Wellness

of a new born

CHO mentoring project

 Learning objectives

At the end of this unit, you will be able to

– Describe the 4 key components of essential newborn care
– Describe the ways to keep a baby warm: warm chain
– Assess and assist a baby with maintaining breathing
– Counsel and assist a mother with breast feeding
– Describe the steps to prevent infection in newborn: clean chain
– Conduct an assessment of a newborn
– Administer vitamin K to Newborn
– Counsel mother on immunizations and danger signs
– Describe the main components of home-based newborn care.
– Describe the care of a small baby (preterm/LBW) including KMC, expressed
breast milk.
– Describe the care of newborns with minor problems
2
 Introduction
• 10 lakh newborns die every year in India and most of them die within the
first 24 hours or first 7 days of their life.
• Why does this happen? How can we prevent this unacceptable number of
deaths?
– Most common causes of death are identified to be birth asphyxia(breathing
difficulty) either from complicated birth or preterm birth and secondly from
infections.
– As a CHO, you can make a big difference just by improving care during
pregnancy and essential newborn care.
• In this lesson, we are going to learn just that- what specific care can you
give to babies immediately after birth to save lives.

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 Let’s review a story from the community
Renu is a first time mother who lives in a remote village and has had only one check-up during her
pregnancy. After her ASHA persuaded her, Renu was brought to the PHC for her delivery

Renu went into active labour and was having very good contractions. After about 12 hours of
active labour, the ANM found that the cervix was finally fully dilated. The ANM told Renu that
she will deliver soon and reassured her.

After 1 hour, Renu began to feel very tired and her pain was reducing. So the ANM gave 5 units of
Oxytocin IM and tried to push the baby by pressing the fundus (top part of uterus) but yet the baby
was not delivered.

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 Stories from the community
Though Renu’s pain was increasing again, she began to have
green discharge from the vagina. Seeing the green discharge,
the ANM became worried and immediately referred her to the
DH.

At the DH, the doctor asked how long she has been in labour
and examined her and identified that the mother has been
having obstructed labour and the baby was now in distress.

Renu was taken immediately for Caesarean section and the

baby required resuscitation. After 5 minutes of resuscitation,
the baby began to breath but had respiratory distress and was
transferred to SNCU.

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Think of the story and answer the questions

1. Was foetal distress preventable in this case? Yes/No?

2. What were the causes of foetal distress? Select all that apply
a) Meconium stained amniotic fluid
b) Obstructed labour
c) Oxytocin in first stage
d) Fundal pressure
3. What could have been used to identify poor progress in labour?
a) Vital signs
b) FHR
c) Partograph
d) Frequent PV exam

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What can I do as a CHO?

Saving lives of newborn begins much

before their birth

All you need to do is

• Monitor the mother for complication
• Monitor the well-being of baby: FHR
• Take timely action if complication present
• Discourage bad practices at all times

You are ready to save lives!

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 Sections in this lesson

This lesson is broadly divided into three sections

 Section 1 : Essential newborn care

 Section 2: Other intervention for newborn at birth

 Section 3: Care of small babies (preterm/LBW)
 Section 4: Minor problems in newborns

Take a break between session if needed!

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 Let’s review the steps of immediate
newborn care learnt in last lesson
1. Call out time of
birth 6.Put baby on skin to
skin contact between
2. Place the baby on mother’s breast.
the mother’s
abdomen-maintains 7.Cover the baby’s
warmth head with a cap and
3. Dry the baby with a blanket to keep
two warm towels warm
8.Place identity tag
4. Assess breathing of
on baby
baby as you dry the
baby 9.Initate breast
5.Delayed cord feeding within one
clamping after 1-3 hour of birth
minutes-to prevent 10.Give Vitamin K to
anemia all newborns

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 Section 1: Essential Newborn care
• When a baby is inside the mother’s body, the baby
receives nourishment and protection through the mother
• After the baby is born, the baby has to try and meet their
needs by themselves.
• Just by helping babies meet these four main needs, you
will save a lot of lives.
 Keeping the baby warm always
 Making sure the baby is breathing normally
So what are they?  Starting breast feeding as soon as birth and
exclusive for 6 months.
 Protecting the baby from infections

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 Keeping the baby WARM!
Think about ways a person can get cold!

• Similarly, babies can easily lose warmth when they are wet or
exposed to cold surfaces and winds. They also can’t produce
heat because of less fat.

• A baby who has hypothermia (low temperature) requires

more energy to breathe, to feed and to protect oneself from
infection and hence becomes the starting point for illness and
even death.

• From the time the baby is born, you have to take steps to
ensure the baby maintains temperature: also called warm
chain.

By simply keeping the baby warm, you can help babies save
energy and protect them from illness.
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 Follow the warm chain at each birth

Warm Delivery Room. Warm baby Skin to skin contact-place baby on Dry the baby with 2 warm towels.
clothes and towel in radiant warmer mother’s abdomen and chest
before birth. immediately after birth.

Initiate breast feeding- it provides Postpone weighing, and full Warm clothing with blankets.
energy to maintain temperature examination of baby to 2 hours after Avoid tight swaddling.
birth and bathing to 48 hours.

Warm resuscitation- resuscitate Kangaroo mother care for low birth

Keep mother and baby together
under radiant warmer. babies and preterm babies
always including transportation 12
 Check the newborn’s breathing!
• Breathing difficulty is the leading cause of deaths in newborns at birth
and in the first few hours after birth.

When a baby is born, quickly check for breathing-

 Good cry?  Normal care

 No cry but chest movements for more than 30 breaths per minute?
 Normal care
 Gasping?  resuscitation
 No chest movements  resuscitation
 Blue colour and lethargic  resuscitation
 Weak cry? Blue colour skin but breathing  Stimulate baby by
rubbing the back

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 Resuscitation of the newborn
• If the newborn is NOT breathing, you must be fast and begin resuscitation
within 1 minute of birth.
• 90% of the newborns can survive if helped with bag and mask ventilation
within 1 minute of birth, even without additional oxygen.
• Often times breathing difficulty in a newborn is because of prematurity,
infections or from complicated labour such as prolonged/obstructed
labour, APH, improper induction of labour, pre-eclampsia etc.
• So Preparing for resuscitation based on the labour process is an
important step to ensure quick resuscitation.

Its all about you being QUICK and giving EFFECTIVE breaths!!

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 General principles of resuscitation
You will learn the skills related to resuscitation in your clinical practice modules.

1.Be prepared: Have supplies (pre-warm
radiant warmer, a functioning newborn
bag and mask, oxygen, infant mucus
extractor, clock with seconds), extra
helper
2.Do initial steps of newborn care
within 30 seconds: Dry and
stimulate baby, suction if secretions
present, cut cord and transfer to flat
warm surface (warmer).
3. Begin bag and Mask ventilation
within 1 minute: Position baby with
shoulder roll, Check seal of mask
over mouth and nose, and give
breaths at 30-40breaths/mt. Chest
MUST rise with every breath.

5.Ask helper to check for 6.Connect Oxygen after 1 minute

4.If chest not rising: Lift chin to open
spontaneous breathing and heart and suction when required. Stop
airway, suction if secretions present and
rate every 30 seconds (felt in cord) ventilation if spontaneous breathing
check no air leak around mask.
returns.
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 Breast feeding

• Breast milk is the cheapest, easily available and the best

nutrition option for a newborn
• Breast milk has all the nutrition required for both growth
of baby and to protect the baby from infection
• Starting to breastfeed within 1 hour of birth helps both
the mother’s body and the baby to adjust to breast
feeding successfully
• A first time mother may need assistance to initiate
breastfeeding- You must provide counselling before birth
and support and supervise first few feeds after birth to
help them succeed.

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 Counsel mother on breast feeding
 Encourage mother to start breast feeding within one hour after birth
 Enocurage to put baby skin to skin between breast as it will stimulate breast
milk and baby will move towards the breast automatically.
 Early initiation of breast milk will help establish breastfeeding and bonding

 Colostrum is the first milk and it is often wrongly discarded as dirty milk
 But Colostrum has lot of antibodies to protect baby from infections
 It provides high nutrition as it is rich in minerals, colesterol, sugar and protein

Teach mother
various positions to
breastfeed: ensure
her posture.
 Guide mother to help baby latch to the nipple correctly
 Bring baby’s head close to breast with head tipped back, chin towards the breast
 The baby will respond by opening their mouth, move quickly and smoothly
 The baby’s lower lip should fully cover the aerola below the nipple

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Counsel mother on breast feeding
 Show mother what are the signs of a good attachement: the baby’s mouth
should be wide open, aereola almost covered, lower lip inverted.
 Poor attachement will lead to sore nipple, inability to feed for baby

 Most mothers are worried that they don’t have enough milk
 Teach them about the let-down reflex: When baby sucks message goes to
mother’s brain produces oxytocin increases milk secretion
 The cyle repeats as the baby continues to breast feed increasing milk

 Most babies tend to swallow air while feeding which makes them
uncomfortable and sometimes vomit
 Teach mother to hold baby supporting neck and to rub or pat back of baby
 Advice to burp baby after every feed.

 Encourage mother to feed in one side of the breast for at least 20-30 minutes
 This will ensure baby gets the later milk called hind milk, which is nutritious
 Advice mother to switch breast between each feed to prevent engorgement

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Counsel mother on breast feeding
 Advice mother to breastfeed initially every 2 hours and then on demand
 Advice mother to breastfeed both day and night
 For small babies: even if baby is sleeping, initiate feeeding every 2 hours to
prevent low sugar as they can only take little at a time.

 Advise mother to give exclusive breast milk for 6 months. Do not give even
water or honey or gripe.
 Cow’s milk and formula milk do not have the antibodies to protect baby
 Artificial feeding through bottle is the major cause of infections and death

 Advice to breastfeed even when the baby is ill such as having diarrhoea
 Breast feed has adequate water and nutrition to help baby recover
 Starting other feeds when baby is ill will worsen their condition.

 Contact ASHA if the baby is not feeding well as it is a sign of severe illness
 A well feeding baby will sleep well, pass urine 8-10 times a day and gain
adequate weight.

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 Breast feeding problems
SORE
NIPPLE
• Caused by poor latching and
unlatching techniques
• Observe breast feeding techniques
• Teach correct method
• Advice to apply breast milk while
not feeding or a ointment with lanolin
• Danger sign: Observe for
engorgement
NOT ENOUGH MILK
• Caused by anxiety and not letting baby
breast feed enough
• Explain let down reflux- the more baby
sucks, the more milk is secreted
• Advice to confident put baby to breast
even if they think mother has less milk
• Encourage mother to drink lot of fluids, rest
well and good nutrition.
• Discourage use of formula feeds or cow’s
milk.
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 Breast feeding problems
BREAST
ENGORGEMENT BREAST INFECTION
• Caused by cracked nipples, breast
• The breasts are swollen, hard and
engorgement, tight bras etc
painful
• Mother may require antibiotics so refer to
• Apply warm compress and gently
hospital
express milk
• Give paracetamol for fever and pain
• Feed more often or express milk to
prevent engorgement • Moist warm compress and expressing milk
may help to relive engorged breast
• Danger sign: If breast engorgement
is not relieved it will lead to breast • Encourage mother to continue breast
infection/ abccess feeding and to wear comfortable bra.

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 Prevention of infection
• Infection is the second most common cause of death among newborns
next to breathing problems.
• Prevention of infection in a newborn should begin during the labour
process such as following the clean chain process.

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 Sources of infection in newborns and their
prevention
Sources of Infection Care to prevent infection
Infection  Do PV examination every four hours ONLY during first stage of labour.
during  Do only sterile PV exam especially after membranes rupture.
labour  Give antibiotics to mother if prolonged rupture of membranes for more
process than 12 hours or signs of infection present: Fever, tachycardia,
FHR>160/mt.

Eye  Clean eyes of newborn immediately after birth with 2 separate wet
infections cotton balls from inner to outer.
 Assess for signs of infection: redness, stickiness, discharge and refer to
doctor.

Umblical  Keep cord dry and clean always

infection  Advise mother not to apply anything on the cord.
 Advise to seek help if signs of infection: redness, discharge (pus).

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 Cont’d: Sources of infection in newborns
and their prevention
Sources of Infection Care to prevent infection
Respiratory  If you identify meconium stained amniotic fluid at birth, assess baby for
infections respiratory infection from meconium aspiration and refer to doctor.
 Advise mother to avoid talcum powder directly on face to prevent
inhalation
 Advise mother to keep baby away from sick people, even those with
common cold.
 Do not force feed baby when having fast breathing as the risk of
aspiration increases.

Gastro  Advise mother to give only breast milk for baby for 6 months. No water,
Infections honey or gripe water too.
(Diarrhoea/  Advise mother to always wash hands with soap after using the toilet or
vomiting) cleaning baby or after her house work.
 Advise mother to bathe everyday and clean her breast before feeds.
 Advise mother to NEVER use bottle to feed. Expressed milk should be
fed with paladai or spoon.
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 Let’s take a break!
1. What is the best way to keep a baby warm immediately after birth?
a. Swaddle the baby with warm clothes
b. Skin to skin contact
c. Keep under radiant warmer
d. Cover with warm blankets.

2. What is the normal temperature of a baby?

a. 35.5-36.4C
b. 36.0-37.5C
c. 36.0-37.0C
d. 36.5-37.4C

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 Cont’d
3. If a baby is not breathing/crying, what should you do?
a. Stimulate the baby at least for 3-5 minutes
b. Start bag and mask ventilation within 1 minute
c. Give oxygen within 1 minute
d. Call the doctor immediately and wait for advice.

4. How would you know if you are giving effective breaths during bag and
mask ventilation?
e. There will be no resistance while giving ventilation
f. There will be no air leak in the mask
g. The chest of baby will rise with each breath
h. The baby will remain pink in colour

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 Cont’d
• When should you begin breastfeeding for a newborn baby?
– After transferring mother and baby to postnatal ward
– After complete examination of baby
– Immediately or within one hour of birth
– Anytime until 2-4 hours of birth

• Please answer if following statements are True of False?

– Colostrum, the first milk can be harmful for baby: False
– Mother should give additional formula or cow’s milk to a newborn to
increase baby’s immunity and nutrition: False
– Baby should be given breastmilk even when the baby is sick with
diarrhoea: True

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 Cont’d
• What is the single most important, best and cheapest way to prevent
infection during newborn care in the hospital?
– Antibiotics to all newborns at birth
– Handwashing before touching any newborn
– Antiseptic on the umbilicus for all newborns
– Antiseptic on eyes for all newborns

• How will you advise mother about cord care at home?

– Gentian Violet on umbilicus for all newborns
– Mother can apply home made antiseptics on cord after bath
– Keep cord clean and dry always. Nothing to be applied.
– Apply a wound dressing to cord and do not wet during baby baths.

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Section 2: Other interventions in the care of
a newborn
Other interventions for a newborn on the first day of birth include
Assessment of a newborn
Administering Vitamin K and immunizations
at birth
Counselling the mother on other
immunization visits using MCP card
Counselling the mother on danger signs and
how to seek help.
Counselling mother on home based new
born care and home visits.

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 Assessment of a newborn
• In this lesson, we will only focus on the most important assessments you should
do every time you visit or interact with the newborn.
• It usually takes only 3-5 minutes.
• Most of the danger signs can be identified by observing the baby carefully and
asking the mother specific questions about feeding and if any danger signs?

Assessment Interpretation of the findings.

 Birth weight should be between 2.5 to 3.5 kg
 Less than 2.5kg is low birth weight and they require extra care
 Babies will lose some weight in first week and then will regain by Day
10.
Weight  Check weight at every visit and mark on the graph (MCP card).
o If baby is not putting on adequate weight -> enquire about
breast feeding and maternal nutrition
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 Cont’d: Assessment of newborn
Assessment Interpretation of the findings.
Colour  The baby should be pink in colour.
 Is the baby blue or pale? -> indicates respiratory or cardiac problem -
> refer
 Check eyes, chest, abdomen, legs and hands for yellow
discolouration by pressing with a finger -> indicates Jaundice -> refer
if occurs within 24hours OR present in palm and soles

Tone/  The baby’s legs and hands should be flexed (folded in the joints)?
activity  Is the baby floppy? Pick and drop a leg/arm-falls easily away from
body? -> the baby is very ill -> refer.

Fontanelles  Fontanelles can be felt as soft gaps in the head between bones
 If they are sunken- especially if baby has diarrhoea-> indicates
dehydration-> refer.
 If they are swollen-> indicated infection in brain-> refer immediately.
 Ask if baby had any fits (sudden stiffness and shaking of body and
limbs)? -> refer

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Cont’d: Assessment of newborn
Chest-  Check chest movements and count breaths per minute. 30-60/minute
respirations is normal
 Check for signs of breathing difficulty -> refer
o Any nasal flaring? Nose opens ups visibly with each
breathing.
o Fast breathing? Greater than 60 breaths per minute?
o Chest indrawing? Skin between ribs pulls inward during
breathing?
Abdomen  The abdomen should feel soft normally
 Is the abdomen hard and distended? -> refer
 Any vomiting or diarrhoea? -> refer
 Has baby passed stools within 24 hours? No? -> refer
 Has baby passed urine within 48 hours? No? -> refer
 Is the umbilicus clean and dry? Refer is any redness or discharge
Skin  Temperature of baby? 36.5-37.4C is normal
 More than 10 skin pustules or 1 large boils? -> refer

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Identify congenital abnormalities and refer
immediately
Cleft lip or cleft palate: Causes
difficulty in sucking and
swallowing. Refer if aspiration
or feeding difficulty present.
Spina Bifida: Cover with sterile
wet gauze and refer for
immediate surgery to prevent
infection and damage.
Food pipe is not connected to
stomach: Do not feed. You can
identify this when the baby
vomits, drools saliva, chokes on
feed, has respiratory distress.
Refer immediately.
Abdomen wall not fully
formed: Cover with
sterile wet gauze and
refer for immediate
surgery to prevent
infection and damage
Club foot: Urgent
referral not required.
But refer to specialist
for further treatment.
Absent or imperforate
anus: Do not feed baby
and refer
Or presence of fistula:
Meconium coming out
of different place in
vagina or penis.
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 Administer Vitamin K to all newborns

• Give to all
newborns

• It helps
prevent
bleeding
problems

34
 Counsel mother on immunization
• Give the newborn immunizations due at birth : OPV, Hep B and BCG.
• Explain the importance of immunization: protects the baby from polio,
respiratory infections, liver disease, diarrhoea etc.
• Write the date for next due immunizations in the MCP card

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Counsel the mother on danger signs

36
Provide home based newborn care
• Inform the mother about the 4
ANM visits for home based
newborn care.

• The ANM must do assessments

(danger signs) and document in
MCP card and counsel mother
on the following:
– Maintaining warmth
– Breast feeding
– Prevention of infection
– Immunization
– Danger signs
– How to seek help

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 Section 3: Care of small babies!
• Newborns who are born before 37 weeks (preterm) and those who weigh
less than 2.5kgs at birth are termed as small babies.
• Small babies have increased chance of illness and death compared to
normal newborns
• Recognising and giving special attention and care for small babies is the
key to save their lives.

You will learn in this section- the

special care for small babies

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 Stories from the community
Before we learn more about small babies, read the following true story and answer the
questions below!

Mohana was 16 years old when her parents got her married to
a boy from the nearby village. They were happily married and
Mohana became pregnant within three months. Though she
had vomiting and was feeling tired all the time, she continued
to work in the fields .

Months passed by. Mohana’s vomiting was better but she continued to feel tired all the
time. When her neighbour told her to go to the local PHC, her mother in law objected
saying “Where did I go when I gave birth to your husband, who is such a strong boy?
Besides… if you go and be there in that hospital for half a day every month ... who will
take care of the house hold work…?”
39
 Stories from the community
When she was in her eight month of pregnancy, she went her parents’ house. As
Mohana looked very weak, her parents took her to the nearby PHC. The ANM was
shocked to see that Mohana was very pale and the size of her abdomen was like that of
a six month old pregnancy.

She explained that Mohana is very anaemic and her baby is very small. She gave her
iron tablets and referred Mohana to the district hospital. Mohana delivered by the end
of that month a 1.9kgs baby.

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Think of the story and answer the questions

1. What is the problem with Mohana’s baby?

a) Anaemia
b) Low birth weight
c) Breathing difficulty
d) Jaundice

2. What are the causes of a low birth weight baby in Mohana’s case story? Tick all
that apply

 Young age of pregnancy  Vomiting in pregnancy  Anaemia in pregnancy

 Low pre-pregnancy weight  Tiredness in pregnancy  Lack of iron intake during
 Poor nutrition in adolescence  Working during pregnancy pregnancy
 Anaemia pre-pregnancy  Heavy labour in pregnancy  Lack of space between
 Lack of ANC in pregnancy pregnancy

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 Common problems among small babies

Certain problems are more enhanced among small babies than normal
newborns. So check them frequently and take action quickly!
 Difficulty to keep warm due to decreased fat
 Difficulty to suck (feed) effectively due to weak muscles
 Difficulty to protect themselves from infection due to decreased
immunity
 Preterm babies may have breathing difficulties due to incomplete
lung development
 Increased chance for jaundice, low blood sugar and bleeding
problems

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 Monitor breathing closely!

One of the first problems you may recognise with a

preterm baby is breathing difficulty.

• Therefore it is very important to send a mother in preterm labour to a DH where

there is an attached SNCU as the baby may need immediate respiratory support
after birth such as resuscitation, oxygen or even CPAP (a machine to help with
breathing).

• If the baby is in the PHC and has breathing difficulty-> resuscitate the baby if
required, transport to SNCU keeping baby in KMC position and with oxygen via
nasal prongs.

43
 Keep small babies warm with KMC!
Have you heard of Kangaroo mother care (KMC)?
Similar to a kangaroos, KMC is the continuous and prolonged
skin to skin contact by placing baby (wearing only cap, nappy
and socks) between the breast of the mother and wrapping a
cloth around to keep baby secure.

• KMC helps to maintain body temperature by taking

warmth from the mother’s body.
• KMC also promotes bonding, helps with breast feeding,
protects baby from infections and even stimulates
preterm babies to breathe
• Encourage mother to increase KMC from 1 hr up to 24
hours a day. Even a father can give KMC!

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 Give expressed breast milk if required!

If the small baby has difficulty to

breastfeed:

 First put them to breast to

stimulate development of
sucking muscles

 Then give them expressed

breast milk using paladai or
spoon.

 Never use bottle to feed.

 Avoid formula feeds.

45
 Let’s take a break
Fill in the blanks for the following questions

1. A low birth baby is a baby weighing less than -------------kgs at birth

2. A preterm baby is a baby born before -----------weeks of gestation
3. Vitamin K is given to prevent ……………….in newborns
4. The dosage of Vitamin K for newborns weighting above 1kg is ………mg
5. The ANM should make minimum of --------home visits for a newborn
born at home.

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 Cont’d
Please select if the following statements are True or false

• Vitamin K should not be given to preterm babies as it can increase risk for
bleeding
• Kangaroo mother care for preterm babies can help stimulate and stabilise
baby’s breathing
• If a preterm baby is unable to suck properly at the breast, the mother
should give bottle feeds preferably to improve sucking.
• A preterm baby can get jaundice much quicker than a term baby

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 Section 4: Minor problems in Newborns

Let’s review a real life story before we study the minor problems among newborns

Malini’s one-day old baby is brought to you by her grandmother. She says that from the
day the baby was born, the baby had swollen breasts. As per old tradition and other
people’s advice, the grandmother applied salt water and massaged the breast.
Now, the baby has fever and is crying continuously.

The right breast looks like this now!

Is swelling of breast normal in a newborn??

48
 Minor problems in newborns
CAPUT
• Caput is a soft swelling of the scalp
giving a elongated shape to whole
head
• It forms when the labour is long or if
the mother pushes before it is time.
• Reassure mother that it usually
disappears within 1-2 days.
CEPHALHEMATOMA
• It is a soft swelling but confined to one part of
the head
• It is formed by mild bleeding inside the soft
tissue under the scalp
• Reassure mother that it will disappear by
itself
• It may cause jaundice in some babies
• If the swelling is very big, then refer to
hospital for observation.
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 Minor problems in newborns
WATERING of EYES
• Sometimes in newborns the tear duct is
blocked
• Reassure mother that it will resolve by
itself within 6-9months
• Advice to gentle massage of the inner
corner of eyes morning and evening ten
times each.
• Advise to come to clinic if signs of
infection: red eyes, pus discharge
Refer
SWELLING OF BREAST
• Both girl and boy babies may have
swelling of breast on 3-4th day after
birth
• This happens because of some mother’s
hormones in the baby
• Reassure mother that the swelling will
disappear by itself
• Advise mother and family not to apply
anything or not to massage the breast:
may cause infection.
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 Minor problems in newborns
UMBILICAL
GRANULOMA
What is umbilical granuloma?
 It is reddish swelling of tissue in the umbilicus which discharges clear watery fluid
Treat :
 Clean the umbilicus with a cotton ball wet with warm boiled water
 After bathing the baby, advice the mother to apply a pinch of salt on the red tissue only
and cover with a gauze for 15-30 minutes.
 Afterwards, clean the area after that with a cotton balls wet with warm boiled water.
 Advise mother to repeat it 1-2 times a day for 3 days.

Advise mother to observe for danger signs

If the granuloma does not resolve within 7 days or any other signs of infection:
Redness and swelling around the umbilicus, bad smelling pus discharge treat
and Refer as per IMNCI guidelines (next lesson)
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 Minor problems in newborns
SKIN RASHES
• Skin rashes can be common among
newborns
• Check for any danger signs: fever, not
feeding well, lethargic, skin pustules,
boil treat and refer as per IMNCI
guidelines (next lesson)
• If no danger signs, advice mother to
o use mild soap for bath,
o to wash baby clothes in mild soap
o to avoid placing baby on plastic
sheets directly.
JAUNDICE
• Jaundice is normal to occur after day 1 and
to disappear in 7-10 days.
• It occurs as there is a accumulation of
bilirubin in the blood.
• Advise mother to breast feed more often
• Danger signs: If the jaundice occurs
o within 24 hours or
o remains for longer than 14 days or
o appears in the palms and soles
anytime refer urgently.
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 Minor problems in newborns
VAGINAL BLEEDING
• Sometimes girl babies may have bleeding
from vagina
• It is due to sudden reduce in mother’s
hormones in the baby after birth.
• Reassure mother that it will resolve by
itself within 3-4 days.
• Advise not to insert or do anything at
home : cause infection and damage.
CRYING WHILE
URINATING
• Normally babies may cry with full
bladder sensation and due to wet nappy
or diaper rash
• Ask mother if there is a good stream of
urine and if baby is passing at least 6-8
times a day
• Ask for danger signs of UTI: dribbling
urine, smelly urine, lethargic, fever,
diaper rash refer
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 Minor problems in newborns
VOMITING
• Vomiting can happen due to faulty
feeing technique or over-feeding
• Advise mother to burp after each feed
and to feed on demand (when the
baby cries for feeds)
• Ask if there is any forceful vomiting
or continuous vomiting refer
• Check for other danger signs:
lethargic, dehydrated, abdominal
distention, not gaining weight  refer
STOOL FREQUENCY
• Some babies may pass stools 5-6 times a day and
some may pass once in 2 days.
• The usual stool pattern is: baby will pass greenish
black stools within 24-48 hours (meconium) and
change to thin yellow stools by day 3-4
(transitional stools).
• A well breast fed baby will have slightly watery
golden yellow stools.
• Ask about danger signs: continuous watery
diarrhoea, lethargic, not feeding well, fever refer
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Ensure respectful care during newborn care
• Congratulate a mother- share her joy

• Ask mother about her feelings for the newborn- be empathetic about her feelings for gender of
newborn, family’s position to care for newborn

– Use this information to plan future care

– Share information about available government support for child care

• Newborn care can be very scary for first time mothers, so take time to explain the simplest of
things such as

– What a newborn’s routine is like- feeding frequency/sleeping and awake times in day and
night/ frequency of passing urine and stools.

– Why a newborn usually cries? What helps to comfort them

– Assist with breast-feeding and give tips to ensure success.

• Finally but most importantly, care for a newborn’s life as important as an adult’s life- take all effort
to ensure the baby’s safety and health at all times.
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 Summary
• Ensure the four main needs of a newborn: Warmth, breathing, breast
feeding and prevention of infection
• Follow other important care at birth: Delayed cord clamping, clean and
dry cord and eye care.
• Monitor newborns closely for danger signs and refer immediately for
appropriate treatment
• Give Vitamin K and immunizations at birth and counsel for future
immunizations
• Identify small babies: low birth weight and preterm babies and give
special care
• Ensure Home based newborn care: 4 visits by ANM and ASHA visits
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Well done! Thank you

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