ESSENTIAL NEWBORN CARE

Essential Newborn Care(ENC) is care that every newborn baby needs regardless of where it
is born or its size. ENC should be apllied immediately after the baby is born and continued
for at least the first 7 days after birth.

EXCLUSIVE BREAST FEEDING

Breastfeeding is an unequalled way of providing ideal food for the healthy growth and
development of infants; it is also an integral part of the reproductive process with important
implications for the health of mothers. Review of evidence has shown that, on a population
basis, exclusive breastfeeding for 6 months is the optimal way of feeding infants. Thereafter
infants should receive complementary foods with continued breastfeeding up to 2 years of
age or beyond.

To enable mothers to establish and sustain exclusive breastfeeding for 6 months, WHO and
UNICEF recommend:

 Initiation of breastfeeding within the first hour of life

 Exclusive breastfeeding – that is the infant only receives breast milk without any
additional food or drink, not even water
 Breastfeeding on demand – that is as often as the child wants, day and night
 No use of bottles, teats or pacifiers

Breast milk is the natural first food for babies, it provides all the energy and nutrients that the
infant needs for the first months of life, and it continues to provide up to half or more of a
child’s nutritional needs during the second half of the first year, and up to one-third during
the second year of life.

Breast milk promotes sensory and cognitive development, and protects the infant against
infectious and chronic diseases. Exclusive breastfeeding reduces infant mortality due to
common childhood illnesses such as diarrhoea or pneumonia, and helps for a quicker
recovery during illness. These effects can be measured in resource-poor and affluent
societies.

Breastfeeding contributes to the health and well-being of mothers; it helps to space children,
reduces the risk of ovarian cancer and breast cancer, increases family and national resources,
is a secure way of feeding and is safe for the environment.

While breastfeeding is a natural act, it is also a learned behaviour. An extensive body of

research has demonstrated that mothers and other caregivers require active support for
establishing and sustaining appropriate breastfeeding practices. WHO and UNICEF launched
the Baby-friendly Hospital Initiative in 1992, to strengthen maternity practices to support
breastfeeding. The foundation for the BFHI are the Ten Steps to Successful Breastfeeding
described in Protecting, Promoting and Supporting Breastfeeding: a Joint WHO/UNICEF
Statement. The evidence for the effectiveness of the Ten Steps has been summarized in a
scientific review document.

The BFHI has been implemented in about 16.000 hospitals in 171 countries and it has
contributed to improving the establishment of exclusive breastfeeding world-wide. While
improved maternity services help to increase the initiation of exclusive breastfeeding, support
throughout the health system is required to help mothers sustain exclusive breastfeeding.

NEWBORN NUTRITION

Feeding and Nutrition of Newborn Babies. ... According to the World Health Organization,
“exclusive breastfeeding for the first six months is the optimal way of feeding infants.
Thereafter, infants should receive complementary foods with continued breastfeeding up to
two years of age or beyond.”

BREASTFEEDING:-

Breastfeeding is the best natural feeding and breastmilk is best milk. The basic food of infant
is mother’s milk.Breastfeeding is the most effective way to provide a baby with a caring
environment and complete food. It meets the nutritional as well as emotional and
psychological needs of the infant.But recently there is tendency to replace the natural means
of infant feeding and introduction of breast milk substitutes.

NUTRITIVE COMPONENTS IN BREASTMILK:-

Human Milk Composition (per liter)

Milk Component Early Milk Mature Milk

Lactose (g) 20-30 67
Total protein (g) 16 9
Fat% 2 3.5
Calories 0 2730-2940
Retinol (mg) 2 0.3-0.6
Caretenoids (mg) 2 0.3-0.6
Riboflavin (ug) 0 400-600
Niacin (mg) 0.5 1.8-6.0
Vitamin B6 (mg) 0 0.9-0.31
Pantothenic acid (mg) 0 2-2.5
Biotin (ug) 0 5-9
Folate (ug) 0 80-140
Vitamin B12 (ug) 0 .5-1.0
Vitamin C (mg) 0 100
Vitamin D (microgram) 0 0.33
Vitamin E (mg) 2-12 3-8
Vitamin K (microgram) 2-8 2-3
Calcium (mg) 250 200-500
Phosphorus (mg) 120-160 120-140
Magnesium (mg) 30-35 30-35
Copper (mg) 0.5-0.8 0.2-0.4
Iron (mg) 0.5-1.0 0.3-0.9
Zinc (mg) 8-12 1-3

COMPOSITION OF BREAST MILK:-

The composition of breast milk varies at different stages in the postnatal period to fulfil the
needs of baby.
  Colostrum- It is secreted during 1st 3 days after delivery.It is thick, Yellow, and small
in quantities.It contains more antibodies and cells with higher amount of proteins and
fat soluble vitamin(A,D,E,K).It is sufficient and protective for the baby and should
not be discarded.Low in fat and carbohydrate.Lactobacillus bifidus factor.Contains
antibodies immune system cells.
 Benefits of colostrum feeding:
 Perfect food for infants in initial days.
 Laxative effect – clears infant’s intestines of initial stools; prevents jaundice.
 Contains leukocytes which prevent infection.
 Contains IgA which also provides immunity.

 Transitional Milk- It follows the colostrum and secretes during first two weeks of
postnatal period.It has increased fat and sugar content and decreased protein and
immunoglobulin content.
 Mature Milk- It is secreted usually from 10-12 days after delivery.It is watery but
contains all nutrient for optimal growth of the baby.
 Preterm Milk- The breastmilk secreted by a mother who has delivered a preterm baby
is different from milk of a mother who has delivered a full term baby.This milk
contains more protiens, sodium, iron, immunoglobulins and calories appropriate for
the requirements of the preterm neonates.
 Fore Milk- It is secreted at the starting of the regular breastfeeding.It is more watery
to satisfy the baby’s thirst and contains more protiens, sugar, vitamins and minerals.
 Hind Milk- It is secreted towards the end of regular breastfeeding and contains more
fat and energy.The mother should feed the baby allowing one breast to empty to
provide both fore milk and hind milk, before offering other breast.For optimum
growth and to fulfill adequate fluid and nutritional requirements, both fore milk and
hind milk are needed for the baby.

FORMULA FEEDING:-

Besides breast milk, infant formula is the only other milk product which the medical
community considers nutritionally acceptable for infants under the age of one year (as
opposed to cow's milk, goat's milk, or follow-on formula). Supplementing with solid food in
addition to breast milk or formula begins during weaning, and most babies begin
supplementing about the time their first teeth appear, usually around the age of six months.
Although cow's milk is the basis of almost all infant formula, plain cow's milk is unsuited for
infants because of its high casein content and low whey content, and untreated cow's milk is
not recommended before the age of 12 months. The infant intestine is not properly equipped
to digest non-human milk, and this may often result in diarrhea, intestinal bleeding and
malnutrition. To reduce the negative effect on the infant's digestive system, cow's milk used
for formula undergoes processing to be made into infant formula. This includes steps to make
protein more easily digestible and alter the whey-to-casein protein balance to one closer to
human milk, the addition of several essential ingredients (often called "fortification", see
below), the partial or total replacement of dairy fat with fats of vegetable or marine origin,
etc.
The nutrient content of infant formula for sale in the United States is regulated by the Food
and Drug Administration (FDA) based on recommendations by the American Academy of
Pediatrics Committee on Nutrition. The following must be included in all formulas produced
in the U.S.:
  Protein
 Fat
 Linoleic acid
 Vitamins: A, C, D, E, K, thiamin (B1), riboflavin (B2), B6, B12
 Niacin
 Folic acid
 Pantothenic acid
 Calcium
 Minerals: magnesium, iron, zinc, manganese, copper
 Phosphorus
 Iodine
 Sodium chloride
 Potassium chloride
 Carbohydrates
Carbohydrates are an important source of energy for growing infants, as they account for 35
to 42% of their daily energy intake. In most cow's milk-based formulas, lactose is the main
source of carbohydrates present, but lactose is not present in cow's milk-based lactose-free
formulas nor specialized non-milk protein formulas or hydrolyzed protein formulas for
infants with milk protein sensitivity. Lactose is also not present in soy-based formulas.
Therefore, those formulas without lactose will use other sources of carbohydrates, such as
sucrose and glucose, dextrins, and natural and modified starches. Lactose is not only a good
source of energy, it also aids in the absorption of the minerals magnesium, calcium, zinc and
iron.

IMMUNIZATION

Immunization is the process whereby a person is made immune or resistant to an infectious

disease, typically by the administration of a vaccine. Vaccines stimulate the body's own
immune system to protect the person against subsequent infection or disease.

National immunization schedule

Age Vaccines BCG-against tuberculosis

recommended OPV- Oral Polio Vaccine
Birth BCG, OPV1, Hep B1 Hep B- Hepatitis B
6 weeks DPT1, HiB1, Hep B2, HiB- H. influenze B
(1.5 months) OPV2 DPT- Diphtheria, Pertussis, Tetanus
10 wks DPT2, HiB2, HepB3, TT- Tetanus toxoid
(2.5 months) OPV3
14 wks DPT3, HiB3, Hep B4, Immunization schedule in India 2017
(3.5 months) OPV4
9-12 months Measles 1st (for infants)
nd
16-24 months Measles 2 , OPV,
Vaccine WhenDPT to booster
Dose Route Site
5-6 years give DPT booster
BCG
10yrs At birth
TTas 0.01ml Intra Left
16yrs early as
TT (0.05ml dermal upper
possible till arm
till 1yr of 1month
 age )
Hepatiti At birth or 0.5 ml Intra Anter
s as early as muscular o
possible lateral
within side
24hr of
mid
thigh
OPV-0 At birth or 2 drops Oral Oral
as early as
possible
within
15days
OPV- 6,10 &14 Drops Oral Oral
1,2 &3 wks
DPT- 6,10 &14 0.5 ml IM Anter
1,2&3 wks o
lateral
side
of
mid
thigh
Hep B- 6,10 &14 0.5 ml IM Anter
1,2 &3 wks o
lateral
side
of
mid
thigh
Measles 9 0.5 ml Sub Right
completed cutaneou upper
-12month s arm
Vitamin At 9 1ml (1 oral Oral
A month lakh
(1st with IU)
dose) measles
For children

DPT booster 16-24 month 0.5ml Intra muscular Antero-lateral

side of mind thigh
Measles 2nd dose 16-24 month 0.5ml Subcutaneous Right upper arm
OPV booster 16-24 month 2 drops Oral Oral
Japanese 16-24 month 0.5ml subcutaneous Left upper arm
encephalitis
Vitamin-A

(2nd to 9th dose) 16months then 2ml (2 lakh IU) Oral Oral
one dose every 6
month upto age
of 5yr
DPT booster 5-6 yr 0.5ml IM Upper arm
TT 10-16 yrs 0.5ml IM Upper arm
There are additional vaccines in the market, which prevent against important disease, including viral
diarrhea and pneumonia, which ideally should be given to children. These are included in the Indian
Academy of Pediatrics (IAP) schedule:

IPV- Injectable (killed) Polio Vaccine

PCV- Pneumococcal conjugate vaccine
MMR- Measles, Mumps, Rubella
Age Vaccines recommended Hep A- Hepatitis A
Td- Typhoid, diphtheria
Birth BCG, OPV, Hep B1 Tdap- Typhoid, diphtheria,
acellular pertussis
6 weeks DPT1, HiB2, HepB,OPV1, IPV1
pentavalent vaccine - DTPw-
(1.5 month) Rotavirus 1, PCV1
HepB-Hib (diphtheria, tetanus,
whooping cough, hepatitis B,
10 weeks DPT2, HiB3, IPV2,OPV2 haemophilus influenza type B)

(2.5 month) Rotavirus 2, PCV2 Common vaccine side effects

14 weeks  injection site reactions

DPT3, HiB3, OPV3, IPV3
(pain, swelling and
Rotavirus3, PCV3
(3.5month) redness)
 mild fever
6 months OPV, Hep B  shivering
 fatigue, headache
9 months OPV, MMR1, measles
 muscle and joint pain

VACCINES FOR HIGH-

9-12 months Typhoid conjugate vaccine RISK CHILDREN

12 months Hepatitis A 1 A child is classified as ‘high-

risk’ when he/she has a
15 months MMR2,varicella, PCV booster congenital disorder, a weak
immune system (including
HIV), asthma, heart/lung
16-18 months DPT, IPV, HiB booster
problems, blood, liver and
kidney diseases.
18 months Hep A2
Even children who have pets at
2 years Typhoid booster home or those who have a high
risk of being bitten by dogs are
considered as such.
DPT booster, Chicken pox, OPV , Typhoid
4-6 years
booster IAP recommends at least 7
vaccines for children belonging
Td/ Tdap to the high-risk category:
10-12 years
HPV
 Influenza Vaccine
  Meningococcal Vaccine
 Japanese Encephalitis Vaccine
 Cholera Vaccine
 Rabies Vaccine
 Yellow Fever Vaccine
 Pneumococcal Polysaccharide Vaccine

NEWBORN HYGEINE

Newborn hygiene care, including bathing, skin care and changing diapers, is important for
your baby's health and comfort.

Bathing and skin care

Giving a small, wiggly baby a bath can make a new parent nervous, but by being calm and
prepared you will become comfortable with the process. Follow these tips to make bath time
a special bonding experience between you and your baby:

 Newborn babies should only be bathed one to two times a week. Bathing your baby
more than this can dry out his or her skin
 Babies should not be placed in water for a bath until the umbilical cord has fallen off.
Give your baby a sponge bath using a soft wash cloth and gentle soap until the
umbilical cord has fallen off
 During bath time, never leave your baby alone, not even for a few seconds

Have all the bath items within arm's reach before you begin, including:

 A basin of warm (not hot) water

 Clean diaper and clothes
 Two bath towels
 Mild soap 
 Soft wash cloth
 Hair brush

Cleaning steps

 Start by washing the face with plain warm water.

 Clean eyes using plain water and wiping from the corner near the nose to the outer
corner. Use a washcloth (use a clean part for each eye) or two cotton balls (one for
each eye)
 When cleaning the ears and nose, clean only the surface of the ears and nose. Do not
put a cotton swab in the ears or nose to clean
 Wash the rest of the baby with mild soap. Do not use a perfumed soap. Rinse with
warm water
 Leaving the diaper area for last, make sure to wash all the creases and folds
 Do not be hesitant about cleaning a baby girl’s genitals
 Use a soft cloth and warm water, and wipe gently between the folds
 After rinsing, pat the baby dry with a clean towel
 Shampoo the hair while you hold the baby in the crook of your arm. Put mild soap on
the hair, gently scrub and rinse out all of the soap. Don't be afraid to gently shampoo
 the soft spots to prevent -yellow, oily, scaly flakes from building up. This condition is
known as cradle cap
 Towel the hair dry and then brush it with a soft baby brush
 Do not use any oil or lotions on your baby because they may cause a rash. Most oils
and lotions are too harsh for your baby’s delicate skin

Nail care

 To prevent scratches, trim your baby's fingernails regularly. If the nail has a rough
edge before it is long enough to cut, use a nail file made for babies
 Using a baby nail clippers, hold the skin away from the nail and cut straight across
 It is easier to trim your baby’s nails after a bath because the bathwater will soften their
nails
 Trimming your baby’s nails may be easier when they are asleep

Mouth and nose

Bulb syringe usage

A bulb syringe can be used to help clear the mouth and nose if your baby has spit up or has a
stuffy nose. To use the bulb syringe:

 Squeeze the bulb to get all the air out

 Put the tip of the syringe into the nostril and gently release the bulb
 Take the syringe out of the nostril and squeeze it out into a tissue a few times
 Clean the bulb syringe by squeezing it full of hot soapy water and rinse by squeezing
it a few times in clean hot water

Changing diapers

 You may use baby wipes on your newborn

 Remove all stool and urine
 Fan the diaper area until dry
 Apply a clean diaper

If redness occurs, clean the area carefully and gently and dry it thoroughly. Apply a thick
layer of diaper rash cream to the red area before diapering.

Cleaning baby's face and head

  With clean hands, moisten a cotton wool ball with warm water and gently clean your
newborn’s eyelids, wiping from inner eye to outer eye. Use a different piece of cotton
wool for each eye.
 Use a cotton wool ball to wipe behind and around the outside of baby’s ears. Be
careful not to stick anything inside baby’s ear – this can cause damage.

After washing baby’s hair, dry it by gently moving the towel back and forward across
the scalp.

 Clean baby’s gums and tongue using water and a washcloth after morning and
evening feeds.

Wipe front and back of teeth using water and a clean washcloth. At 12 months use a
soft infant toothbrush to brush teeth with water at least twice a day.

Cleaning baby’s eyes, ears and nose: basics

You can clean your baby’s eyes, nose and ears when you’re bathing him. Water on its own is
fine, because the skin on your baby’s face is too sensitive for soap.

Procedure.

(1) Care of the eyes.

(a) Cleansing of the circumorbital (circular area around the eye) area of the eye is usually
performed during the bath, and involves washing with a clean washcloth moistened with clear
water. Do not use soap because of the possibility of burning and irritation. The eye is
cleansed from the inner to outer canthus.

A separate section of the washcloth is used each time. This is to prevent spread of infection.
Place a damp cotton ball on lid margins to loosen secretions. Never apply direct pressure over
the eyeball. Exudate from the eye should be removed carefully, and as often as necessary to
keep the eye clean.

(b) The eyelashes, tearing, and split-second blink reflex usually keeps the eyes well protected.
An unconscious patient may need frequent special eye care. Secretions may collect along the
margins of the lid and inner canthus when the blink reflex is absent or when the eyes do not
completely close. The physician may order lubricating eye drops. In some cases, the eyes
may be medicated and covered to prevent irritation and corneal drying.

(c) Many patients wear eyeglasses. The specialist will use care when cleaning glasses, and
protect them from breaking. Eyeglasses should be stored in the case and placed in the drawer
of the bedside stand. Glasses are made of hardened glass or plastic that is impact resistant to
prevent shattering, but they can easily be scratched.

Plastic glasses require special cleaning solutions and drying tissues. Warm water and a soft
dry cloth may be used for cleansing glass lens.

(d) Most patients prefer to care for their own contact lens. A contact lens is a small, round,
sometimes colored disk that fits over the cornea. If the patient is unable to remove the lens,
the specialist should seek assistance from someone who is familiar with the procedure.

The lens should not be reinserted until the patient is capable of caring for the lens himself. It
is very important that you care for the patients who are unable to properly take care of their
lens. Prolonged wearing of contact lens may cause serious damage to the cornea.

(2) Care of the ears.

(a) The ears are cleaned during the bed bath. A clean corner of a moistened washcloth rotated
gently into the ear is used for cleaning. Also, a cotton-tipped applicator is useful for cleansing
the pinna.

(b) The care of the hearing aid involves routine cleaning, battery care, and proper insertion
techniques. The specialist must assess the patient’s knowledge and routines for cleaning and
caring for his hearing aid. The specialist will also determine whether the patient can hear
clearly with the use of the aid by talking slowly and clearly in a normal tone of voice. Have
the patient suggest any additional tips for care of the hearing aid.

When not in use, the hearing aid should be stored where it will not become damaged. The
hearing aid should be turned off when not in use. The outside of the hearing aid should
be cleaned with a clean, dry cloth. Hearing loss is a common health problem with the elderly,
and the aid assists in the ability to communicate and react appropriately in the environment.

(3) Care of the nose.

(a) Secretions can usually be removed from the nose by having the patient blow into a soft
tissue. The specialist must teach the patient that harsh blowing causes pressure capable of
injuring the eardrum, nasal mucosa, and even sensitive eye structures.

If the patient is not able to clean his nose, the specialist will assist using a saline moistened
washcloth or cotton tipped applicator. Do not insert the applicator beyond the cotton tip.

(b) Suctioning may be necessary if the secretions are excessive. When patients receive
oxygen per nasal cannula, or have a nasogastric tube, you should cleanse the nares every 8
hours. Use a cotton-tipped applicator moistened with saline. Secretions are likely to collect
and dry around the tube; therefore, you will need to cleanse the tube with soap and water.

.Steps for cleaning baby’s face

1. Get some cotton balls.
2. Soak one cotton ball in some warm water.
3. Clean the corners of your baby’s eye, wiping gently from the inside corner to the
outside corner. Use a new cotton ball for each eye.
 4. Wipe gently around each nostril to get rid of mucus. It’s best not to put anything
inside your baby’s nostrils (including cotton buds). This can damage the lining of
the nose and cause bleeding.
5. Wipe behind your baby’s ears and around the outside of each ear. Be careful not to
stick anything inside her ear, because it’s very easy to cause damage.
6. Wipe gently under your baby’s chin and neck, making sure you wipe between the
folds of skin.

Your baby might get anxious or irritated when you try to clean his face. Singing a song might
distract him. But sometimes it’s good just to be quick and get on with it.

Nails and umbilical cord

 Use special baby nail scissors or an emery board. Work with someone else if it helps
– one holds the newborn as the other trims the nails. You can try trimming your
baby’s nails when he’s asleep, in the highchair or while singing a favourite song.
 Wash your hands before handling your baby’s umbilical cord. Clean the area with
water. Make sure the stump is dry after bathing. To help the stump heal faster, avoid
covering it with plastic pants and nappies. Fold nappies away from the stump if
possible. Avoid touching the cord stump as much as possible.

Genital care

 When bathing your baby girl, wet a cotton ball, hold her legs apart and wipe between
the labia with the cotton ball. Start at the front and gently wipe backwards.
 For baby boys, gently rinse the genital area with water while bathing.
 Give your baby some ‘nappy-free’ time, and air her skin to prevent nappy rash.

Cleaning your son’s penis

 As with any part of the body, good general hygiene for the penis will help prevent
infection and disease. It’s particularly important for uncircumcised boys.
 The circumcised penis
If your baby boy is circumcised, keeping his penis clean is quite straightforward.
 Gently rinse the genital area while bathing. It’s not necessary to use soap. If you’re
going to use soap, choose one with a built-in moisturiser, and use only a small
amount. Harsh soap and too much washing can irritate the penis.  
 To prevent your baby’s penis from sticking to the nappy, it’s recommended that you
moisten the front of the nappy with petroleum jelly, paw paw cream or something
similar. 
 The uncircumcised penis
Parents with an uncircumcised son often have questions about keeping the penis
clean, because their child still has the foreskin covering most of the head (or glans) of
the penis.
 If your baby boy is uncircumcised, you need only clean the outside of the foreskin
during his first 2-3 years. You can do this at bath time, and bath water alone is all you
need. The foreskin won’t become loose or mobile until your son is 2-3 years old, or
possibly later.
 It’s normal for a milky white substance (called smegma) to gather under the foreskin.
This is just made of dead skin cells and natural secretions.

Cleaning and caring for your daughter’s labia

 Nappy creams, sweat and other substances can collect in and around the labia.
 When bathing your baby girl, wet a cotton ball, hold her legs apart and wipe between
the labia with the cotton ball. Start at the front and gently wipe backwards.
 You might notice a discharge that looks a bit like egg white. This is perfectly normal,
and you don’t need to clean it away. If you’re unsure about any other discharge, see
your GP or child and family health nurse.
 Don’t use vaginal deodorants or douches on your child. They can upset the natural
chemical balance of the vagina and increase the risk of infection. Avoid using talcum
powder – it has fine particles that your baby can inhale. Talcum powder can also
sometimes irritate the vagina.
 Bloody vaginal discharge at this age might be a normal response to mum’s hormones,
so there’s no need to be alarmed. But if this discharge doesn’t go away, you should
contact your GP or child and family health nurse.