Welcome to Infant Care...
Here you’ll find a wealth of information to help you prepare for bringing your baby home—from discharge details and newborn screenings to feeding tips, health and wellness guidance, safe sleep practices, and car seat safety.
Our goal is to provide you with everything you need to feel confident and supported as you start this exciting journey with your little one.
Before Baby is Discharged
Before being discharged home, your baby will require a few tests. Bilirubin and the Newborn screen are blood tests collected at the same time. You will receive the Bilirubin results within 1-2 hours, and a plan will be made with you at that time if any further testing is required.
A Critical Congenital Heart Disease (CCHD) screen will also be performed at or shortly after 24 hours of life. This is a simple non-invasive test where your baby’s oxygen saturation is measured in their wrist and foot (using a small probe with a red light on it). This test screens for potential life-threatening heart conditions before your baby shows any symptoms.
Newborn Screening
To help your baby get the best start in life and stay healthy, your newborn will be screened for 28 disorders through a simple blood test prior to discharge. For more information, visit the Ontario Newborn Screening Program website.
Infant Hearing Program
You will be contacted by Thrive after discharge to book your baby’s hearing test if it was unable to be completed during your inpatient stay. This test is done by a certified worker from THRIVE Child Devleopment Centre, and will take place at Sault Area Hospital in 1A – Women and Children’s Health Unit.
During the test, a tiny soft ear bud is placed in your baby’s ear and if needed, small stickers (electrodes) may be placed on your baby’s head. The screen will measure your baby’s response to soft sounds played in their ear- their response will not be visible. You may stay with and hold your baby during this test.
The test is reliable and will not hurt your baby. There’s no fee for the test and you will get the results right away. It is best to have a hearing test done before your baby is 1 month old.
Occasionally, the baby needs a second screening. If this occurs, the mother will be contacted for the baby to be seen at Algoma Public Health. Community clinics are scheduled monthly in Sault Ste. Marie, Wawa, Blind River and Elliot Lake.
Jaundice
Jaundice is the yellow colour seen in the skin of many newborns. It happens when a chemical called bilirubin builds up in the baby’s blood. Jaundice can occur in babies of any race or colour.
Everyone’s blood contains bilirubin, which is removed by the liver. Before birth, the mother’s liver does this for the baby. Most babies develop jaundice in the first few days after birth because it takes a few days for the baby’s liver to become more efficient at removing bilirubin.
Jaundice likely goes away by 2 weeks of age. If you have concerns contact your health care provider.
The skin of a baby with jaundice usually appears yellow. The best way to see jaundice is in good light, such as daylight or under fluorescent lights. Jaundice usually appears first in the face and then moves to the chest, abdomen, arms, and legs as the bilirubin level increases. The whites of the eyes may also be yellow. Jaundice may be harder to see in babies with darker skin colour.
Most infants have mild jaundice that is harmless, but in unusual situations the bilirubin level can get very high and could cause brain damage. This is why newborns should be checked carefully for jaundice and treated immediately to prevent a high bilirubin level.
A routine bilirubin test will be ordered for your baby while he/she is in hospital after birth. Whether another test is needed will depend on the baby’s age, the amount of jaundice and whether the baby has other factors that make jaundice more likely to develop.
It is important for your baby to be seen by a health care provider when the baby is between 3 and 5 days old because this is when a baby’s bilirubin level is highest. The timing of this visit may vary depending on your baby’s age when released from the hospital.
Breast milk jaundice is usually seen at 5-7 days of age. The baby should be gaining weight, breastfeeding exclusively, having lots of bowel movements, passing clear urine and be generally well. Breast milk jaundice peaks at 10-21 days of age and can last for up to 12 weeks. This may require a visit to your health care provider, but in most cases no treatment is necessary.
Jaundice is often more common in newborns that are not nursing well. If you are breastfeeding, you should nurse your baby at least 8 times or more per day. This will help you produce enough milk and will help to keep the baby’s bilirubin level down. If you are having trouble breastfeeding, there are many community resources available to you. Refer to the Breastfeeding Matters booklet on where to get help.
Some babies have a greater risk for high levels of bilirubin and may need to be seen sooner after discharge from the hospital.
Ask your doctor about an early follow-up visit if your baby has any of the following:
- A high bilirubin level before leaving the hospital
- Early birth (more than 2 weeks before your due date)
- Jaundice in the first 24 hours after birth
- Breastfeeding that is not going well
- A lot of bruising or bleeding under the scalp related to labor and delivery
- A parent, brother or sister who had high bilirubin and received light therapy
- If your baby weighed less than 2500 grams (5.5 lbs) at birth
Call your baby’s doctor if:
- Your baby’s abdomen, arms and legs are yellow
- Your baby is jaundiced and is hard to wake, fussy or not feeding well.
Sometimes your baby’s bilirubin levels get too high, and treatment is needed.
For treatment, your baby would be re-admitted to the hospital, and would need to be in an isolette (incubator) with special blue lights called phototherapy.
These lights help your baby’s body to break down bilirubin molecules so that they can be removed from their body through their stool and urine.
The length of this treatment depends on how high the bilirubin levels are, and how quickly the levels are going down.
Feeding
Newborns should be fed exclusively with breastmilk and/or iron-fortified formula on demand (meaning when they show signs of hunger), rather than on a schedule.
Infants will typically feed 8-12+ times in 24 hours. As they grow, they may feed less frequently.
Breastmilk and/or formula is all the nutrition your baby needs for the first 6 months of their life.
Babies receiving breastmilk alone, or a combination of breastmilk and infant formula are at risk of vitamin D deficiency and will require a daily vitamin D supplement of 400 IU until the baby is at least one year of age.
If you have made the decision to breastfeed, you will receive an additional information book “Breastfeeding Matters”.
This book, along with the help from your nurse, will provide you with up-to-date information on how to start breastfeeding your baby.
You will be given a “Breastfeeding Diary” to use and track the times baby is feeding. This also has information for when and how often baby should be at breast. It is important to remove milk from your breasts frequently in the early hours and days.
It may be necessary to hand express your breasts to help milk production and the baby to latch. All breastfeeding women should learn how to hand express milk from their breasts and instructions/diagrams are in the Breastfeeding Matters book.
Combination feeding refers to using both breast and bottles to feed your baby.
Some infants may require additional calories during the first few days of breastfeeding to prevent their blood sugar from dropping too low. Your nurse will discuss your options with you. Supplementation can be your own expressed breastmilk, donor milk, or formula. The choice to give your baby formula is yours and you must consent to it.
Once at home, some families will choose to combination feed for a variety of reasons.
To maintain a healthy milk supply:
- Do not start combination feeding until breastfeeding is established
- Pump at regular intervals, approximately 8 times a day, including at least one pumping session at night
- Start combination feeding gradually to give your body time to adjust
Breast milk is important to your baby’s growth and development. It provides needed nutrition, aids in digestion and helps prevent allergies and infections. Until your baby can nurse directly from you, your pumped breast milk can be given to the baby. Using a breast pump also helps ensure that you develop a good milk supply.
Hospital-grade pumps have more powerful motors designed for starting your milk supply in the first few days when you are admitted. They also have the double-pumping feature, which pumps both breasts simultaneously and helps increase the hormone prolactin, resulting in more milk over a 15-minute session compared to pumping one breast at a time. The pump motor is also protected by a barrier, making it 100% sterile for multiple users. You can purchase a breast pump kit or package (which includes a plastic basin and microwave steam bags for sterilization) to use with the hospital pump. The kit includes breast shields (flanges) with 2 different sizes for best fit, connectors, tubes, valves, protective caps and membranes, and collection containers.
During your hospital stay, you will be given the opportunity to purchase a single breast pump package. For $25 this includes a breast pump kit, microwave sterilizing bag, a storage/wash basin and the instructions and education needed. A second kit may be purchased for an additional $20 for the option of double pumping). The nurse will review what is included in the package, how to assemble the pump kit and how to use the breast pump.
There are many reasons why you may choose to bottle feed your baby. It may be a personal choice, or it may be necessary.
Bottles can be used to feed your baby expressed breast milk, warmed breast milk, or infant formula. Nipples come in different shapes, sizes, materials, degrees of firmness, and flow rates. You should choose bottles and nipples that are suitable for your baby.
- If using plastic bottles, ensure they do not contain polycarbonate, a hard and transparent plastic that can release bisphenol A when it comes in contact with hot liquids.
- Do not warm milk in a microwave oven or in boiling water on the stove top.
- Put the milk container in warm water for a few minutes until lukewarm.
- Check the temperature by pouring a few drops on the back of your hand or the inside of your wrist to ensure the milk is neither hot nor cold to the touch.
Infant formula contains proteins (from cow’s milk, goat’s milk, or plants), carbohydrates, fats, vitamins and minerals, and water. You should not feed your baby other formulas unless they are recommended by your healthcare provider. Infant formula is available in different forms, such as ready-to-feed or concentrated liquid, or powder. You should follow the directions on the label and use the measuring device that comes with the product.
The formula should be used within 2 hours of starting a feed or within 2 hours after being made. If you aren’t going to use the prepared formula right away, refrigerate it for up to 24 hours. Discard any formula that’s left in your baby’s bottle after feeding, as baby’s saliva in the leftover formula can grow harmful bacteria.
Babies who are exclusively formula-fed and receive no breastmilk do not require a vitamin D supplement, as Health Canada approved infant formula contains all the vitamin D they need.
Try burping your baby after each breast if breastfeeding or after every ounce if bottle-feeding. Breastfed babies do not always burp after the first breast.
To burp your baby, put a cloth over your shoulder and then put your baby up so that the baby’s chin rests on your shoulder. Pat or rub his back from his waist upwards. Often just changing the baby’s position will cause baby to burp. You can also burp your baby by sitting baby on your lap holding the head in one hand, your thumb and index finger on the cheeks in front of baby’s ears and the chin resting between them. If your baby does not burp within a few minutes, baby might not need to – try again later.
Your baby may be spitting up a small amount of milk when burping after feedings. This is normal. Try not to handle your baby too much after feeding. Frequent burping and smaller feedings may help. If your baby is always spitting up or you are concerned about the amount of feeding your baby is spitting up, contact your baby’s doctor.
During the first month of life, hiccupping is common and not harmful. They often occur following a feeding. You have probably noticed that hiccups last only a few minutes. Pat your baby gently on the back or give him/her a little more milk. To prevent spitting up (regurgitation) of milk while your baby is hiccupping, hold his/her head up.
Infant Nutrition and Weight Gain
It is normal for all newborns to lose as much as 7 to 10% of their birth weight in the first 3-4 days.
- Newborns should return to their birth weight within 2 weeks
- Weight gain is usually ½ -1 oz per day or 4-8 ounces per week in the first 3 months.
- Birth weight is usually doubled by 5-6 months
Growth Spurts
All babies have sudden growth spurts during their early months. These growth spurts are usually seen at 10 days, 3 weeks, 6 weeks, 3 months, and 6 months. However, growth spurts can occur as often as every 2 weeks. When your baby suddenly wants to feed more often, it is usually because he/she is having a growth spurt.
At the bottom of this page you will find supportive resources to guide you through newborn feeding and nutrition.
Diapering
Some babies develop an allergic reaction to certain kinds of soap, food and disposable diapers. Their skin can also become irritated from urine and stool in the diaper. Diapers should also be in the right size for your baby. If your baby has a reaction to certain brands of diapers, consider switching to a different one.
To Prevent Diaper Rash…
- Change diapers frequently
- Clean diaper area thoroughly and dry well
- Expose baby’s bottom to air daily
If diaper rash persists, you may use medicated diaper cream and leave the diaper area open to the air for short periods of time regularly throughout the day.
If using disposable diapers, try changing brands if skin reactions are noted.
Safe Sleep
Research has shown that room sharing (Crib next to the adult’s bed – room sharing) is associated with a reduced risk of SIDS, and is recommended until your baby is at least six months old. Bed sharing or co-sleeping is when you share the same sleep surface as your baby. This has been identified as a risk factor for SIDS, and can also lead to suffocation.
Adult beds, couches, futons, recliners, air mattress, memory foam, or any makeshift beds are not designed with infant safety in mind:
- A baby can become trapped in a space between the mattress and the wall, or between the mattress and the bed frame
- A baby can roll off the bed
- An adult can roll over and suffocate a baby
- Soft bedding, such as comforters or duvets, can cover a baby’s head and cause overheating. Babies who get their heads covered during sleep are at increased risk of SIDS.
Sudden Infant Death Syndrome (SIDS), also known as crib death, refers to the sudden and unexpected death of an apparently healthy infant less than one year of age. Each week, three babies die of SIDS in Canada. Such deaths usually occur while the child is sleeping and remain unexplained even after a full investigation. Nobody knows how to prevent SIDS, but the latest research shows that there are things you can do to make your baby safer at home.
Overheating can be a risk for SIDS
Instead of a blanket, use light sleeping clothing for your baby, such as a one-piece sleeper. Blankets can be dangerous if your baby’s head becomes covered when he or she is asleep.
The bedroom temperature should be kept comfortable for a lightly clothed adult. If the room temperature is comfortable for you, then it is also comfortable for your baby.
Babies who sleep on their back have a reduced risk of SIDS. Since the launch of the “back to sleep” campaign in Canada in 1999, the number of babies placed to sleep on their backs has increased dramatically and the rate of SIDS has dropped by more than 50%. Newborn babies tend to get in the habit of sleeping the way they are first placed, so start putting your baby on his or her back right from birth. Sleep positioners or rolled up blankets present a risk of suffocation and are not needed to help your baby sleep on his or her back.
Reminder: When the baby is awake and being watched, some “tummy time” is necessary for the baby’s development. This will also avoid temporary flat spots, which sometimes develop on the back of their heads from lying on their backs.
The Crib:
- Look for a label on the crib that shows when the crib was made (date of manufacture), a product label (model name or number) and instructions for proper use
- Check the crib often to make sure the frame is solid. Tighten loose screws regularly and check the crib to make sure the sides lock into place
The Mattress:
- Make sure the mattress is tight against all four sides of the crib
- Replace the mattress if it is not firm or if it is worn out
- Move the mattress down to its lowest level as soon as the baby can sit up
Baby Safety:
- Never tie the baby in the crib and do not let the baby wear a necklace or a soother on a cord around the neck.
- Place the crib away from windows, curtains, blind cords, lamps, electrical plugs and extension cords.
- Bumper pads should never be used
- Babies should always be supervised with toys and bottles
In addition:
- Mobiles should be removed from crib as soon as the baby is able to reach and grab them
- As soon as the baby is able to sit up, remove crib exercisers or any toys that are strung across the crib
- Remove any large toys or crib bumper pads that could serve as steps to climb out. Stop using the crib when your baby can climb out.
Bathing and Baby Care
Bathing your newborn baby should be a relaxed and enjoyable time for both you and your baby. Initially, some parents find bathing difficult. In no time however, you will be handling your baby easily. At first, your baby might not enjoy bathing, but most babies learn to enjoy bath time. It is an excellent time for play and exercise.
A few safety precautions…
- Never leave baby alone in the bath or on a table
- Do not add warm or hot water to the bath while the baby is in the tub
- When supporting your newborn baby, ALWAYS support the head and neck
- Set your hot water tank at 49oC – 52oC to reduce the risk of burns throughout childhood
Bathing your baby should be done when convenient for you. Bathe your baby before a feeding so that baby does not spit up from the activity of the bath. Some families will bathe their infants daily or less often. This is your choice.
Steps in bathing your baby – clean from top to bottom…
- Eyes – moisten the washcloth with clear water, wiping from the inner corner to outer. Use a separate corner of the washcloth to do the second eye – this prevents spreading anything from one eye to the other.
- Face – Use clear water – No Soap
- Nose – Wipe only particles that are outside the nose. Do not use cotton tipped swabs as you might hurt the nose, or push particles further into the nose.
- Ears – Cleanse the outer ear with the face cloth. Wash behind the ear and thoroughly dry.
- Hair – Wash hair once or twice a week to keep the scalp clean. Wrap your baby in a towel. Hold your baby under the arm (football hold). Your baby’s head should be over the basin or tub and baby’s face turned upward. Use mild soap or baby shampoo. Rinse well and dry. Brush the hair gently every day to help prevent cradle cap, which is a greasy yellow scale that sometimes forms on your baby’s scalp.
- Body – Wash your baby’s body with soap. Use either your hands or washcloth. Begin at the neck and work down arms, chest, and legs. Pay special attention to the creases. Turn your baby over, supporting the head and wash the back. Rinse and dry your baby well. Cover your baby quickly after you have finished.
- Genitals – Female – Wash gently from front to back to avoid spreading bacteria. Male – Cleanse and dry penis and scrotum. Clean and dry anal area. If your baby is uncircumcised, do not push back the foreskin of the penis to clean. The foreskin will naturally retract back itself as your boy gets older (3 – 7 years of age). At that point, he can learn to cleanse himself
Clean the cord base and the cord itself with cotton tipped swabs soaked with warm tap water. This procedure is painless. Clean the cord at each diaper change until healed. Allow to air dry following bathing. It is recommended that you fold down the top of the diaper to expose the cord. If at any time the area becomes reddened, develops an odour and/or discharge, notify the doctor.
After approximately 5-10, days the cord separates. The navel may be a bit red and raw and a little spot of blood may be visible when the cord falls off.
Eczema is a rough, red and itchy rash. It usually occurs around the ears, face, in creases and at times on the legs and arms. Consult your baby’s doctor if this rash persists.
Suggestions for preventing rashes…
- Rinse the skin thoroughly after washing your baby.
- Launder all of your baby’s clothing before using.
- Do not use bleach or use fabric softeners (may contain chemicals that could irritate the skin)
- Rinse baby’s clothing well
- If changing brands of soap, make one change at a time. This will help identify the cause of any adverse reaction.
- If using disposable diapers try changing brands.
At birth, baby’s nails tend to be soft. Do not cut the baby’s nails for the first 2 weeks of life. If they are long, sleepers with cuffs that cover the hands, little mittens or socks will prevent your baby from scratching his/her face. A small emery board can be used to file sharp edges.
Newborn Health, Safety and Wellness
Studies show that exposure to smoke is a health risk for your baby both before and after birth, and it has been identified as one of the greatest risk factors for SIDS. Create a smoke free environment for your baby before and after birth.
Do not let anyone smoke near your baby once he or she is born – not in the house, the car, or anywhere your baby sleeps or spends time. If you, your partner, family members or friends smoke, it should be done outside and well away from your baby.
Health Canada recommends taking your baby’s temperature under the armpit (axillary) rather than by mouth or rectally.
Ear (tympanic) thermometers may be used in children older than 2 years. There is evidence that they are not consistently accurate in younger children; therefore use with infants and children up to 2 years of age is not recommended.
Take your baby’s temperature at any time you think he/she is sick. Write down the temperature and the time you take it.
Normally axillary temperature 36.5º-37.5ºC or 97.7º- 99.0ºF.
An axillary temperature above 40ºC (102ºF) can be serious.
It is normal for babies to have fussy periods. The time of day differs from baby to baby. If your baby feels unusually warm to the touch, has flushed cheeks and is irritable, he/she may have a slight fever.
Suggestions if you think your baby has a fever…
- Take your baby’s temperature
- Give your baby extra fluids
- Dress your baby in light clothing. DO NOT bundle your baby with heavy blankets. This may be all that is necessary to settle the baby and bring the temperature down to normal.
The system that controls your baby’s body temperature is immature. This causes the baby to become overheated easily in the summer months. Try not to overdress your baby. Your baby should be dressed in the same amount of clothing as an adult. Overdressing causes a pink rash in the shoulder and neck area. Keep baby’s skin clean and dry.
The normal crying curve starts at about 2 weeks, peaks at about two months, and usually comes to an end by about 4-5 months, and often earlier. If you have tried everything to soothe your baby it is often comforting to know that sometimes there is no reason for the crying and there is nothing you can do to stop it. This does not mean that your baby has colic but rather it is the normal crying curve for infants. Some infants are just high criers and may cry for several hours a day.
A baby’s constant crying can be stressful and can also be a dangerous trigger for shaking a baby. No one thinks they will shake their infant, but research shows crying is the number one trigger leading caregivers to violently shake and injure babies.
Most parents and caregivers will feel angry and frustrated by a baby’s constant crying …. IT is OK to put your baby down in their crib which is the safest place for a baby and walk away if you feel yourself getting upset.
When children are immunized, their bodies make antibodies that fight infections. If they are not protected and come in contact with one of the infections, they may get very sick or even die. Vaccination is the best way to protect your child against many serious diseases.
It is important that you discuss your child’s immunization schedule with your health care provider. The immunization schedule starts at 2 months of age.
Circumcision of baby boys is an optional surgical procedure to remove the layer of skin (called the foreskin or the prepuce) that covers the head (glans) of the penis. It is most often done during the first few days after birth. It is not recommended by the Canadian Paediatric Society as a routine procedure.
Parents who decide to circumcise their newborn boys often do so for religious, social or cultural reasons.
If you are trying to make a decision about circumcision, talk to your baby’s health care provider. Ask for up-to-date information about the potential medical benefits and risks of circumcision.
Discharge
Before leaving the hospital with your baby, you will need to sign a form indicated that you and your baby’s bracelets have matching I.D. numbers. If your baby needs to stay in hospital after you are discharged, please keep your I.D. bracelet with you at all times as it is our only means of identifying you with your baby. Your baby’s security bracelet will also need to be de-activated and removed at time of discharge.
While in the hospital, you will be asked to sign an Ontario Health Coverage form. The nurse will give you the bottom section of this form to be used as a temporary health card to ensure baby’s coverage. A permanent health card will be mailed to you in approximately 6 weeks.
You will also receive a Service Ontario, Newborn Registration Card providing you with the information needed to register your baby’s birth and apply for a birth certificate, social insurance number and Canada child benefits.
Your baby will need a doctor or nurse practitioner appointment to be seen within one week of discharge. Parents are expected to book this appointment prior to discharge.
Your baby will go home with the cord clamps still on and will fall off with the cord within a couple of weeks.
Healthy Baby Healthy Children Program referral consent will be obtained by your nurse so that an Algoma Public Health Unit nurse can call you to provide a follow-up visit with you and your baby within 48 hours of discharge. They are available to provide support and services if needed.
A hospital stay survey may be mailed to you. We would appreciate if you could please take the time to fill in the survey, as your input is of great value to the hospital to help identify needed changes and to improve the services of the Maternal Child Program.
Car Seat
When you and your baby are preparing for discharge, and if you plan to drive home in a personal vehicle or are receiving a ride, your nurse will prompt you to have your infant car seat retrieved from the vehicle. This allows staff to support a safe and smooth transition home and ensures your baby is ready for their first ride.
Please ensure your car seat is brought to the unit when requested.
The use of car seats is required by Ontario law. Parents must be familiar with, and practice how to use their infant’s car seat prior to coming to hospital.
It is the parent’s responsibility to:
- Ensure the car seat meets Canadian Motor Vehicle Safety Standards
- Ensure the infant is secured properly in his/her car seat, and
- Ensure the car seat is properly secured in the vehicle
Car seats that do not meet Canadian Motor Vehicle Safety standards include (but not limited to):
- Car seats that are more than 10 years old or beyond the expiry date of the manufacturer
- Car seats purchased in the United States. Use of these car seats in Canada can result in a fine as well as demerit points.
A car seat clinic is available through the THRIVE Child Development Centre. If interested, you can call 705-759-1131 and ask for the car seat clinic to schedule an appointment.