Routine Care of the Normal New born Infant

Learning objectives

After completion of this session the participant should be able to:

Why is care of the normal term infant so important?

The vast majority of newborns require no intervention at birth other than routine normal care. If this is done well, it vastly reduces the likelihood of problems. Most newborn’s should be transferred to the post-natal wards for rooming-in with their mothers. These babies still need to be monitored because they are at continued risk of hypothermia and feeding difficulties during the first few days of life. These babies can also become sick and develop danger signs. The mother-infant pair needs counselling and appropriate treatment when required. Newborns born in health facilities should not be sent home in the crucial first 48 hours of life.

A postnatal room should be kept warm with no draughts from open doors or windows. A temperature of at least 25°C is required to help keep baby warm. A mother and her baby should be kept together from birth if possible. This helps the mother form an early close loving relationship (bonding), she can also respond quickly when her baby wants to feed, which helps establish breast feeding and reduces breast feeding difficulties (1).

Daily routine care of the newborn

Key facts for providers – Routine care of the term newborn

Keep mother and baby together if possible

Encourage unrestricted frequency and duration of breastfeeding

Assess breastfeeding in terms of position and attachment

Tetracycline Eye Ointment (TEO) should be administered to both eyes once after birth according to national guidelines

Vitamin K should be administered to all newborns (1mg IM to term infants)

After ensuring the baby is dry and warm, and the eyes are clean, apply chlorhexidine (CHX) to the tip of the cord, the stump and around the base of the stump. (Apply CHX once within 24 hours after the birth, but preferably in the first 2 hrs.)

A full examination of the newborn must be done on admission, at 24 hours and at discharge from the post-natal ward HIV and VDRL exposure status must be known and acted on if exposed

BCG vaccine should be administered to all newborns

Oral polio vaccine should be administered to all newborns

Key facts for providers - How to examine the newborn

Do on day zero (on admission) to the post-natal ward, at 24 hours and at discharge

  • Temperature, Pulse rate and Respiratory rate (TPR)
  • Head to toe

  • Look for congenital abnormalities
  • Head – fontanelle, moulding, signs of birth trauma
  • Eyes - Jaundice, check for the red reflex
  • Lips/mouth - cyanosis, pallor, cleft lip/ palate
  • Abdomen - is the umbilicus red or discharging? Look for abdominal wall defects, organomegaly.
  • Check for normal genitalia, femoral pulses, patent anus.
  • Turn baby around, check for spina bifida

Assessment of danger signs

The following signs should be assessed during each postnatal care contact, and the newborn should be referred for further evaluation if any of the following danger symptoms or signs are present:

Key facts for providers and mothers/guardians - Danger symptoms or signs
  1. Not feeding, poor feeding, vomiting
  2. Lethargy
  3. Convulsions
  4. Low body temperature (<35.5 °C)
  5. Fever (>38 °C)
  6. Chest in-drawing
  7. Fast breathing (breathing rate >60 per minute), grunting
  8. Any jaundice in first 24 hours of life, or yellow palms and soles at any age

Parental education about maintaining Infant Health

At each post-natal contact, parents should be offered information and guidance to enable them to care for their baby.

Key facts for providers and mothers/guardians


Appropriate clothing of the baby for ambient temperature is recommended. This means 1-2 layers of clothes more than adults, and use of hats/ caps


Babies are not bathed routinely in the hospital to prevent complications like hypothermia and infection, they may however be sponged with lukewarm water.

Cord Care

Chlorhexidine is applied once after birth. After this instruct the mothers not to apply anything to the cord but keep clean and dry

Nappy rash

Prevent with frequent nappy changes and cleansing and exposure of the perineal area in order to reduce babies’ contact with faeces and urine. Cleansing agents should not be added to bath water nor should lotions or medicated wipes be used. When required, the only cleansing agent that should be used is mild non-perfumed soap. Cloth nappies are preferred to plastic nappies.


If thrush is identified in her baby, the breast feeding woman should be offered information and guidance about relevant hygiene practices. Symptomatic thrush (difficulty feeding) requires antifungal treatment.


Parents should be offered information about jaundice including: 50% of newborn and 80% of preterm have some jaundice. It may be normal or abnormal. Normal or physiological jaundice occurs around 3-4 days after birth. The mother of a breastfed baby who has signs of jaundice should be actively encouraged to breastfeed frequently, and the baby awakened to feed if necessary. Breastfed babies with jaundice should not be routinely supplemented with formula, water or dextrose water. Parents should be advised to contact the health care professional if their baby’s jaundice is worsening, or if their baby appears unwell in any way. If jaundice remains after 14 days in an otherwise healthy baby it should be evaluated.

Weight Loss

Weight loss of 10% in the first days of life is normal. Most term infants regain their birth weight by 10-14 days.


Advise mother to wash hands with soap and water after using the toilet and after cleaning the baby.
Danger signs Remind mother about danger signs and care seeking.


See Breastfeeding for feeding of a term, healthy baby.

Congenital infections

See Common congenital infections for treatment of common congenital infections.

Discharge and Providing Follow-Up Care

Correct planning of discharge from the hospital is very important for the newborn. Infants who are discharged from the hospital should return for follow-up care to the nearest health facility. Communicate with the health personnel who will be responsible for follow-up care by writing in the health passport.

Key facts for providers and mothers/guardians - Discharge

  • Ensure breast feeding is established
  • Write the birth weight and birth date
  • Indicate if any neonatal problems such as jaundice, sepsis or asphyxia
  • Ensure HIV exposure status is known and recorded in the passport.
  • Ensure Vitamin K has been administered and recorded
  • Ensure BCG and oral polio have been received and recorded
  • Counsel on exclusive breast feeding, keeping baby warm and to seek health care early if they identify any of the danger signs in-between postnatal care visits. Ask the parent to repeat the danger signs so that you know they have remembered them.
  • Follow-up schedule (at home or as close to home as possible) - at one week and at six weeks after discharge