52-1 Keep 1 hand on a child lying on a raised surface.

• Keep pins and small objects out of the baby’s reach.

• Do not shake powder directly over the baby. The powder can get into the baby’s eyes and lungs. Shake some on your hand away from the baby.

• Do not tie a pacifier around the baby’s neck.

Holding a Baby

• Use both hands to lift a newborn. Use 1 hand to support the head and upper back. Use your other hand to support the legs. Do not lift a newborn by the arms.

• Hold the baby securely. Use the cradle hold, football hold, or shoulder hold (Fig. 52-2).

FIGURE 52-2 Holding a baby. A, The cradle hold. B, The football hold. C, The shoulder hold.

• Support the baby’s head and neck when lifting or holding the baby. Neck support is necessary for the first 3 months after birth.

• Handle the baby with gentle, smooth movements. Avoid sudden or jerking movements. Do not startle the baby.

• Hold and cuddle infants. It is comforting and helps them learn to feel love and security.

Crib and Furniture Safety

• Make sure the crib is within hearing distance of the caregivers.

• Do not put a pillow, quilts, bumper pads, or soft toys in the crib. They can cause suffocation.

• Place infants on a firm surface to sleep. Do not lay an infant on soft bedding products. This includes fluffy, plush products such as sheepskin, quilts, comforters, pillows, and toys. Soft products can cause suffocation.

• Report crib or furniture problems at once. Loose nuts, bolts, screws or bent, broken, or open mattress hooks are examples.

• See Appendix D, p. 877 for nursery equipment safety.

Sleep

• Remove bibs and necklaces before sleep.

• Lay babies on their backs for sleep. Do not lay babies on their stomachs for sleep. This can interfere with chest expansion and breathing. The baby can suffocate. Infants can lie on their sides and stomachs when awake and supervised.

• Make sure there is no soft bedding under the baby.

• Maintain a comfortable temperature. Babies must not get too hot during sleep. Avoid clothing that may cover the infant’s head or cause over-heating.

See Focus on Long-Term Care and Home Care: Safety and Security, p. 802.

Focus on Long-Term Care and Home Care

Safety and Security

Home Care

Injuries in the home are preventable. Safety measures can protect infants and children from harm.

• Supervise infants and children at all times.

• Use childproof locks or door knob covers leading to non-childproof areas (Fig. 52-3).

• Use safety gates at the top and bottom of stairs.

• Do not let children climb on furniture. Also prevent furniture from tipping.

• Remove or pad furniture with sharp or rough edges.

• Check that the crib meets federal safety standards.

• Store harmful items where children cannot reach them. Keep items in locked storage areas.

• Keep child-resistant caps on drugs and other harmful substances.

• Keep cords and strings out of reach and away from cribs and playpens.

• Use outlet safety covers or outlet plugs on electrical outlets (Chapter 13). A choking hazard, use outlet plugs with caution. The plug must not be easily removed by children.

• Keep the hot water heater temperature below 120°F (Fahrenheit) (48°C [centigrade]) to prevent burns.

• Supervise children in or near water. Prevent children from entering areas that contain water.

• Use federally approved car safety seats that fit the child’s size and weight (Fig. 52-4). Follow the manufacturer’s instructions for weight and height limits.

FIGURE 52-4 Federally approved car safety seats carry this label.

• Use car safety seats correctly. Seats are kept rear-facing as long as possible—usually until age 2 (Fig. 52-5).

FIGURE 52-5 Car safety seat that is rear-facing.

• Check that the child’s clothing is safe and fits well. Drawstrings, ribbons, and cords are hazards (Fig. 52-6). Loose clothing, long clothing, and items around the neck are dangerous.

FIGURE 52-6 Drawstrings, ribbons, and cords can get caught in many things and strangle the child.

• Check that all toys are age-appropriate and are not damaged.

• Keep small items away from children. Make sure the child cannot fit items in the mouth.

• Follow the safety measures in Appendix D (p. 877).

Nursery equipment must be safe and in good repair. Use the guidelines in Appendix D (p. 877) to check nursery equipment.

Crib Safety

Cribs and crib linens present safety hazards. They can strangle and suffocate the baby. Mattresses, linens, and bumper pads pose many dangers.

• Bumper pads are not used.

• The mattress is covered with a crib sheet. The crib sheet fits snugly.

• Only fitted crib sheets that fit snugly are used. Sheets for larger beds are not used.

• Sheets are not used if they are frayed, worn, or have loose threads or stitching.

• Pillows, blankets, comforters, quilts, sheepskin, sleep positioners, and pillow-like stuffed toys and other soft products are not placed in the crib.

• Plastic trash bags, dry-cleaning bags, or plastic packaging materials are not used to protect the mattress. The plastic can cling to the baby’s face, nose, and mouth. This prevents breathing and causes suffocation.

Report any hazard to the nurse.

See Focus on Long-Term Care and Home Care: Crib Safety.

Focus on Long-Term Care and Home Care

Crib Safety

Home Care

The Consumer Product Safety Improvement Act of 2008 (CPSIA) created safety standards for new and used full-sized cribs effective June 28, 2011. The law applies to cribs in homes, childcare facilities, family childcare homes, and other businesses providing cribs. The law also applies to the re-sale of used and antique cribs at garage, yard, rummage, and similar sales; on-line auction sites; and donations to thrift stores. Because they are medical devices, the law does not apply to hospital cribs.

According to the American Academy of Pediatrics, new children’s furniture should bear the Juvenile Products Manufacturers Association (JPMA) safety certification seal (Fig. 52-7, p. 804). This seal means that the product meets required safety testing standards.

FIGURE 52-7 Juvenile Products Manufacturers Association safety certification seal. NOTE: ASTM stands for American Society for Testing and Materials. (From JPMA [Juvenile Products Manufacturers Association], Mt. Laurel, New Jersey.)

The CPSIA full-sized crib standard:

• Bans the manufacture and sale of drop-side rail cribs. Drop-side cribs have been linked to infant suffocation and strangulation deaths.

• The mattress thickness must not be greater than 6 inches.

• The crib mattress must be firm. It must not sag from the infant’s weight. A soft mattress can cover the baby’s nose and mouth. This prevents breathing.

• The mattress must fit tight into the crib. There must be no gaps or space between the mattress and the crib. The baby can get trapped in such gaps or spaces between the mattress and the crib.

• Crib slats (bars) are no more than inches apart—the width of a soda can. The baby’s head can get caught between larger spaces, causing suffocation and death.

• The bottom of the 6-inch mattress is at least 26 inches lower than the top of the crib sides. This prevents the baby from falling out of the crib. The mattress is lowered to the lowest level when the baby starts to stand in the crib.

• The head-boards and foot-boards must not have cut-outs. The baby’s head can get trapped in cut-outs.

• Corner posts (spindles) must be no higher than of an inch above the end-panels. This prevents the baby’s clothing from getting caught on the corner posts.

Sudden Unexpected Infant Death

Sudden unexpected infant death (SUID) is any sudden and unexpected death in an infant younger than 1 year old. The death may be explained or unexplained. The most common causes of SUID are:

• Sudden infant death syndrome (SIDS)—the sudden, unexplained death of an infant younger than 1 year old. SIDS is the leading cause of death in children between 1 month and 1 year of age. Most SIDS deaths occur between 1 and 4 months of age. It usually occurs during sleep.

• Accidental suffocation or strangulation in bed.

• Unknown causes.

Crib and sleep safety help prevent sudden infant death. See Box 52-1. Lay babies on their backs for sleep. These measures also reduce the risk.

• Place babies to sleep in the same room as the parents but not the same bed. Parents who share a bed with a baby can roll onto the child during sleep. Or the baby can suffocate in blankets or sheets.

• Breast-feed.

• Offer a pacifier for sleep. For breast-fed babies, wait until the baby feeds well before giving a pacifier.

• Keep babies away from smoke. This includes people who smoke and places where smoking occurs.

• Avoid home products such as wedges, positioning devices, special mattresses, and heart and lung monitors that claim to reduce SIDS risk.

Regular wellness visits are important for infant and child health. Vaccines may protect against sudden infant death.

The mother’s health during pregnancy affects the baby’s risk. Women should receive regular prenatal care. Prenatal care is the health care a woman receives while pregnant. Mothers must avoid smoking, alcohol, and illegal drug use during pregnancy.

Signs and Symptoms of Illness

Babies can become ill quickly. Signs and symptoms may be sudden. You must be very alert. Report any of the signs and symptoms in Box 52-2 at once. Be alert to any change in the baby’s behavior—sleep pattern, cry, appetite, or activity.

Box 52-2

Illness in Babies—

Signs and Symptoms

• The baby has jaundice—a yellowish color to the skin and whites of the eyes.

• The baby looks sick.

• The baby has redness or drainage around the cord stump (p. 813) or circumcision (p. 813).

• The baby has a fever (Chapter 29).

• The baby is limp and slow to respond.

• The baby is hard to wake up.

• The baby is less active than usual.

• The baby cries all the time or does not stop crying.

• The baby is flushed, pale, or perspiring.

• The baby has noisy, rapid, difficult, or slow respirations.

• The baby is coughing or sneezing.

• The baby has reddened or irritated eyes.

• The baby turns his or her head to 1 side or puts a hand to 1 ear (signs of an earache).

• The baby screams for a long time.

• The baby is feeding poorly or has skipped feedings.

• The baby has vomited most of the feeding or vomits between feedings.

• The baby has watery stools or hard, formed stools.

• Stools are light-colored, green, or foul-smelling.

• The baby has fewer wet diapers.

• The baby has a rash.

Tell the nurse when a sign or symptom began. You may need to measure the baby’s temperature, pulse, and respirations (Chapter 29). The nurse tells you what temperature site to use—tympanic, rectal, temporal artery, or axillary. Apical pulses are taken on infants and young children.

Helping Mothers Breast-Feed

Breast-feeding (nursing) is feeding a baby milk from the mother’s breasts.

• The baby can feed at the mother’s breast.

• The mother can pump milk from her breasts. The baby is fed breast-milk from a bottle.

Babies usually breast-feed every 2 to 3 hours during the first month (8 to 12 times a day). They are fed on demand. That is, they are fed when hungry, not on a schedule. Breast-milk is digested faster than formula. Therefore nursing is needed more often.

Babies nurse for a short time the first few days (5 to 10 minutes at each breast). Eventually nursing time takes 10 to 20 minutes at each breast. The rate varies for each baby.

A feeding ends when:

• The baby’s sucking slows.

• The baby pulls off the breast.

• The baby is no longer interested in feeding.

Nurses help new mothers learn to breast-feed and about breast care. Tell the nurse if the mother or baby is having problems nursing.

Mothers may need help getting ready to nurse. They may need help with hand-washing and positioning. Provide for privacy and make sure the call light is within reach before leaving the room. Follow the care plan and the measures in Box 52-3.

Box 52-3

Assisting With Breast-Feeding

• Practice hand hygiene and Standard Precautions. Remember, the human immunodeficiency virus (HIV) can be transmitted through breast-milk (Chapter 43).

• Place milk, juice, or water near the mother. Most mothers become thirsty while breast-feeding.

• Help the mother wash her hands. She needs clean hands before handling her breasts.

• Help the mother to a comfortable position. The cradle position, side-lying position, and football hold are the basic positions for breast-feeding (Fig. 52-8, p. 806).

FIGURE 52-8 Basic breast-feeding positions. A, Cradle position. B, Side-lying position. C, Football hold. (From James SR and Ashwill JW: Nursing Care of Children: Principles and Practice, ed 3, St Louis, 2007, Saunders.)

• Change the baby’s diaper if necessary. Bring the baby to the mother.

• Make sure the mother holds the baby close to her breast.

• Have the mother use her nipple to stroke the baby’s cheek or lower lip. This stimulates the rooting reflex. The baby turns his or her head toward the breast and starts to suck.

• Make sure the baby’s nose is not blocked by the mother’s breast. One nostril must be clear for breathing. If the nose seems blocked, have the mother do 1 of the following.

• Re-position the baby. She can raise the baby’s hips. Or she can move the baby’s head back slightly.

• Use her thumb to keep breast tissue away from the baby’s nose with her thumb (Fig. 52-9, p. 806).

FIGURE 52-9 The mother supports her breast with 1 hand. The thumb is on top of the breast to keep breast tissue away from the baby’s nose. (From James SR and Ashwill JW: Nursing Care of Children: Principles and Practice, ed 3, St Louis, 2007, Saunders.)

• Give her a baby blanket to cover the baby and her breast. This promotes privacy.

• Encourage nursing from both breasts at each feeding. If the last feeding ended at the right breast, the next feeding is started at the right breast. The mother can use a ribbon or diaper pin on her bra strap to remind her which breast to start with.

• Remind her how to remove the baby from the breast. To break the suction between the baby and the breast, she can insert a finger into a corner of the baby’s mouth (Fig. 52-10, p. 806).

FIGURE 52-10 The mother inserts a finger into the corner of the baby’s mouth to remove the baby from the breast. (From James SR, Ashwill JW, Droske SC: Nursing Care of Children: Principles and Practice, ed 2, Philadelphia, 2002, Saunders.)

• Help the mother burp the baby (p. 809). The baby is burped after nursing at 1 breast. Then the baby is burped after nursing at the other breast.

• Remind the mother to air-dry her nipples after a feeding.

• Change the baby’s diaper after the feeding.

• Lay the baby in the crib if he or she has fallen asleep. Lay the baby on his or her back. Do not lay the baby on the stomach.

• Help the mother prevent dry and cracked nipples. Follow the nurse’s directions and the care plan.

• Milk is left on the nipple after a feeding. The milk is allowed to air-dry.

• The mother applies prescribed ointment or cream after each feeding if the nipples are cracked. If directed, remind her to wash her breasts with water before a feeding to remove the ointment or cream.

• Soap is not used to clean the breasts and nipples.

• Breasts and nipples are washed and dried gently.

• Help the mother straighten clothing after the feeding if necessary.

• Remind the mother to wash her breasts with a clean washcloth and warm water. Soap is not used. It can cause the nipples to dry and crack. Nipples are air-dried after washing to prevent cracking and soreness.

• Encourage the mother to wear a nursing bra day and night. The bra supports the breasts and promotes comfort.

• Encourage the mother to place nursing pads in the bra. The pads absorb leaking milk.

See Focus on Long-Term Care and Home Care: Helping Mothers Breast-Feed, p. 806.

Focus on Long-Term Care and Home Care

Helping Mothers Breast-Feed

Home Care

When the mother is nursing, stay within hearing distance. She may need help.

The nursing mother needs good nutrition. When planning meals or grocery shopping, remember that:

• Calorie intake may increase. The nurse tells you what the mother’s calorie intake needs to be.

• She should have 3 servings a day from the dairy group. The nurse tells you if more servings are needed.

• She needs foods high in calcium.

• She can eat the foods she likes. A certain food may cause the baby to be fussy or gassy or have cramping or diarrhea. She should avoid that food for a while. Onions, garlic, spices, cabbage, Brussels sprouts, asparagus, and beans are examples.

• Caffeine is used in moderation. Chocolate, coffee, tea, soda, and energy drinks contain caffeine. Caffeine can cause the baby to be fussy or gassy, become agitated, or have sleep problems.

• She should not drink alcohol.

Bottle-Feeding Babies

Babies who are not breast-fed use formula. The doctor prescribes the formula. It provides the nutrients the infant needs.

Formula comes in 3 forms.

• Ready-to-feed. Ready to use, it is poured from the can into a baby bottle (Fig. 52-11). The can may have more than 1 feeding. Refrigerate the can after opening it. Use the contents within 24 hours.

FIGURE 52-11 Ready-to-feed formula is poured from the container into the bottle.

• Powdered. Container directions tell how much powder and water to use.

• Liquid concentrate. Container directions tell you how much liquid and water to use.

Bottles are prepared 1 at a time or in batches for the whole day. To prepare a bottle:

• Boil water as directed by the nurse.

• Follow the container directions carefully. Measure exact amounts.

• Pour the correct amount of water and formula into the bottle.

• Gently shake or swirl the bottle to mix.

• Place the bottle under cold water to cool the formula. Or place the bottle in cold or ice water. Keep the level of the cooling water below the bottle’s lid to avoid contaminating the formula.

• Dry the outside of the bottle.

• Check the temperature by placing drops on the inside of your wrist. The formula should feel warm, not hot.

• Cap extra bottles (Fig. 52-12). Store them in the refrigerator. Use stored bottles within 24 hours.

FIGURE 52-12 Bottles are capped for storage in the refrigerator.

Cleaning Baby Bottles

Protect the baby from infection. Baby bottles, caps, nipples, and other items must be as clean as possible. Disposable equipment is used in hospitals. Reusable equipment is common in homes. It is carefully washed in hot, soapy water or in a dishwasher. Complete rinsing is needed to remove all soap. Some bottles have plastic liners that are discarded after 1 use.