INFANT TUB BATH

A process of cleansing
or bathing an infant
that provides the
nurse a chance to give
hygiene, an
opportunity to teach
the mother on how to
care for her newborn,
and also for the nurse
to observe infant’s
behavior, alertness
and muscular activity.
Objectives
1. To cleanse the
baby’s body
from head-to-
toe.
2. To promote
comfort.
3. To assess the
general
condition of the
infant.
Vital Statistics
• Newborns have trouble regulating their
temperature; crucial

• Every 30 minutes for 2 hours then 8 hours

• 4th ICS , apical, femoral, brachial- presence of

pulsations and equality
 Vital Signs
• 97.6 to 98.8 °F
• > 60 mmHg (ave. SBP)
• 100 to 160 beats per minute
• 30 to 60 breaths per minute
– Irregular, quiet, effortless
 Weight/ Height
• Newborn: 2500 to 3400g
• Small – below or less than the 10th percentile
• Large- Above the 90th percentile
• Weight loss up to 5 - 10% in early days
• Weight regain in 10 days
• Length: 46 – 54 cm
 Head circumference
From birth to 36 months
During the first year of life the head circumference increases
by 1.2 cm or 0.5 inch each month
Head is ¼ of the newborn’s length
34 to 35 cm

Appear asymmetric

Abnormal rate of development (microcephaly or

macrocephaly), tumor growth or an abnormal accumulation
Cerebrospinal Fluid (CSF) known as hydrocephalus
 Head
• The posterior fontanel
is closed by age 2 to 3
months.
• The anterior fontanel
closes between 12 to 18
months.
• A sunken fontanel:
dehydration
• Bulging: infant cries,
coughs or vomits
 Chest Circumference

• Newborn’s head circumference is larger than

the chest circumference.
• 2-3 cm smaller than the head
• 32-33cm
• Chest circumference is almost equal with head
circumference after age 1 year.
• Nipple line (when measuring)
 Mid-arm circumference
• Reflects muscle mass and fat

• With decrease in fat or muscle atrophy, mid-

arm circumference decreases
• Increase with weight gain
 Neck
Normal Abnormal
• Short neck • Weakness, contractures or
• Turns head easily from side rigidity
to side • Webbing of the neck, large
• Raises head when prone fat part at the back of the
neck
 Face
• The face is assessed for dysmorphic features.
• Spacing and symmetry of facial features are
noted.
• Ears should be aligned with the eye.
• Low set ears may indicate an intellectual
disability or renal anomaly.
 Eyes
• Difficult to evaluate in young child
• At 3 years of age, visual acuity testing is
recommended.
• From birth to age 1 or 2 months gazes at black
and white contrasting figures.
• At age 4 weeks or older, an infant fixates at
brightly-colored object, and follows it.
• Newborn before discharge is tested of the
acoustic nerve.
• Infant turns to locate the sound.
• A very young infant, younger than 4 months,
may demonstrate a startle reflex to loud
sounds.
 Posture
Normal Abnormal
• Flexed extremities • Limp, flaccid or rigid
• Move freely extremities
• Resist extension, returns • Jitteriness or tremors
quickly to flexed state • Stiff
• Hands usually clenched • Seizures
• Movements symmetric
• Slight tremors when crying
• Responds to quieting when
needs met.
 Cry
Normal Abnormal
• Lusty, strong • High pitched
• Weak, absent, irritable,
catlike “mewing”
• Hoarse or crowing
 Reflexes
• Moro reflex
– Dramatic reflex
– Drop back to 30 degrees
– Arms extend and abduct,
with the fingers fanning
and thumbs and
forefingers forming a C
position
– Legs may also be extend
and then flex
– Disappears 5-6 months
• Palmar grasp reflex
– Occurs when the infant’s
palm is touched
– The hand closes into a
tight fist.
– Weak or absent, injury
to the nerves of the
arms
– Disappears 2-3 months
• Plantar reflex
– When the area below
the toes is touched, the
infant’s toes curl over
the nurse’s finger.
– Disappears 8-9 months
• Babinski reflex
Stroking the lateral
sole of the foot from the
heel forward and across
the ball of the foot
Causes the toes to
flare outward and the big
toe dorsiflex
Disappears at 8-9 months
Sucking Reflex
Rooting reflex
Tonic-clonic reflex
• Stepping Reflex
– Trying to walk
– Disappears at 3-4
months
 Materials
• 70% alcohol (depending on
the agency policy or
pediatrician’s order)
• Baby shampoo
• Clean clothes
• Cotton balls
• Diaper
• Neutral or hypoallergenic
soap
• Kidney basins
• Plastic tub or sink
• Powder, lotion or cream
(Mother’s preference)
• Pail and small dipper (if
necessary)
• Soft towel
• Tape measure
• Thermometer
• Warm water (37.7 °C or 100
° F, should not exceed)
• Weighing scale
• Baby clothes pin/ Plaster
(modification)
 Preparation
1. Review medical record and plan of care.

2. Bathing should take place before feeding.

3. Consider culture and beliefs of mother or the

family.
3. Prepare or gather
materials needed.

4. Wash the sink or tub

with disinfectant cleaner.
Then, line the sink or tub
with bath towel.
6. Place a towel on the counter next to the sink
or tub and clothes.

7. Arrange materials in order of use.

8. Ensure baby’s safety.

9. Eliminate air draft or ensure that the

environment is warm.

10. Wash hands.

11. Fill the tub with warm water and check using
your elbow.
12. Bring the infant to the workplace.

13. Undress the infant.

 Procedure
1. Assess the infant.
a. Weigh infant and record weight.
b. Take axillary temperature.
c. Observe the respiratory rate, depth and ease
of respiration.
d. Determine the other anthropometric
measurements such as the height, head,
chest and mid-arm circumference.
2. Continue to assess the infant as you perform the
procedure.

3. Wrap him/ her in a blanket or towel.

a. When wrapping the baby, place blanket or towel
in a flat surface diagonally.
b. Place baby at the center, fold the lower corner
of the blanket over the legs and feet.
c. Fold the two side corners under the arms over
the chest.
3. Wrap him/ her in a blanket or towel.

a. When wrapping the baby, place blanket or towel

in a flat surface diagonally. Place baby at the center,
fold the lower corner of the blanket over the legs
and feet.

b. Fold the two side corners under the arms and

over the chest.
4. Using a cotton ball or wash cloth moistened
with water and squeezed out, clean/ wipe eyes
gently from inside corner outward.

5. Clean the nose, face and ears using

washcloth. Using the different sides of clean
washcloth.
6. Wash infant’s head, use a neutral soap or baby shampoo.
a. To wash the hair/ head, hold the infant in a football hold or
manner.
a.1. Support the baby’s head on the palm of your left hand.
a.2. The baby’s back will be supported along your left forearm.
a.3. The hips will be pressed against your waist by your left
elbow.
You may use either arm as long as you support the head and
back.

b. Wash infant’s head or hair in a gentle circular motion.

To prevent cradle cap.
7. Dry the infant’s head with a towel carefully.

8. Unwrap the infant and gently place him on

the tub lined with towel.

9. One hand should always be holding the baby.

10. Tilt head back to cleanse the neck using the
washcloth.

11. Wash and soap the baby’s chest, abdomen,

arms, armpit, back and lower extremities. Pay
attention to creases or folds.

12. Refill the basin or tub with clean, clear, and

warm water, then rinse thoroughly.
13. Clean the genitalia.
a. If the infant is female, wash perineal area from
front to back.
b. Cleanse penis without retracting it.
c. Circumcision area, just keep area clean, you
may apply petrolatum gauze. Observe for
bleeding.
14. Lift the infant out of the tub and dry
thoroughly.

15. Do cord care.

a. Inspect umbilical cord.
b. Check area for bleeding or foul odor.
c. A drying agent such as 70% alcohol may be
used.
Check agency policy and physician’s order.
d. Do not cover with diaper.
Cord stump heals in 2 weeks.
16. You may apply powder, lotion or cream to the infant
whichever the mother prefers.

17. Diaper and dress the infant.

18. Place infant in the crib or allow mother to hold the

baby.
 • .
19. Clean and return equipment used to their proper
place.

20. Clean the area.

21. Wash hands.

22. Document care rendered and observations/
assessments.