BABY BATH

TOPIC : BABY BATH

CLINICAL GUIDELINES Bathing is completed by a parent, Registered Nurse (RN) licensed Practical Nurse (LPN), or Nursing Assistant. The healthy newborns first bath is given after the infants temperature has stabilized in the normal range (98.2-99 oF or 36.8-37.2oC axillary) and when appropriate care is taken to support thermal stability. The older infant should have a temperature between 97.5 o and 98.6F or 36.4o and 37oC axillary or orally initiation of the bath. The infant is given a complete bath two to three time a week or more often, if necessary. Hair washing is completed with the first newborn bath and as needed thereafter.

 Between complete baths, the infants face, neck, hands, and genital areas are washed as needed. The infants age, medical conditions, and neuro developmental stability determines the type of bath given. A tub bath may be given once the umbilical cord as fallen off. or a tub ban may be given if the infant is place in a tub containing a shallow amount of water that does not immerse the umbilical cord. The circumcised male should not be bathed in a tub until the penis is healed.

EQUIPMENTS
Warming lamp Dry blanket or waterproof pad basin with warm water : 100oF (37.8oC) Nonsterile gloves Mild soap or cleansing agent Towels (at least two) washcloth Cotton swabs or gauze Perfume-free lotion of ointment Petroleum jelly Emollient Soft-bristle brush or comb Clean clothing and diaper Bedding Bulb syringe (if needed)

CHILD AND FAMILY ASSESSMENT AND PREPARATION

Assess the special needs of the child before starting the bath. Some restrictions may apply to children with surgical incisions, traction, intravenous catheters, casts, urinary catheters, and artificial airways. Review the chart to determine the type of bath ordered (if specified), when the last bath was given, and childs last recorded temperature. Assess the premature infants physiologic state (vagal tone, heart rate, oxygen saturation) to determine the appropriate timing for sponge bath.

 Ensure that the room is warm and free of drafts. It needed, use a heat lamp to provide direct warmth to the area where the bath will be given. Allow the parent to participate in bathing the child, instructing her or him as necessary about any special precautions or equipment. Use bath time as an opportunity to teach about tub and water safety. With the order infant, the bath can be incorporated into a playful game.

PROCEDURE : GIVING A SPONGE BATH

Steps 1. Gather the necessary supplies Rationale / Points of Emphasis Promotes efficient time management and provides an organized approach to the procedure.

2. Ensure that the opposite side rail of a Depending on the developmental level of cribs is raised. Keep isolette door closed the child, he or she could roll off the bed until equipment is ready for the bath if side rails are left down. 3. Turn on warming lamp and ensure it is Prepares environment to be thermally appropriate distance from infant (see stable. Heat loss can occur by convection. Chapter 135) An infants temperature-regulating mechanism are immature, and the infant is at high risk for heat loss, especially premature infants or very-low-birthweight infants. 4. Place a dry bath blanket or waterproof A dry surface will reduce heat loss by pad the-bed surface of the crib or isolette. conduction. 5. Fill basin or small tub with warm Prevents scalding of infant skin. If a water. Water temperature should be about thermometer is not available, test the 100oF (37.8oC) temperature of the water with the sensitive skin on the inside of your wrist or elbow. 6. Perform hand hygiene and don gloves. Standard precaution to transmission of micro organism. reduce

7. Position in infant in a supine position. Keeping the total body area from being Loosely cover the infant at all times with exposed to the air helps reduce heat loss. a dry towel or blanket. 8. Begin bath by bathing the face using Using plain water will prevent soap from cotton balls or a soft washcloth and water. irritating the eyes.

9. When cleansing orbital area, wash from Following the natural tear flow will inner canthus to outer canthus, using of prevent the spread of micro-organism. fresh cotton ball or clean corner of washcloth for each eye. 10. Pat bathed area dry with a clean, dry Rubbing can irritate the skin towel. 11.a. Cleanse nose with corner of cloth or Moisture loosens the incrustations in the cotton ball. Remove any incrustations nares for easy removal. from the nares by using a twisted moist cotton ball or washcloth. 11b. Gentle suctioning of the nares with a Infants and small children cannot expel bulb syringe may help clear the nares of the secretion in the nose by blowing nasal secretions. through the nasal passages. 12. Wash the external ears and behind the Prevents possible packing of the ear by winding a damp washcloth around discharge farther down the ear canal. the index finger. Prevents damage to the eardrum. Never place cotton swabs or other small objects in the infants ear canal. 13a. using a mild soap or cleansing agent, work from the shoulders to the feet in a systematic manner to wash one section of the body at a time. Pay special attention to the folds of the neck, thighs, and underarms. Ensures that all areas of the body are bathed as efficiently as possible. The younger the infant, the more sensitive the skin is to abrasive soaps. Cleansing agents that have a neutral pH and minimal dyes and perfumes will reduce risk of future allergy sensitization to topical agents. There are no studies to support the use of antimicrobial solutions or cleansers for the purpose of bathing the infant or premature child. Using mild soap as opposed to water alone for the first newborn bath has demonstrated minimal effect on skin bacterial colonization. For extremely premature infants 13b. Excess vernix can be removed from Studies indicate that vernix may provide the newborns skin; however, removal of antibacterial protection and promote all vernix is not necessary. wound healing. It may also contribute to the development of the epidermal barrier function, regulating postnatal and surface adhesion properties, heat flux, and surface electrical activities.

14. Rinse and dry each area after Soap residue can be irritating to the washing. Do not rub the skin surfaces. infants skin. rubbing skin surfaces can cause chafing and irritation. Alert! If the infant is being monitored, observe the heart rate and oxygen saturation level. Discontinue the bath procedures if the infants condition deteriorates. 15. Clean the umbilical area with soap and water. Observe umbilicus for redness or drainage. Lift cord and clean base; do not wet the umbilical cord. Rinse and dry the area. Leave site open to air; do not apply alcohol, antiseptics, or antibiotics to umbilical cord stump. Promotes drying of the stump. Prevents infection (anmphalitis) that can be life threatening. Studies have shown that natural drying of the umbilical cord does not result in increased incidence of infection and that treatment will antiseptics prolongs time to cord separation.

16. Place the infant on his or her stomach. Prevents loss of body heat. Wash, rinse, and dry the infants back. Cover the infant with a dry towel. 17. Apply a small amount of perfume-free Baby oil dogs the skin pores, and baby lotion or ointment (petroleum jelly or powder may irritate dry skin. hydrophilic ointment) to any dry area. Vitamin (cream may also be used. Avoid the use of body oil or baby powder. 18. Cleanse the genital area : Cleaning from front to back reduces lisk a. For females, gently wash the area from for contamination of the ruthra or vagina front to back, from vagina to rectum. Use from the anus. Reduces transmission of a portion of the washcloth or a moistened micro-organisms. cotton ball to cleanse the area. Use cotton ball only once to wipe area. Discard after one use and change to new cotton ball for each subsequent wipe. b. If a white substance is noted in the Some mucus may be noted in the vaginal labial fold, do not attempt to wipe clean. area of the neonate. Blood may be present Females may have blood present during because of maternal hormones. diaper change. c. For males, squeeze clean water over head of the penis. In the uncircumcised male, gently move the foreskin back as far as it will go, cleanse the head of the penis, and return the foreskin to the At birth, only 4% of boys have a retractile prepuce; by age 3 years, the foreskin is retractable in 90% of boys. Leaving the prepuce in a retracted position constricts the blood vessels supplying the glans

normal position. Do not force the foreskin penis, causing edema. Retracting the back. foreskin when bathing decreases the chances of having smegma accumulation, inflammation, phimosis, or adhesions. d. In the circumcised infant, a petroleumcoated gauze bandage or petroleum jelly should be applied to the tip of the penis if the circumcision was the Gomco type. May apply on antibiotic ointment on Plastibell-type circumcision if ordered by physician. The dressing helps prevent the circumcised area from rubbing against the diaper or sticking to the diaper as the healing process progresses.

19. Raise the infants lower body the Wash from front to back to reduce the ankles to expose the buttocks. Wash, transmission of micro-organisms from the rinse, and dry the infants buttocks. anus. 20. Apply petroleum jelly or A & D Cream barrier keeps ammonia away from ointment to buttock area and crease areas the infants skin and prevents diaper rash. if indicated by redness and or breakdown of skin in the area. Alert : Powders should not be used on the infant. Baby powders may be accidentally aspirated by the infant. Aspiration of the particles can lead to pneumonia and even death. 21. Apply a clean diaper. If the umbilical The umbilical area should be uncovered cord is still in place, adjust the top of the to prevent irritation and infection. diaper so that it is below the umbilical area. 22. Apply emollient (e.g. Aquaphor) to Emollients can prevent excessive drying, the infants skin an needed. skin cracking, and fissures. avoid products with perfumes or dyes because these substances can be absorbed and are potential contact irritants. Emollients are safe to use with premature infants. 23. If washing hair, wrap the infant in a work blanket, securing the arms close to the body. Place the infant in a football hold position. A worm blanket will help stabilize body temperature during hair washing. With the football hold, the infant will be securely held in place, allowing the parent a free hand to wash the infants hair.

24. Position the infants head over the Gentle washing helps reduce seborrhea, a wash basin. Lather the infants scalp with scaly scalp condition commonly called

a mild soap or shampoo.

cradle cap.

25. Using a damp, soapy cloth, wash the Soap or shampoo residue may irritate the infants hair and rinse thoroughly. Dry scalp if either is left at the site. with a towel. 26. Comb the infants hair with a fine- Aids in removing crust from the infants toothed comb or a soft-bristle brush. scalp if cradle cap is present. 27. Remove blankets from infant after Prevents loss of body heat. Promotes safe hair washing. Proceed to dress the infant environment. in dry clothing and wrap him or her in a dry blanket. Cover his or her head with a cap or bonnet. Position for comfort and safety. Ensure the bedside rails are up or isolette doors closed. 28. Cleanse and rinse the basin or tub. Reduces the transmission of microReturn all equipment to its proper storage organisms. Standard precautions. are. Dispose of waste in appropriate receptacle. 29. Remove gloves and perform hand Reduces transmission hygiene. organisms. of micro-

PROCEDURE:

GIVING A TUB BATH

Steps Rationale / Points of Emphasis Promotes efficient time management and provides an organized approach to the procedure.

1. Gather the necessary supplies

2. Ensure that the opposite side rail of a Depending on the developmental level of crib is raised. Keep isolette doors closed the child, he or she could roll off the bed until equipments is ready for the bath. if side rails are left down. 3. Turn on warming lamp and ensure it is Prepares environment to be thermally appropriate distance from infant (see stable. Heat loss can occur by convection. Chapter 135) An infants temperature-regulating mechanisms are immature, and the infants at high risk for heat loss, especially premature infants or very - low - birth - weight infants. Hypothermia can result in increased oxygen consumption and respiratory distress. 4. Fill basin or tub with two or three An infant can drown in a few inches of

inches of warm water. Water temperature water. Prevents scalding of infant skin. If should be about 100oF (37.8oC) a thermometer is not available, test the temperature of the water using the inside of your wrist or elbow. 5. Perform hand hygiene and don gloves. 6. Undress the infant. Standard precautions to reduce transmission of micro-organisms. Prepares for bath.

7. Gradually slip the infant into the tub An infant is unable to support his or her while supporting the neck and head. own head. 8. Wash the infant with the soapy cloth Starting with the cleanest area progressing beginning at the shoulders and arms, to the area that is most soiled keeps the continuing to the lower extremities. bath water cleaner. Use soap sparingly. Cleanse the skin folds thoroughly. 9. Rinse the infant thoroughly with a Rinse well so soap residue will not irritate clean, damp washcloth. the infants skin. 10. Wash the infants hair, following Prevents drying of scalp and development steps 23-26 in Sponge Bath. To position of cradle cap. Soap and water in the eyes the infant for hair washing in the tub, will cause irritation. support the infants back and neck while allowing the head to drop backward at an angle that prevents water and soap from running into the infants eyes. 11. Dry the infant and dress him or her in Prevents loss of body heat. Promotes safe dry clothing. Place infant in crib. Position environment. for comfort and safety. Ensure the bedside rails are up. 12. Cleanse and rinse the basin or tube. Reduces the transmission of microReturn all equipment to its proper storage organisms. Standard precautions. area. Dispose of waste in appropriate receptacle. 13. Remove gloves and perform hand Reduces transmission hygiene. organisms. of micro-

ROUTINE NURSING CARE DURING NEONATAL PERIOD :

The baby should be bathed again on third day. Then daily bath is followed the meconium should be cleaned from buttock and external genitals. Care is taken to keep the cord dry. Care is taken to prevent entry of water in ear. Cotton plug may be given for this.

 After giving the bath the baby napkin is worn along with body clothing. The napkin should be soft and smooth. Whatever the type or method of putting the napkin, in all cases the safety pin should be lie horizontally to minimize risk of injury.

CHILD AND FAMILY EVALUATION AND DOCUMENTATIO

Monitor childs response to bathing and hygiene procedures; discontinue if the child demonstrates signs of stress or hypothermia. Evaluate abnormal findings noted during the bath, such as umbilical redness or drainage, which may indicate infection, and report to the physician or advanced nurse practitioner. Document the following : Completion of bath Assessments made of skin and general appearance of infant Infants response to the bath parent-child interaction during the bath Parental teaching completed during the bath demonstration and competencies noted upon return demonstration.

BIBLIOGRAPHY :
Vicky R. Bowden, Undy Smith Greenberg, Paediatric Nursing Procedures Second Edition, Lippincott Publicaitons, P.No. 107-111. LC Gupta, U.C. Sahu, Prya Gupta, Practical Nursing Procedures, 3 rd Edition, Jaypee Brothers Medical Publications, New Delhi, Page No. 364-367.