RUA: Discharge Teaching Guidelines
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RUA_DischargeTeachingupdated.pptx
Discharge Teaching
What can I do to get my baby to sleep?
SIDS Safety included
Good Morning Everyone,
Discharge Teaching Presentation - Sudden infant death syndrome.
Introduction
You are now going home with your infant. Here are some safety tips for new parents about getting to know the needs of their infants and optimize health. We will review newborn safety and teaching.
The purpose of this presentation is to provide parents with education about different methods to help but babies to sleep, such as bathing, swaddling, and feeding.
Identification of benefits
Getting to know your infant
Recognizing what is normal and abnormal
Keeping newborns safe
Easing the transition to caring for your baby at home
Helpful newborn hints
Langan RC. Discharge procedures for healthy newborns. Am Fam Physician. 2006 Mar 1;73(5):849-52. PMID: 16529093.
Sleep time and cycle
On average, newborns sleep 16+ hours in every 24 hours.
Newborns usually sleep in short bursts of 2-4 hours through the day and night.
Some newborns get their days and nights confused. Some sleep better at night if they spend more time awake during the day.
https://www.hopkinsmedicine.org/howard_county_general_hospital/_downloads/takingbabyhome_english.pdf
Recommended
During the day:
Keep the house bright even during naps
Wake baby for feedings every three to four hours if they do not wake up on their own
Play, sing, and talk to baby
Do not keep the house quiet: allow normal household noises
During the night
Keep the lights dim when baby wakes to feed
Limit distraction and stimulation
Keep the room quiet
Cuddle and soothe a crying baby to help them back to sleep
Feeding
Early breastfeeding can help promote long term health benefits it can prevent newborn from infection and improve cognitive development in babies.
Newborns need to be fed every 2-3 hours during the day and every 3-4 hours during the night.
Newborns should feed every 2-3 hours while breastfeeding and every 3-4 hours if bottle feeding
Should have at least 6-8 wet diapers a day
Newborns should be fed 2 hours prior to bedtime to help promote calmness and so that a routine can be established.
The noise in the room should diminish as well as the brightness
Alashi, MatoomMi, Comussu, Nicoletaionescu, Praneat, Kbeis, . . . Sohappywo. (n.d.). Baby Drinking Bottle Cartoons stock illustrations. Retrieved from https://www.istockphoto.com/illustrations/baby-drinking-bottle-cartoons
Bathing Baby
When bathing a newborn, it is important to make sure the babies' temperature is not below 97.7.
The baby should be bathed 2-3 times a week.
The temperature of the tub should be 100 degrees of less.
Baby should not be in a bathtub if circumcision is not fully healed.
The baby should only be given a sponge bath until the cord has fallen off.
Babies can be bathed in the tub or in the sink prior to sleep time. Bathing the baby prior to bedtime every day can also help promote a soothing effect and help mother establish a routine
Should Your Bedtime Routine Include a Bath? (n.d.). Retrieved from https://www.helpingbabiessleep.com/blog/bedtime-routines-should-they-include-a-bath
Depositphotos, I. (n.d.). Baby in bath vector illustration. Retrieved from https://depositphotos.com/122464752/stock-illustration-baby-in-bath-vector-illustration.html
Swaddling baby
Baby should be swaddled when crying or in pain and prior to bedtime to help promote comfort.
Swaddling should be done for about 4-6 months
This method can help promote better sleep and help regulate the babies temperature if needed
After swaddling the baby who is sleepy he or she should be placed in their own crib to prevent suffocation.
It is important to note that a blanket should be wrapped around the baby securely to prevent cold stress. The baby should also be held lightly to allow for for normal gas exchange to occur.
Should Your Bedtime Routine Include a Bath? (n.d.). Retrieved from https://www.helpingbabiessleep.com/blog/bedtime-routines-should-they-include-a-bath
Newborn crib Safety
Place baby in the crib with no extra blankets or linen
Do not place the baby on their stomach when sleeping
Do not place toys in the crib
Make sure to keep the baby warm with blanket
Do not place the baby under a cool air conditioner
Babies should not be overdressed during bedtime
Make sure the babies crib is only 2in away from your bed. The baby should have its own separate crib and should not be in bed with you. Make sure the crib is flat,hard, and firm.Do not place the baby in bed right after they have been breastfed to prevent aspirations. Cribs should also be assembled properly and should be placed in the moms room.
oon, Y. R. (2020). How to Keep your Sleeping Infant Safe. American Academy of Pediatrics. Retrieved April 10, 2021 from https://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/A-Parents-Guide-to-Safe-Sleep.aspx
Limited, A. (n.d.). Stock Vector - Baby crib. Newborn vector illustration. Sketch of cot for the infant boy. Retrieved from https://www.alamy.com/baby-crib-newborn-vector-illustration-sketch-of-cot-for-the-infant-boy-image239135782.html
Identifications of risk factors: SIDS
Sudden infant death syndrome is known to happen to newborns who sleep on their stomach. Newborns lack motor control therefore causing them to be unable to roll over in their crib. Putting the newborn on their stomach can cause oxygen to be deprived and sudden death.
babies should only be on their tummy when they are awake and only when they have shoulder and back strength/control.
Jr., F. R. (Ed.). (2017, February). Sudden Infant Death Syndrome (SIDS) (for Parents) - Nemours KidsHealth. Retrieved from https://kidshealth.org/en/parents/sids.html
About 3,500 babies in the US are lost to sleep-related deaths each year. (2018, January 09). Retrieved April 3, 2021, from https://www.cdc.gov/media/releases/2018/p0109-sleep-related-deaths.html
Risk factors: decreased sleep-in infants
Risk factors related to newborns not getting adequate amounts of sleep include:
Smoking
Prematurity
Low birth weight
Overheating
Poor prenatal care
Mothers younger than 20
Jr., F. R. (Ed.). (2017, February). Sudden Infant Death Syndrome (SIDS) (for Parents) - Nemours KidsHealth. Retrieved from https://kidshealth.org/en/parents/sids.html
Most SIDS deaths happen in babies 2 to 4 months old, and cases rise during cold weather. Black and Native American infants are more likely to die of SIDS than Caucasian infants. More boys than girls fall victim to SIDS.
Risk Factors: Loud noises and frequent wake up cycles
Newborns are able to sleep with some noise however, if loud constant noises are present, they stimulate the baby and they can have a difficult time falling back to sleep.
Contant wake up periods at night can also influence the newborns sleep pattern.
Limit loud noises when infants are sleeping. Newborns are easily stimulated.
Early Problems With Crying and Sleeping
Air bubbles
Diapers
Clothing
Warmth
Overstimulation
Hunger
Olsen, A. L., Ammitzbøll, J., Olsen, E. M., & Skovgaard, A. M. (2019). Problems of feeding, sleeping and excessive crying in infancy: a general population study. Archives of Disease in Childhood, 104(11), 1034–1041. https://doi.org/10.1136/archdischild-2019-316851
Air bubbles - fussy infants may need more frequent burping during and after feeding. Try burping before putting the infant to sleep
Diapers - check and change diaper before feeding
Clothing - Check the infant's clothing for any discomfort
Warmth - warm enough, dress the newborn as warmly as an adult would want, but overdress can cause infant to discomfort
Overstimulation - Too many visitors handling
Hunger - Try to feed infant if it has been more than 30 minutes since the last feeding. A bubble air can cause a feeling of fullness too soon during the last feeding.
Growth Spurt - need more frequent feeding for a day or two. (make sure to not over feeding)
Quieting & Soothing Techniques
White noise
Car rides
Taking turn
Skin-to-skin contact
Swaddling
Boyd, M. M. (2017). Implementing Skin-to-Skin Contact for Cesarean Birth. AORN Journal, 105(6), 579–592. https://doi.org/10.1016/j.aorn.2017.04.003
Liao, J., Hu, R., Su, L., Wang, S., Xu, Q., Qian, X., & He, H. (2018). Nonpharmacological Interventions for Sleep Promotion on Preterm Infants in Neonatal Intensive Care Unit: A Systematic Review. Worldviews on Evidence-Based Nursing, 15(5), 386–393. https://doi.org/10.1111/wvn.12315
White noise - background noise sometime put infant to sleep
Car ride - some infants go to sleep in a moving care.
Taking turn - ask your partner to take turn comforting the newborn
Skin-to-skin contact - Place the baby against the parent's bare skin can soothing to a young infant
Swaddling - Wrap the infant snugly. This is comforting and helpful during the first few weeks after birth
Quieting & Soothing Techniques continued..
massage
Music
pacifiers
Bathing
Stroller rides
Liao, J., Hu, R., Su, L., Wang, S., Xu, Q., Qian, X., & He, H. (2018). Nonpharmacological Interventions for Sleep Promotion on Preterm Infants in Neonatal Intensive Care Unit: A Systematic Review. Worldviews on Evidence-Based Nursing, 15(5), 386–393. https://doi.org/10.1111/wvn.12315
Boyd, M. M. (2017). Implementing Skin-to-Skin Contact for Cesarean Birth. AORN Journal, 105(6), 579–592. https://doi.org/10.1016/j.aorn.2017.04.003
Massage- soothing for some infants
Music - a low radio volume or music with steady beat (some infant respond well with music box or classical music
pacifiers - sucking motion helps
bathing - older infants love baths, young infants may not yet have reached that stage. However, infant may fall asleep after the bath
Stroller rides - riding around the house, motion of the stroller may be soothing to some infants. The stroller should allow the infant to lie down rather than sit
Infants & Parents’ sleep pattern (Ying)
Infants
- Sleep between 16 - 17 hours per day
- Infants should be position on the back for sleep (SIDS prevention)
Mother
- should try to make up for lost sleep
- Have family member assistance
- Father’s support
Namnabati, M. (2019). Support and guide parents on infants problems with home visits and a focus on maternal mental health. Evidence-Based Nursing, ebnurs–2019–103196–. https://doi.org/10.1136/ebnurs-2019-103196
Marinelli, K. A., Ball, H. L., McKenna, J. J., & Blair, P. S. (2019). An Integrated Analysis of Maternal-Infant Sleep, Breastfeeding, and Sudden Infant Death Syndrome Research Supporting a Balanced Discourse. Journal of Human Lactation, 35(3), 510–520. https://doi.org/10.1177/0890334419851797
How to Help Infants Sleep through the Night
Patient Teaching
Feeding
Allow infant to sleep on their own
Allow to cry (a few minutes)
Avoid stimulation
Change diaper before feeding
Provide comfort and trust (patting; touch)
Crawford, D. (2017). Understanding the physiology of sleep and promoting effective routines with infants in hospital and at home. Nursing Children and Young People, 29(4), 36–44. https://doi.org/10.7748/ncyp.2017.e895
Feeding - keep night feeding short and put the infant back to bed immediately
allow the infants to fall asleep at bedtime on their own instead of always rocking or feeding. if rocking - place the infant into when when drowsy but not fully asleep
Allow to cry for a few minutes - may not need to feed
Diaper - change before feeding
Patting and touching them on the back instead of feeding
Professional Organizations
The American Academy of Pediatrics mission is to ensure optimal physical, mental, and social health and well-being for all infants, children, adolescents and young adults.
Breastfeeding
Newborn Screening
Newborn Care
Immunization
About the aap. services.aap.org. (n.d.). https://services.aap.org/en/about-the-aap/.
Professional Organizations
Getparentingtips.com is an organizations that focuses on prevention and early intervention by providing free resources for parents.
Parenting stress and selfcare
Safe sleep
Breastfeeding
Baby proofing your home
https://www.getparentingtips.com/babies/safety/ABCs-of-safe-sleep-for-babies/
https://www.istockphoto.com/illustrations/new-parents (image)
Community Resources
The Texas Nurses Family Partnership is a free, voluntary program where nurses work with mothers to improve prenatal, newborn, and infant care.
Parental and infant bonding
Home care
Bathing
Sleep
Feeding (breast and formula)
Parental stress
Well child visits
Community Resources
The Lactation Foundation Houston
Partnership with Texas WIC and Program and the UTHealth McGovern Medical School Department of Pediatrics.
The goal is to educate mothers on breastfeeding in a nurturing environment .
https://med.uth.edu/lactation-foundation/about/
https://www.istockphoto.com/search/2/image?mediatype=illustration&phrase=%20breastfeeding (image)
Community Resources
The Lactation Foundation
Lactation Consultations
Prenatal Consultations
Phone Consultations
Group Classes
Breastfeeding Support Groups
2636 South Loop West, Suite 135
Houston, TX 77054
Email: [email protected]
Phone: 713.500.2800
References
Jr., F. R. (Ed.). (2017, February). Sudden Infant Death Syndrome (SIDS) (for Parents) - Nemours KidsHealth. Retrieved from https://kidshealth.org/en/parents/sids.html
Langan RC. Discharge procedures for healthy newborns. Am Fam Physician. 2006 Mar 1;73(5):849-52. PMID: 16529093.Jr., F. R. (Ed.). (2017, February). Sudden Infant Death Syndrome (SIDS) (for Parents) - Nemours KidsHealth. Retrieved from https://kidshealth.org/en/parents/sids.html
About 3,500 babies in the US are lost to sleep-related deaths each year. (2018, January 09). Retrieved April 3, 2021, from https://www.cdc.gov/media/releases/2018/p0109-sleep-related-deaths.html
Should Your Bedtime Routine Include a Bath? (n.d.). Retrieved from oon, Y. R. (2020). How to Keep your Sleeping Infant Safe. American Academy of Pediatrics. Retrieved April 10, 2021 from https://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/A-Parents-Guide-to-Safe-Sleep.aspx
Limited, A. (n.d.). Stock Vector - Baby crib. Newborn vector illustration. Sketch of cot for the infant boy. Retrieved from https://www.alamy.com/baby-crib-newborn-vector-illustration-sketch-of-cot-for-the-infant-boy-image239135782.html
References
Depositphotos, I. (n.d.). Baby in bath vector illustration. Retrieved from https://depositphotos.com/122464752/stock-illustration-baby-in-bath-vector-illustration.html
https://www.helpingbabiessleep.com/blog/bedtime-routines-should-they-include-a-batAlashi, MatoomMi, Comussu, Nicoletaionescu, Praneat, Kbeis, Sohappywo. (n.d.). Baby Drinking Bottle Cartoons stock illustrations. Retrieved from https://www.istockphoto.com/illustrations/baby-drinking-bottle-cartoons
Kathryn Sibley HortonKathryn is the director for research and safety with the Prevention and Early Intervention division of the Texas Department of Family and Protective Services. (n.d.). Get parenting tips. ABCs of Safe Sleep for Babies - Babies, Infants & Newborns - Safety GetParentingTips.com. https://www.getparentingtips.com/babies/safety/ABCs-of-safe-sleep-for-babies/.Olsen, A. L., Ammitzbøll, J., Olsen, E. M., & Skovgaard, A. M. (2019). Problems of feeding, sleeping and excessive crying in infancy: a general population study. Archives of Disease in Childhood, 104(11), 1034–1041. https://doi.org/10.1136/archdischild-2019-316851
Reference
Boyd, M. M. (2017). Implementing Skin-to-Skin Contact for Cesarean Birth. AORN Journal, 105(6), 579–592. https://doi.org/10.1016/j.aorn.2017.04.003
Liao, J., Hu, R., Su, L., Wang, S., Xu, Q., Qian, X., & He, H. (2018). Nonpharmacological Interventions for Sleep Promotion on Preterm Infants in Neonatal Intensive Care Unit: A Systematic Review. Worldviews on Evidence-Based Nursing, 15(5), 386–393. https://doi.org/10.1111/wvn.12315
Namnabati, M. (2019). Support and guide parents on infants problems with home visits and a focus on maternal mental health. Evidence-Based Nursing, ebnurs–2019–103196–. https://doi.org/10.1136/ebnurs-2019-103196
Marinelli, K. A., Ball, H. L., McKenna, J. J., & Blair, P. S. (2019). An Integrated Analysis of Maternal-Infant Sleep, Breastfeeding, and Sudden Infant Death Syndrome Research Supporting a Balanced Discourse. Journal of Human Lactation, 35(3), 510–520. https://doi.org/10.1177/0890334419851797
McKinney, Sharon Murray, E. Foundations of Maternal-Newborn and Women's Health Nursing. Available from: VitalSource Bookshelf, (7th Edition)
