A Guide to Newborn Safety for First-Time Parents: Birth to 6 months

Ally Ward is a neonatal nurse practitioner and mom of twin preemies, providing education and support to families of infants through clinical expertise, collaboration and compassion.

Here are Ally's tips to help you keep your baby out of harm's way from birth through 6 months!

What are top tips for newborn safety in the car?

1. Car seats are primarily for transportation for infants

   1. Even though car seats are certified for safety, they are not meant for newborns to spend extended lengths of time in them.

   2. The angle of the seat and the propensity of the infant’s head to droop forward due to low muscle tone in the newborn create the potential for asphyxia or decreased ability to air to be inhaled and exhaled.

   3. Newborns ride in the car seat in a semi reclined position. This allows for the airway to remain open. It is important to make sure that the seat is installed in the car according to the manufacturer’s recommendations. The issue of positioning comes into play when the car seat is used as a carrier and the baby remains at an angle that is different than the angle when the baby is in the car.

2. Do not forget the baby, seriously

   1. Some newer cars remind drivers to look in the backseat to check for the baby or child.

   2. Some people suggest placing their bag or purse in the backseat in order to ensure that the backseat is checked for the presence of the baby.

3. Back seat always, rear facing until a minimum of 2 years of age.

   1. Data from Sweden suggests that the risk to children is greatly reduced during a MVC if the child remains rear facing until 4 years of age.

4. Need to transition out of the infant car seat based on manufacturer recommendations of weight.

How can parents ensure they are safely bathing their baby?

1. Bath not needed in the first 6-24 hours of life

   1. Helps prevent neonatal hypothermia, hypoglycemia

   2. Helps establish breastfeeding and bonding

   3. Vernix contains anti-bacterial properties and moisturizes the skin

2. Lower the heat in the central water heater to less than 120 degrees F

3. Swaddled baths are amazing and less stressful for the baby

   1. Use an infant towel to loosely swaddle the baby

   2. Gently place tub in tub

      1. Wash face and head/hair first

      2. Expose one extremity to wash and rinse

   3. May gently pour warm water over baby’s body to rinse and enjoy tube time

4. Have what you need at hand

   1. Review your mental checklist before bath begins

      1. Towel, washcloth, infant soap

5. NEVER LEAVE THE BABY ALONE IN ANY AMOUNT OF WATER

   1. No matter the circumstances (doorbell, telephone ringing, oven going off).

      1. If supplies are nearby caregiver can lift baby out of water and place on towel

      2. Particularly important to remember that siblings may also “try and help” while baby is in the water and may actually make the situation more dangerous

   2. Infants can die in 1-2 inches of water

   3. Newborns do not have the muscle strength to lift head and neck out of the water

   4. Infants less than 1 account for nearly half of all childhood drownings

What can parents do to prevent choking or strangulation?

1. The first step is to recognize the vulnerability of the newborn

   1. *Newborns do not have the muscle tone or strength or turn away from situations where the mouth and nose are occluded

   2. 8Newborns are obligate nose breathers, which is why it is so important to keep the nose and specifically the nares visible at all times.

   3. *MANY items marketed to parents are NOT safe.

      1. Unless a medical provider instructs a family to add items to the baby’s crib, do not add wedges, bumper, mesh material, etc into or around crib as baby may be caught in the item and strangle

      2. Positioners and items such as boppy’s, Doc-A-Tot and wedges all have the potential to place the airway in a position that BLOCKS THE AIRFLOW or the baby’s face can become smashed into the product

   4. Routinely look around the baby’s environment for objects that they may come in contact. Make this a part of your daily routine.

      1. Infants also have VERY small airways and objects, and food can potentially obstruct airway

      2. Newborns and infants may not be able to produce a cough strong enough to dislodge object/food from the airway

2. Remove toys and household items that an infant could come in contact with infant

   1. NO balloons in the house or anywhere near an infant or toddler

3. Always have a bulb syringe nearby to remove liquid (breastmilk, formula, mucus or saliva from nose and/or mouth

What are safe ways parents can bond with their baby if babywearing or co-sleeping?

Baby-wearing Benefits

Sooths the baby as baby is close to mom= less infant distress

Decreases risk of postpartum depression

Helps with breastmilk production

Aids in baby’s development

Creates bond between baby and mother

Baby-wearing has proven benefit of continued breastfeeding

The first consideration is safety with specific attention to the airway.

In ALL situations involving positioning of a newborn/infant, the person who is holding the baby should ALWAYS be able to view the baby’s nose and mouth in order to ensure that airflow can be maintained and avoid having the baby curled in a “C” shape

This includes

1. In the hospital at all times after delivery

2. Skin-to-skin after delivery

3. During breastfeeding

4. When holding the baby

5. When in a sling or carrier

Baby-wearing considerations

1. Baby-wearing mindset should be bonding and attachment and not necessarily as a way to “multi-task”

2. Underlying condition such as prematurity, low birth weight or decreased muscle tone should be considered

   1. These infants are at a higher risk for decreased muscle tone and at greater risk of airway obstruction

3. Knowledge that infant’s nose and mouth should be visible at ALL times by the wearer

   1. Suffocation can occur in 1-2 minutes

4. Remember TICKS

   1. Carrier is tight

   2. Nose and mouth IN view of wearer at all times

   3. Infant Close enough to kiss

   4. Keep infant’s chin off of chest

   5. Support back (prevents the C shape of baby)

      1. If a sling is used, infant’s nose and mouth should not come in contact with material from sling or wearer’s body

Co-sleeping defined, baby and mom in close proximity-not necessarily in the same bed.

1. It is recommended that infants remain in the same room as the mom/parent/caregiver as this is an American Academy of Pediatrics recommendation as a way to decrease SIDS.

2. Breastfeeding may be easier if mom and baby are in the same room and able to attend to baby’s cues prior to ravenous hunger, which may negatively impact latch.

3. Potentially decreases maternal/parental anxiety if baby is within parents’ view/arms’ reach

4. Again, newborns are particularly vulnerable to suffocation due to decreased muscle tone and no way to remove face from blankets, pillows, other parent etc.

   1. Infant at particular risk if either parent has used alcohol or drugs

   2. Sibling and/or pet presence in bed is of particular risk to infant

Co-sleeping

1. Baby in own space with tight fitting sheet, in a sleeper and light blanket, swaddler or sleep sack

2. Infant placed on their back

3. Infant can be within arms’ reach of parent