BABY BATH INTRODUCTION: the hygiene care of the newborn is very important to prevent various infections. Babies do not perspire for the first month nor do they respond with goose flesh. The newborn’s body temperature regulating mechanisms are underdeveloped, so measures to avoid overheating and chilling are important. When the newborn’s body temperature has stabilized, he or she may be bathed. Bath time provides the nurse an excellent opportunity for observation and assessment of the newborn. Bathing of infant can be done 2-3 times in a week, but can be done more often during hot weather. DEFINITION: Baby bath is a procedure to maintain hygiene of the baby to prevent colonization of harmful organisms. PURPOSE:
To keep the baby’s skin clean. To refresh the baby. To stimulate circulation. To increase bonding between mother and child. To prevent baby from infection. To provide opportunity for mother to explore the baby for any abnormality. TYPES OF BATHING: Sponging: sponge baths are given to infants who are acutely ill. Bath is given on the bed itself using a soft sponge cloth. Tub bath: this is the common method of giving bath to a baby. The baby is submerged into the water in a tub or basin. Lap bath: when tub baths are not possible, mother keep their babies on their lap and give the bath. Oil bath: premature babies and sick babies are given oil bath. Oil is applied all over the body and it is wiped off with cotton balls or rag pieces. When the baby’s body is covered with vernix caseosa, an oil bath is given to remove it. IDEAL TIME FOR BATH: Baby should be bathed within an hour after feed because moving may cause vomit. Most babies go to sleep soon after the feeding. Ideally, the babies are bathed before the second feeding, taking care that the baby is not tired or hungry. GENERAL CONSIDERATION DURING BABY BATH: An infant can be bath in much the same way as an adult, by a sponge bath or in a small tub. However the nurse should take special precautions because an infant’s temperature control mechanisms are still immature. Prolonged exposure of baby parts may cause rapid heat loss. Some considerations are:
Fitting baths into families schedule: give bath at any time convenient to the family
members, but not immediately after feeding because increase handling may cause regurgitation of the feed. Preventing heat loss: before starting the procedure put off the fans and closes the doors and windows. The temperature of the room should be free from drafts. Bathing the infant quickly. Exposing only a portion of the baby at a time and thoroughly 0 0 drying. The initial bath is given, when the infant’s skin temperature is 36.5 c (97 f) or 0 0 the core temperature is 37 c (98 f). Preservation of the skin acid mantle: at birth the skin pH is acidic around 5 (pH<5). This is bacteriostatic so soap is used. Select mild soap, the soap containing less alkali. Preventing the skin trauma: too vigorous handling can injure the fragile skin of the
baby. If stool or other skin debris has dried and caked on the skin, soaked the area to remove it, do not attempt to rub it off. Care of the cord: the cord is allowed to remain open and to get dried and shed of naturally.
POINTS TO REMEMBERED:
Ensure that before giving the bath the infant’s temperature should be normal. Bathing
should be avoided for atleast 2-6 hours after birth until cardio-respiratory and temperature status are stabilized (in our hospital bathing should be avoided for at least 24 hours after birth). Babies < 2500 grams are not to be given bath. Demonstrate baby bath at least once to the mother before discharge from the hospital. Vigorous cleaning of vernix is not recommended as it will fall off in few days. It acts as an insulator for the preterm babies and helps to prevent risk of infection.
NURSE’S RESPONSIBILITY IN GIVING A TUB BATH: Preliminary assessment:
Check the physician’s orders to see the specific precautions to be taken any. Assess the infant’s need for bathing. Check the temperature, respiration and color of the skin. Check whether the child has taken the feed in the previous one hour. Check the articles available in the unit. Check weight of the baby.
PREPARATION OF THE ARTICLE: Articles A tray containing: Bath basin or a tub Jugs 2 Buckets 2
purpose To bath the bath To keep hot and cold water One for collecting the dirty water and another for soiled
linen To protect the table Makintosh and towel To wrap the baby Bath blanket To wrap the baby during the bath Towels big 1, To dry the baby Towels small 1 To remove the dirt Soap in a soap dish Boiled Cotton balls, RagTo clean eyes, ear, nose and mouth
pieces cotton wisps and a forceps in a bowl To use as ear plug Cotton balls in a container For oil massage Oil in a container To prevent bad odour Baby powder To prevent baby from chill Dress for the baby (cap, nappy, baby frock, socks) To collect waste Kidney tray To collect waste Paper bag To prevent wetting of cloth of care giver Apron 1
Getting started
Baby massage is soothing, enjoyable and a great way to connect with your baby. You can do it after a bath or when baby is clothed or in his cot. Before you begin, show baby your hands so he can 'consent' to the massage (he'll turn his head or roll away if he's not interested). To get started, smooth a few drops of oil such as olive or sweet almond oil into your warm hands and begin massaging the soles of baby’s feet. Use firm, gentle, slow strokes from the heel towards the toes.
Continue with long smooth strokes up baby’s legs. Massage from the ankle up to the thigh and over the hip. You can try massaging both legs at once or just one at time.
Massaging the upper body
Start the upper body massage with your hands on baby's shoulders and make gentle strokes in towards the chest. Massage the arms by stroking from the shoulders down towards the wrists. Try not to get oil on baby's hands but if that happens, wipe his fingers clean before he sucks them. If baby’s tummy feels soft (not hard or full) massage his belly using circular, clockwise strokes. Babies' tummies are sensitive, so if he becomes unsettled, move on to the next step.
Massaging the face and back
Use your fingertips to massage baby’s face. Stroke from the middle of his forehead, down the outside of his face and in towards his cheeks. If baby is still relaxed once you've finished massaging the front of his body, you can turn him onto his tummy and use long, smooth strokes from head to toe. Use respectful touch and stop the massage if baby is not enjoying himself or showing any
signs of being uncomfortable. It’s also best to avoid a massage if you are very tense, or if baby is agitated or upset. PREPARATION OF THE INFANT AND THE UNIT: Check infants condition i.e. feeding time, general condition like temperature,
drowsiness, lethargy etc. Check the room temperature and warm it if necessary. Close the windows and out off the fan to prevent droughts. Explain the mother what you are going to do. Hand washing prior to touching the baby. Set the articles Adjust the position of the bath table to prevent the baby from falling: a) Keep the table against the wall
b) Place the tub or basin on one end of the table and place the toilet tray and clothing on the other end, so that the baby will be protected on 3 sides and there is less chance for the baby to roll and fall from the table. c) Prepare an L shaped setting of the trolly, on the main trolly procedure is done and the trolly on the side placed in L position contains weighing machine and a TPR tray. Place the mackintosh on the table. Collect all the articles in readiness before beginning the procedure, so as to avoid
leaving the child unnecessarily until the entire procedure, so as to avoid leaving the child unnecessarily until the entire procedure has been completed. Wash hand and Wear apron. Bring the baby to the bath table wrapped in a baht
blanket. Check whether the baby is wet with urine or stool. If wet, clean the baby. Undress the baby and wrap in the big towel. Cover the baby in such a way that his hands are restrained in the towel.
PROCEDURE: Steps of procedure Reason Clean the perineum if dirty Wash hands after cleaning the perineum. Check temperature of the baby Check weight of the baby. Take the baby into the bath trolley. Firstly oil massage should be done Improves blood circulation. - Massage the head in circulatory manner with oil and then massage the face, arms, chest, abdomen, legs and back. - Expose needed areas only. Wrap the baby in clean dry towel. Attend to the infant’s face, ears and scalp - Wipe eyes, from the inner canthus using separate wisp for each eye. Use one wisp for one stroke. - If the secreations are crusted in Cotton tipped applicators
are
contra-
the nostrils, take a rolled wisp ofindicated. They can break when the baby cotton, and gently introduced into moves, causing injury to the mucus the nostrils and rotate. The babymembrane. Oil can be used if secretions of will sneeze and bring out the nose are crusted. secretions. - Clean the mouth by used wet rag piece. Clean the thrush if present. - The inside of the ears are cleaned Cotton applicators can injure the ear drum. with a rolled wisp of cotton. - With the wet hand, clean the face and behind the ears. Do not apply soap on the face. Dry the face by patting and not by rubbing. Pick up the baby securely by sliding your hand until the baby’s head is well supported, in your palm. Hold the baby’s head over the basin, apply ear plug, wet the head preventing water entry into ears, apply soap, rinse it with water and dry it To have the water clean and at correct thoroughly. Discard the water and take fresh temperature for the cleaning of the body. water. Keep 1 mug of water aside. Unwrap the baby. Hold the baby securely in the tub supporting head, neck and shoulder. Apply soap all over the body, giving special attention to the neck, arms, axillae, groins, To prevent falling or slipping of the baby into fingers and toes. And rinse well. tub and get injured. Turn the baby carefully hold the baby securely supporting head, neck and shoulder. Apply soap over the back, and buttocks. Rinse well. Take baby up from the tub and pour the mug full of water over baby’s body preventing the entry of water into mouth. Take the baby from the water and dry him/her by patting gently. Special attention is given to clean the body creases. To prevent chilling of baby. Change the towel, wrap the baby in a dry and clean towel.
AFTER CARE OF THE BABY AND ARTICLES: Apply powder over the skin folds. Keep the cord open and dry. Dress the baby as early as possible. Wrap him in the blanket to prevent chills. Comb the hair. Hand over the baby to mother for feeding. Take articles to the utility room. Disinfect the towels and basin. Clean and dry them
and replace in their proper places. Wash hand Record the procedure in the nurse’s record with date and time.
BIBLIOGRAPHY:
Bates.M.Sheila, Practical paediatric nursing (1971). London: the English language
book society and Blackwell scientific publications Oxford London Edinburgh. PP : (39-41)
Sr. Nancy (2007), (vol 1), (6
NR brothers. PP: (289-293)
th
edition)“Principles and practice of nursing”, Indore:
Wilson David, Hockenberry Marilyn. J.Wong’s, (2009)(8
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