Caring for your baby

Caring for your baby

In this section we will cover:

Nappies

How to change a nappy

Some babies have very delicate skin and need their nappy changed as soon as they wet themselves, otherwise their skin becomes sore and red. Others can wait until before or after every feed to be changed.

All babies need a nappy change as soon as possible when they’ve passed a stool (poo) to prevent nappy rash and stop them from smelling.

Getting organised

Get everything you need in one place before you start. The best place to change a nappy is on a changing mat or towel on the floor, particularly if you have more than one baby. That way, if you
need to see to another child for a moment, the baby can’t fall. Sit down so that you don’t hurt your back.

If you’re using a changing table, keep an eye on your baby at all times. Don’t walk away or turn your back.

Always have a good supply of nappies. If you’re using cloth nappies it might take a while to get used to how they fold and fit. Pre-wash them to make them softer. Take care to choose the right size of nappy and cover for your baby’s weight.

You’ll need a supply of either cottonwool and warm water, or baby wipes. It’s also a good idea to have a spare set of clothes handy, especially in the first few weeks.

Getting started

If your baby’s nappy is dirty, use the nappy to clean off most of the poo from your baby’s bottom. Then use the cottonwool and warm water (or baby lotion or baby wipes) to remove the rest and get your baby really clean.

Girls should be cleaned from front to back to avoid getting germs into the vagina. Boys should be cleaned around the testicles and penis, but there’s no need to pull back the foreskin. It’s just as important to clean carefully when you’re changing a wet nappy.

If you’re using cloth nappies, put in a nappy liner then fasten the nappy around your baby. Adjust it to fit snugly round the waist and legs. If you’re using disposable nappies, take care not to get water or cream on the sticky tabs as they won’t stick if you do.

It can help to chat to your baby while you’re changing them. Pulling faces, smiling and laughing with your baby will help you bond and help their development.

Put as much of the contents as you can down the toilet. If you’re using nappies with disposable liners the liner can be flushed away. Don’t flush the nappy as it can block the toilet.

Disposable nappies can be rolled up and resealed, using the tabs. Put them in a plastic bag kept only for nappies, then tie it up and put it in an outside bin. Washable cloth nappies can be machine washed at 60°C, or you could use a local nappy laundry service.

To avoid infection, wash your hands after changing a nappy and before doing anything else.

Baby poo

Your baby’s first poo (or stool) will be made up of something called meconium. This is sticky and greenish/black.

After a few days the poo will change to a yellow or mustard colour. Breastfed babies’ poo is runny and doesn’t smell. Formula fed babies’ poo is firmer, darker brown and more smelly.

Some infant formulas can also make your baby’s poo dark green. If you change from breast to formula feeding, you’ll find that your baby’s poos become darker and more paste-like.

How often should my baby do a poo?

Some babies fill their nappies at or around every feed. Some, especially breastfed babies, can go for several days without a bowel movement.

Both are normal. It’s also normal for babies to strain or even cry when passing a poo. Your baby isn’t constipated as long as their poos are soft, even if they haven’t passed one for a few days.

Is it normal for my baby’s poos to change?

From day to day or week to week your baby’s poos will probably vary. If you notice a marked change of any kind, such as the poos becoming very smelly, very watery or harder, particularly if there’s blood in them, you should talk to your doctor.

Pale poos may be a sign of jaundice. If you’re worried, speak to your midwife or GP.

Nappy rash

Most babies get nappy rash at some time in the first 18 months.

Nappy rash can be caused by:

  • Prolonged contact with urine (wee) or stools (poo)
  • Sensitive skin
  • Rubbing or chafing
  • Soap, detergent or bubble bath
  • Baby wipes
  • Diarrhoea or other illness

There may be red patches on your baby’s bottom, or the whole area may be red. The skin may look sore and feel hot to touch, and there may be spots, pimples or blisters.

The best way to deal with nappy rash is to try to prevent your baby getting it in the first place. These simple steps will help:

  • Change wet or soiled nappies as soon as possible. Young babies need changing as many as 10 or 12 times a day; older babies at least six to eight times
  • Clean the whole nappy area thoroughly, wiping from front to back. Use plain water or baby wipes
  • Lie your baby on a towel and leave the nappy off for as long and as often as you can in order to let fresh air get to the skin
  • Use a barrier cream, such as zinc and castor oil

If your baby gets nappy rash you can treat it with a nappy rash cream. Ask your pharmacist to recommend one.

If the rash doesn’t go away or your baby develops a persistent bright red, moist rash with white or red pimples, which spreads to the folds of the skin, they may have a thrush infection.

You’ll need to use an anti-fungal cream, available either from the pharmacist or on prescription from your GP. Ask your pharmacist for advice.

Bathing your Baby

You don’t need to bathe your baby every day but topping and tailing needs to be done every day. This is when you should wash their face, neck, hands and bottom.

Choose a time when your baby is awake and content. Make sure the room is warm. Get everything ready beforehand. You’ll need a bowl of warm water, a towel, cotton wool, a fresh nappy and, if necessary, clean clothes.

You may find the following step-by-step guide useful:

  • Hold your baby on your knee or lay them on a changing mat. Take off all their clothes, apart from their vest and nappy, and wrap them in a towel
  • Dip the cotton wool in the water (make sure it doesn’t get too wet) and wipe gently around your baby’s eyes from the nose outward, using a fresh piece of cotton wool for each eye. This is so that you don’t transfer any stickiness or infection from one eye to another
  • Use a fresh piece of cotton wool to clean around your baby’s ears, but not inside them. Never use cotton buds to clean inside your baby’s ears. Wash the rest of your baby’s face, neck and hands in the same way and dry them gently with the towel
  • Take off the nappy and wash your baby’s bottom and genital area with fresh cotton wool and warm water. Dry very carefully, including between the skin folds, and put on a clean nappy
  • It will help your baby to relax if you keep talking while you wash them. The more they hear your voice, the more they’ll get used to listening to you and start to understand what you’re saying

Bathing

Babies only need a bath two or three times a week, but if your baby really enjoys its bath do it every day.

Don’t bathe your baby straight after a feed or when they’re hungry or tired. Make sure the room is warm. Have everything you need at hand: a baby bath or washing-up bowl filled with warm water, two towels, baby bath liquid (unless your baby has particularly dry skin), a clean nappy, clean clothes and cotton wool.

  • The water should be warm, not hot. Check it with your elbow or wrist and mix it well so there are no hot patches
  • Hold your baby on your knee and clean their face, following the instructions given under ‘Washing’
  • Next, wash their hair with water or a liquid soap or baby shampoo. Rinse carefully, supporting them over the bowl
  • Once you’ve dried their hair gently, you can take off their nappy, wiping away any mess
  • Lower your baby gently into the bowl or bath using one hand to hold their upper arm and support their head and shoulders
  • Keep your baby’s head clear of the water. Use the other hand to gently move the water over your baby without splashing
  • Never leave your baby alone in the bath, not even for a second
  • Lift your baby out and pat them dry, paying special attention to the creases in their skin
  • This is a good time to massage some oil or cream into your baby’s skin. Lots of babies love being massaged, and it can help them relax and sleep. It’s best if you lay your baby on a
    towel on the floor as both the baby and your hands can get slippery
  • If your baby seems frightened of bathing and cries, try bathing together. Make sure the water isn’t too hot. It’s easier if someone else holds your baby while you get in and out of
    the bath

Getting your baby to sleep

How much sleep should my newborn baby have?

Baby sleep advice

Every baby is different, some babies sleep much more than others. Some sleep for long periods, others in short periods. Some sleep through the night and some don’t for a long time.

Your baby will have their own pattern of waking and sleeping, and it’s unlikely to be the same as other babies you know.

Try to sleep when your baby sleeps. If you’re breastfeeding, in the early weeks your baby is likely to doze off for short periods during a feed.

Carry on feeding until you think your baby has finished or until they’re fully asleep. This is a good opportunity to try to get some rest yourself.

If you’re not sleeping at the same time as your baby, don’t worry about keeping the house quiet while they sleep. It’s good to get your baby used to sleeping through a certain amount of noise.

How can I get my baby used to night and day being different?

It’s a good idea to teach your baby that night time is different to daytime from the start.

During the day, open curtains, and don’t worry too much about everyday noises when they sleep.

At night, you might find it helpful to:

  • Keep the lights down low
  • Very little talk and keep your voice quiet
  • Put your baby down as soon as they’ve been fed and changed
  • Don’t change your baby unless they need it
  • Don’t play with your baby

Soon, your baby will learn that night time is for sleeping.

Where should my baby sleep?

For the first six months your baby should be in the same room as you when they’re asleep, both day and night. Particularly in the early weeks, you may find that your baby only falls asleep in your or your partner’s arms, or when you’re standing by the cot.

You can start getting your baby used to going to sleep without you comforting them by putting them down before they fall asleep or when they’ve just finished a feed.

It may be easier to do this once your baby starts to stay alert more frequently or for longer.

Is it important to have a routine from the beginning?

Newborn babies will sleep on and off throughout the day and night. It can be helpful to have a pattern, but you can always change the routine to suit what you are doing. For example, you could try waking your baby for a feed just before you go to bed in the hope that you’ll get a long sleep before they wake up again.

Establishing a bedtime routine

Around 3 months you may feel ready to introduce a bedtime routine. Getting them into a simple bedtime routine can be helpful for everyone and can help prevent sleeping problems later on. It’s
also a nice time for you and baby together and you are not distracted by other chores. The routine could run like this:

  • Having a bath
  • Changing into night clothes and a fresh nappy
  • Brushing their teeth (if they have any!)
  • Putting to bed
  • Reading a bedtime story
  • Dimming the lights in the room to create a calm atmosphere
  • Giving a goodnight kiss and cuddle
  • Singing a lullaby or having a wind-up musical mobile that you can turn on when you’ve put your baby to bed

Leave the room while your baby is still awake, happy and relaxed and they will learn how to fall asleep on their own in their cot. Try to avoid getting them to sleep by rocking or cuddling them in your arms. If they get used to going to sleep in your arms, they may look to be nursed back to sleep if they wake up again.

As your child gets older, try to keep to a similar bedtime routine. Too much excitement and stimulation just before bedtime can wake your child up again. Spend some time doing some calmer activities, like reading.

Avoid bedtime feasts

Having a time gap between your baby’s last feed and bedtime. If you feed your baby to sleep, feeding and going to sleep will become linked in your baby’s mind. When they wake in the night, they’ll want a feed to help them go back to sleep.

How much sleep is enough?

Babies’ and children’s sleep patterns vary just like adults. From birth, some babies need more sleep or less sleep than others. This list shows the average amount of sleep that babies and children need during a 24-hour period, including daytime naps.

  • Birth to three months: most newborn babies are asleep more than they are awake. Their total daily sleep varies, but can be from eight hours, up to 16-18 hours. Babies will wake during the night because they need to be fed. Being too hot or too cold can also disturb their sleep
  • Three to six months: as your baby grows, they’ll need fewer night feeds and be able to sleep for longer. Some babies will sleep for eight hours or longer at night. By four months, they could be spending around twice as long sleeping at night as they do during the day
  • Six to 12 months: at this age, night feeds should no longer be necessary, and some babies will sleep for up to 12 hours at night. Teething discomfort or hunger may wake some babies during the night
  • 12 months: babies will sleep for around 12-15 hours in total
  • Two years: most two-year-olds will sleep for 11-12 hours at night, with one or two naps in the daytime
  • Three to four years: most will need about 12 hours sleep, but this can range from 8 hours up to 14. Some young children will still need a nap during the day

Coping with disturbed nights

Try not to rush in if your baby murmurs in the night. Leave them for a few minutes and see if they settle on their own.

Having said that, newborn babies can wake up repeatedly in the night for the first few months and disturbed nights can be very hard to cope with.

If you’re formula feeding, encourage your partner to share the feeds. If you’re breastfeeding, ask your partner to take over the early morning changing and dressing so that you can go back to sleep.

Once you’re into a good breastfeeding routine, your partner could occasionally give a bottle of expressed breast milk during the night, or you could ask a friend or relative to stay for a few days so that you can sleep.

Reducing the risk of cot death

(sudden infant death syndrome)
It’s not known why some babies die suddenly and for no apparent reason from what’s known as cot death or sudden infant death syndrome (SIDS). Experts do know that placing a baby to sleep on
their back reduces the risk and that exposing a baby to cigarette smoke or overheating a baby increases the risk.

Cot death is rare, so don’t let worrying about it stop you enjoying your baby’s first few months. Follow the advice below to reduce the risks as much as possible.

To reduce the risk of cot death:

  • Place your baby on their back to sleep, in a cot in the room with you
  • Don’t smoke during pregnancy or let anyone smoke in the same room as your baby
  • Don’t share a bed with your baby if you’ve been drinking alcohol, if you take drugs or if you’re a smoker
  • Never sleep with your baby on a sofa or armchair
  • Don’t let your baby get too hot
  • Keep your baby’s head uncovered. Their blanket should be tucked in no higher than their shoulders
  • Place your baby in the ‘feet to foot’ position (with their feet at the end of the cot or pram)
  • The safest place for your baby to sleep is on their back in a cot in a room with you for the first six months

Place your baby on their back to sleep.

Place your baby on their back to sleep from the very beginning, for both day and night sleeps. This will reduce the risk of cot death. It’s not as safe for babies to sleep on their sides as on their backs. Healthy babies placed on their backs are not more likely to choke.

When the baby is old enough to roll over, don’t prevent them from doing so.

The risks of bed sharing

The safest place for your baby to sleep for the first six months is in a cot in a room with you. Don’t share a bed with your baby if you or your partner:

  • Are smokers (no matter where or when you smoke and even if you never smoke in bed)
  • Have recently drunk alcohol
  • Have taken medication or drugs that make you sleep more heavily
  • Feel very tired

The risks of bed sharing are also increased if your baby:

  • Was premature (born before 37 weeks), or
  • Was of low birth weight (less than 2.5kg or 5.5lb)

There’s also a risk that you might roll over in your sleep and suffocate your baby. Or your baby could get caught between the wall and the bed, or roll out of an adult bed and be injured.

Never sleep with a baby on a sofa or armchair.

It’s lovely to have your baby with you for a cuddle or a feed, but it’s safest to put your baby back in their cot before you go to sleep.

Don’t let anyone smoke in the same room as your baby.

Babies exposed to cigarette smoke after birth are at increased risk of cot death. Nobody should smoke in the house, including visitors.

Anyone who needs to smoke should go outside. Don’t take your baby into smoky places. If you’re a smoker, sharing a bed with your baby increases the risk of cot death.

Don’t let your baby get too hot (or too cold)

Overheating can increase the risk of cot death. Babies can overheat because of too much bedding or clothing, or because the room is too hot.

  • When you check your baby, make sure they’re not too hot. If your baby is sweating or their tummy feels hot to the touch, take off some of the bedding. Don’t worry if your baby’s hands or feet feel cool. This is normal
  • It’s easier to adjust for the temperature by using lightweight blankets. Remember, a folded blanket counts as two blankets
  • Babies don’t need hot rooms. All-night heating is rarely necessary. Keep the room at a temperature that’s comfortable for you at night. About 18°C (65°F) is comfortable
  • If it’s very warm, your baby may not need any bedclothes other than a sheet
  • Even in winter, most babies who are unwell or feverish don’t need extra clothes
  • Babies should never sleep with a hot-water bottle or electric blanket, next to a radiator, heater or fire, or in direct sunshine
  • Babies lose excess heat through their heads, so make sure their heads can’t be covered by bedclothes during sleep periods
  • Remove hats and extra clothing as soon as you come indoors or enter a warm car, bus or train, even if it means waking your baby

Don’t let your baby’s head become covered

Babies whose heads are covered with bedding are at increased risk of cot death. To prevent your baby wriggling down under the covers, place them in the ‘feet to foot’ position. This means that
their feet are at the end of the crib, cot or pram.

  • Make the covers up so that they reach no higher than the shoulders. Tuck the covers in securely so that they can’t slip over the baby’s head. Use one or more layers of lightweight blankets
  • Use a baby mattress that’s firm, flat, well-fitting and clean, and waterproof on the outside. Cover the mattress with a single sheet
  • Don’t use duvets, quilts, baby nests, wedges, bedding rolls or pillows

Feeding and dummies

Breastfeeding your baby reduces the risk of cot death.

It’s possible that using a dummy at the start of any sleep period reduces the risk of cot death. However, the evidence is not strong and not all experts agree that dummies should be promoted. Don’t give your baby a dummy until breastfeeding is well established, usually when they’re around one month old. Stop giving them the dummy when they’re between 6 and 12 months old.

If your baby is unwell, seek medical help promptly.

Babies often have minor illnesses, which you don’t need to worry about. Give your baby plenty of fluids to drink and don’t let them get too hot. If your baby sleeps a lot, wake them up regularly for a drink.

Enjoy your baby

Cot death is uncommon and becomes rare after the age of 5 months – about the time when babies are able to roll over and move a bit more. Don’t let the worry of cot death spoil the precious time of getting to know your baby. But, the measures listed above reduce the small risk of cot death even further. Perhaps the most important thing is simply to remember to put your baby on their back when you place them down to sleep.

Soothing a crying baby

Coping with crying

All babies cry, and some cry a lot. Crying is your baby’s way of telling you they need comfort and care.

Sometimes it’s easy to work out what they want, and sometimes it isn’t. The most common reasons are:

  • Hunger
  • A dirty or wet nappy
  • Tiredness
  • Wanting a cuddle
  • Wind
  • Being too hot or too cold
  • Boredom
  • Overstimulation

Some days your baby may cry a lot and can’t be comforted. Early evening is the most common time for this to happen. This can be hard for you as it’s often the time when you’re most tired and least able to cope.

Try some of the following ways to comfort your baby. Some may be more effective than others:

  • If you’re breastfeeding, let your baby suckle at your breast
  • If you’re bottle feeding, give your baby a dummy. Sterilise dummies as you would bottles. To avoid tooth decay don’t dip them in anything sweet. Some babies find their thumb instead
  • Later, some will use a bit of cloth as a comforter
  • Hold your baby or put them in a sling so that they’re close to you. Move about gently, sway and dance, talk to them and sing
  • Rock your baby backwards and forwards in the pram, or go out for a walk or a drive. Lots of babies like to sleep in cars. Even if they wake up again when you stop, at least you’ll have had a break
  • Find something for them to listen to or look at. This could be music on the radio, a CD, a rattle or a mobile above the cot
  • Try stroking your baby’s back firmly and rhythmically, holding them against you or lying face downwards on your lap. You could also undress your baby and massage them with baby oil, gently and firmly. Talk soothingly as you do it and keep the room warm enough. Some clinics run baby massage courses. Try a warm bath. This calms some babies instantly, but makes others cry even more
  • Sometimes, rocking and singing can keep your baby awake. You might find that lying them down after a feed will help
  • Ask your pharmacist for advice

Crying during feeds

Some babies cry and seem unsettled around the time of a feed. If you’re breastfeeding, you may find that checking how your baby is attached at the breast helps them settle. Breast feeding support groups can be very
helpful.

It may be that something you’re eating or drinking is affecting your baby. Some things will reach your milk within a few hours, while others may take 24 hours. All babies are different, and what affects one won’t necessarily affect yours. You might want to consider avoiding dairy products, chocolate, fruit squashes, diet drinks and drinks containing caffeine.

If this doesn’t work, try keeping a note of when the crying happens to see if there’s a pattern. Sometimes, crying during feeds can be a symptom of reflux which is relatively common in babies. Speak to your GP or pharmacist for more information and advice.

Excessive crying

There are several reasons that can cause a baby to cry excessively. It can be exhausting if you’ve tried everything and nothing seems to comfort your baby.

Colic

Excessive crying could be a sign that your baby has colic.

Everyone agrees that colic exists but no one knows what causes it. Some doctors think it’s a kind of stomach cramp. The crying sounds miserable and distressed, and stops for a moment or two,
then starts up again, which suggests it could be caused by waves of stomach pain.

The crying can go on for some hours. There may be little you can do except try to comfort your baby and wait for the crying to pass.

Crying and illness

Although all babies cry sometimes, there are times when crying may be a sign of illness.

Listen for sudden changes in the pattern or sound of your baby’s crying. Often, there’ll be a simple explanation.

If they seem to have other symptoms, such as a high temperature, they may have an illness, such as a cold, or something treatable, such as reflux. If this is the case, contact your GP.

Get medical attention if your baby:

  • Has a weak, high-pitched continuous cry
  • Seems floppy when you pick them up
  • Takes less than a third of their usual amount of fluids
  • Passes much less urine than usual
  • Vomits green fluid
  • Passes blood in their stools
  • Has a high temperature, but their hands and feet feel cold
  • Has a bulging fontanelle
  • Has had a fit
  • Turns blue, mottled or very pale
  • Has a stiff neck
  • Has difficulty breathing, breathes fast or grunts while breathing, or seems to be working hard to breathe
  • Has a spotty purple-red rash anywhere on the body (this could be sign of meningitis)

Getting help

If you’ve decided to talk to your GP it can help if you keep a record of how often and when your baby cries. For example, this might be after every feed or during the evening. This can help your GP to work out whether there is a particular cause for the crying.

Keeping a record can also help you identify the times when you need extra support. You could also think about possible changes to your routine. There may be times when you’re so tired and angry you feel like you can’t take any more. This happens to a lot of parents, so don’t be ashamed to ask for help.

If you don’t have anyone who can take care of your baby for a short time and the crying is making you stressed, put your baby in their cot or pram, make sure they’re safe, close the door, go into another room and try to calm yourself down. Set a time limit (for example, 10 minutes) then go back.

Never shake your baby

No matter how frustrated you feel, you must never shake your baby. Shaking moves their head violently, and can cause bleeding and brain damage.

If you think there’s something wrong, always follow your instincts and contact your GP.

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