Foundational NCS Flashcards
What are the differences between a Newborn Care specialist and other caregivers who work with newborns?
A NCS is specially trained to work with newborns. They work independently with families (little guidance), often short term. They are well versed in good sleep practices and breastfeeding. They can recognize and address PPMDs. They often work overnights or around the clock care. Other caregivers working with newborns may or may not have the experience, knowledge, or confidence as a NCS.
What are the NCS’ goals?
To foster healthy sleep patterns in baby(s), to get baby to sleep through the night as soon as reasonably possible, and to leave parents feeling empowered.
What does a NCS understand?
How to establish healthy feeding and sleep habits.
How to create structure in baby(s) day.
Understands the special needs of families with multiples and preemies.
Knows various sleep conditioning methods and has a successful plan for baby(s).
Knows the limits of their scope and who to refer to if needed.
Understands the value and can support breastfeeding.
Can recognize PPMD and confidently address them.
Understands and can recognize signs of possible food allergies or intolerances and reflux + knows ways to help.
Keeps up to date with research.
What is a night nanny?
A nanny who works overnight shifts under the direct guidance and supervision of the parents.
What is a postpartum doula?
A person who helps provide support to the postpartum family in the first few weeks following birth through education, basic baby care, mother care, and household assistance. The focus is on the whole family with an emphasis on mother, not primarily the newborn.
Vernix
Newborns are often born with a waxy, cheese-like white substance on their body.
- usually only full term babies.
-Often develops around 18 weeks gestation.
-has antibacterial properties
-absorbs into skin
It is theorized to provide moisture and to facilitate passage through the birth canal.
Lanugo
Newborns are often born covered in a fine layer of hair.
It is the first hair produced by fetal follicles and often appears around 5 months gestation.
It often disappears before birth, but in babies born with it, it falls out within a few days of birth in most cases.
Its purpose is to hold the Vernix on the skin so they are often seen together.
Appearance and care for the newborn head
They come in many shapes and sizes.
Usually only come in the pretty round shape form in C-sections.
Can be born with no hair, some hair, or lots of hair.
Their hair does not need to be washed daily!
Only use a soft bristled brush on a baby with hair long enough to need brushing.
Cradle cap
A common condition in newborns.
Most often presents as greasy skin covered by flaky white or yellow scales - occasionally with mild redness under it.
- often is the first sign of a food intolerance or allergy. (Be aware if cradle cap keeps coming back)
- does not “need” to be treated but parents are often highly disturbed by it.
- can come down to the face.
Treatment options for cradle cap.
- Need permission from healthcare provider and signed liability form!*
- Washing daily with a mild shampoo, using a gentle washcloth or baby brush to break up scales.
- Soaking babies scalp with olive or coconut oil for 15-30 mins and then exfoliating.
- more aggressive measures like dandruff shampoo are sometimes suggested by healthcare provider.
- Don’t put downwards pressure on head when “treating”.
Cradle cap or Exzema?
Cradle cap and Eczema have similar appearance.
- cradle cap is rarely itchy or uncomfortable.
- Eczema is often itchy and uncomfortable.
Causes of cradle cap?
Exact cause is unknown, but most experts suggest it has to do with:
- Hormones passed from the mother.
- Yeast bacteria on the skin.
- Food intolerances or allergies.
Cradle cap - it is time to see the doctor when?
- self care is not working.
- patches are interfering with babies eyes, nose, or mouth.
- The patches appear to be spreading, either in size or to new locations.
- parents are concerned.
The newborn head - how to clean.
- Wash babies face with warm water and a soft cloth - soap is not necessary in most instances.
- Wash corners of eyes gently with a soft cloth and water only as needed - the “gunk” in corners of the eyes is a normal part of eye cleaning. Never touch the eyeball!.
- Wash the outside of nose and nostrils with a soft cloth and water. Only use a nasal aspirator when needed for congestion - the nose is designed to flush itself. Saline can be used under the guidance of a healthcare provider.
- Wash the inside of the mouth and gums with a soft cloth or baby “toothbrush”.
- Gently wash outside of ears with a soft cloth and water - do not put anything inside the ear canal!
- Keep the neck area clean with a soft cloth and water - be sure to dry this area gently but well or a yeast infection can develop in skin folds.
What conditions are concerning and should be addressed with a healthcare provider?
- Thrush
- Torticollis
- plagiocephaly
Thrush
An oral yeast infection. Often contracted by breastfeeding babies if the mother is on antibiotics. Can be passed back and forth between mother and baby.
- Requires careful washing and sterilizing of everything that comes in contact with both mother and baby.
Not dangerous, but requires medical assistance from a healthcare provider.
- I do not diagnose - I suggest that it looks like it could be xx but they need a doctor to diagnose and prescribe treatment.
Torticollis
means “twisted neck” in Latin and can happen because of positioning in the womb, difficult birth or sleep positioning.
- another cause are the use of “containers”/”baby buckets” (carriers, rock & plays, etc)
- can be present at birth or show up in the first few weeks.
- characteristic pulling of the head to one side, difficulty turning of the head, or even a preference to nurse on one side.
- can also present as a small knot or lump on the side of the neck.
- Must be diagnosed by a doctor!
- Can be helped sometimes by repositioning or simple stretches, but PT may be needed.
- Need direct guidance and signed liability form to perform stretches.
What is plagiocephaly?
It is the flattening of a part of the head. Babies with torticollis often can develop plagiocephaly.
What are some in scope practices to help prevent torticollis and plagiocephaly?
- Switch which side baby naps on in his crib frequently to naturally help keep head turning balanced.
- Switch which side you feed baby on frequently.
Desquamation
this is the peeling of the skin of a newborn. Common and usually resolves shortly after birth (within days).
- Healthcare provider may suggest lotions to help.
What are some common conditions in newborns?
- Cradle cap
- Desquamation
- Milia
- Newborn acne
- Transient Pustular Melanosis
Milia
Small whit bumps on the head and face that look like small whiteheads. Can be in the mouth as well. They go away on their own within a few days.
Newborn acne
Fairly common but may or may not go away on its own. Acne pustules should never be popped! Seek medical attention if it is a concern. If it is persistent it could be a sign of an allergy.
Transient Pustular Melanosis
More common on darker skinned babies, it looks like Milia but often leaves a dark mark on the skin when it disappears.
Brachial Plexus injuries
Injury to the Brachial Plexus, the bundle of nerves in the neck that provide signals to the arm and shoulder - sometimes into the chest and leg.
- more common that down syndrome and cerebral palsy combined.
- medical schools teach that these injuries heal but the reality is much different.
- caused by the doctor pulling too hard on the babies head while twisting during delivery in most cases.
- babies with a BP injury often also have a broken clavicle due to shoulder dystocia.
- Babies with a BP injury often have reflux and trouble sleeping because of the nerve pain.
- These babies require referral to a pediatric neurologist and brachial plexus specialist.
- This injury can paralyze them for life, often requires extensive painful surgeries and years of occupational therapy.
Characteristics of non-Caucasian babies
- Darker pigmentation of fingers and toes.
- More purple-grey in color (Caucasian babies are usually red)
- Eyes are still often dark blue then change.
- “Mongolian spots” (slate gray nevi or congenital dermal melanocystosis) on back and extremities in many cases.
- People (parents, physicians, anyone) can wrongly assume that Mongolian spots are bruises and accusations of abuse have occurred towards caregivers by parents and from physicians towards parents* Be prepared to educate people on them.
How to care for a newborn’s skin?
With warm water, mild soap and a soft wash cloth.
- until umbilical cord (and circumcision if appropriate) has healed, clean using the “top and tail” method.
- umbilical cord and circumcisions cannot be submerged in water - sponge bathe until it is safe to give “real bath”
- be sure to dry baby well under the arms and in any skin folds to minimize risk of irritation and yeast infection development.
- keep baby covered as much as possible while cleaning.
- Clean around the penis - Do not pull on it! If circumcised, scabbing is not a good sign.
How to care for the umbilical cord?
Follow the instructions from the doctor. Some recommend:
- rubbing alcohol.
- doing nothing except keeping it dry.
How to care for a cicumcision?
Follow the instructions from the doctor. Some recommend:
- white petroleum jelly.
- antibiotic ointment.
- nothing but gauze.
Signs of an infection in an umbilical cord or circumcision?
- redness
- warmth
- inflammation
- oozing or puss
- requires medical attention*
Signs of adhesion with a circumcision?
- difficulty pulling the foreskin back.
- redness under edge of the foreskin after the circumcision has healed.
- little white “bumps” under the skin along circumcision edge.
How to care for a non-circumcised penis?
- It simply needs to be kept clean.
- no pulling of the foreskin required. Damage can be caused by pulling.
Vaginal care?
- Always wipe front to back.
- Make sure to clean in between the labial folds.
- Never put anything into the vaginal opening.
- Do watch that the vaginal opening does not appear red or inflamed as this may be a sign of infection.
- Uncommon but watch for closing of the vaginal opening. Requires medical attention (usually a hormone cream is prescribed).
- Tip: Fold up wipe to create a gentle but firm wipe to clean inside labia folds.
Anus care?
- Requires no special care unless their is a sign of infection.
- A red ring around the anal opening can be an early sign of a food allergy (most often dairy).
- Red, scaling skin or weepy skin indicate a strep infection.
- both require medical attention*
How to care for the nails and toes?
- It is recommended that an NCS not trim babies nails for liability reasons.*
- can still support and walk parent through the process.
- Be aware of small threads and any hair that may get into the babies clothing, blankets, or bed. - these can get wrapped around their fingers/toes creating a dangerous loss of circulation very quickly and could result in amputation.
What are the different types of diaper rash that can occur?
- Wet contact rash
- Yeast
- Acidic poop rash
- Allergic rash
- Impetigo
- Psoriasis
- Eczema
Wet contact rash
Just a redness or slight irritation.
- usually simply treated with OTC diaper rash cream (or homemade by parent)
Yeast
A raised, prickly red rash.
- usually starts in the folds of the skin.
- requires medical attention.
- if cloth diapering, requires switching to disposables and treating cloth diapers once the rash is cleared.
Acidic poop rash
Looks and feels like a sunburn.
- can turn into burning open sores.
- Seek medical advice.
- Butt paste and sometimes antibiotic cream works well in most cases.
Allergic rash
- Could be from something in the diaper, detergent, environment, or diet.
- Usually covers the entire diapered area and sometimes beyond.
- requires medical attention (preferably from a pediatric allergist)
Impetigo
Caused by staph or strep and appears as an open, weeping, crusty sore.
- Requires immediate medical treatment.
- highly contagious.
psoriasis
inflamed, scaly red patches of skin which can become infected.
- requires the care of a dermatologist.
eczema
Red, itchy, scaly rash that can blister and weep.
- looks a lot like cradle cap.
- Often an early first sign of a food intolerance or allergy.
- if mom is breastfeeding, a diet log is needed to try an identify associations with certain foods.
- if formula feeding, a medical professional should be consulted about the possibility of a food allergy (most often a milk protein issue)
Bathing baby once the umbilical cord (and circumcision) is healed.
Baby can now safely take a full bath.
- ideally it will not be daily as it can dry out baby’s skin.
- Warm water in an infant tub or lined sink, put a warm wet wash cloth or hand towel over exposed skin areas.
- Bathe from top to bottom.
- Ideally bathe at the same time daily.
- With medical provider approval, lavender oil in the bath water or massaged on baby following bath (in a carrier oil) can be extremely soothing and benefit sleep. Or diffuse lavender oil in the bathing area and/or nursery (with medical approval).
- Don’t fight with parents if they want to bathe their baby(s) daily. Can inform them that it’s not necessary but don’t insist otherwise if they continue to want to.
- babies lose heat fast so be quick to cover hair/head right after cleaning it while you clean the rest of baby.*
Feeding a newborn - Breast or bottle?
- In most cases, breastfeeding is the healthiest option for the baby, assuming mom is relatively healthy, both physically and mentally.
- bottle feeding breastmilk is the next healthiest option.
- Bottle feeding formula or specialized formula is the least healthy option.
- but what is best for the whole family?*
Feeding a newborn - Why is breast sometimes not best?
- Mom has a medical condition that makes it hard or impossible for her to breastfeed.
- Thyroid disease, pituitary disease, PCOS, medication that passes through the breastmilk that is dangerous to baby.
- When mom is struggling emotionally postpartum and it is just “one more thing” that adds stress to her life.
- When baby has a medical condition (rare) that makes breastfeeding incompatible-called galactosemia and makes baby unable to digest sugars (requires immediate medical attention/specialized formula)
Signs of galactosemia (rare condition that prevents baby from digesting sugar)?
- lethargy
- diarrhea
- vomiting
How to help baby find mothers nipple if breastfeeding?
Put baby’s saliva on mom’s nipples.
- acts as a messaging service for mom and baby.
Breastfeeding - Does mom’s diet matter?
- Many foods/chemicals pass through breastmilk.
- Mom’s diet can produce gas, constipation, diaper rash, and more in a newborn.
- Mom can also pass potential allergens through to baby (cows milk protein intolerance, etc).
- Baby cause an unhappy baby and disrupt sleep.
- ideally we like to see a non-gmo, organic and balanced diet heavy in most fruits and veggies, lean healthy protein and healthy fats and minimally processes grains.
- Avoiding most processed foods is highly beneficial and most babies do better when mom avoids dairy, particularly uncooked dairy.
- Studies show that organic foods have more beneficial nutrients than non organic foods.
- Studies show that THC passes through breastmilk in small quantities but we don’t know the long term effects.
