OBSERVATION AND

CARE OF NEWBORN
&
PARENTING PROCESS .

PRESENTED BY:

ARCHITA SHARMA

MSc(N) 1st Year

SNGNC, IGMC

SHIMLA
 INTRODUCTION
• Newborns are one of the most curious and interesting humans one
can ever encounter.
• They continue to become everyone’s joy wherever they go.
• As their healthcare provider, we are one of them who handle them
primarily at the moment they were delivered, so it is up to us to
give the best primary care to these little angels before we
handover them to their parents.
 DEFINITION
• The period from birth to 28 days of life is called neonatal period.
• The first week of life is known as early neonatal period and the late
neonatal period extends from 7th to 28th days of age.
• Care given to new born during neonatal period is known as the new
born care.
 TYPES OF NEWBORN CARE
Immediate care of newborn: Later care of newborn:
• Care of the baby that needs to be • Care of the baby that needs to be
given at birth in the labor room. given in the postnatal ward and
after discharge at home.
 ELEMENTS OF NEW BORN CARE

• There are three basic elements of new born care as discussed below:

A. Basic preventive care including clean delivery practices and

exclusive breast feeding.

B. Early detection of danger signs.

C. Treatment of problems such as sepsis and birth asphyxia.

 APGAR SCORE

 Apgar scoring is described by Dr. Virginia Apgar.

 It is useful for quantitative assessment of

newborn’s condition at birth especially for the
respiratory, circulatory and neurological changes.
 Five objective criteria are evaluated at 1 minute
and 5 minutes, after the newborn body is
completely born.
7-10 is normal; 4-6 is moderately depressed; 0-3 needs immediate resuscitation.
 CONT….
 Each parameter can have the highest score of two and the lowest is 0.

 The scores of the five parameters are added to determine the status of the
infant.
 0-3 points: the baby is serious and in danger and need immediate
resuscitation.
 4-6 points: the baby’s condition is guarded and may need more extensive
clearing of the airway and supplementary oxygen.

• 7-10 points: are considered good and in the best possible health.
 IMMEDIATE CARE OF NEWBORN
• Objectives:
 To establish and maintain respiration.

 To ensure warmth.

 To prevent infection.

 To provide care to the eyes.

 To provide care to the umbilical cord.

 To provide care to the skin.

 To make observation and documentation.

• To make identification and transfer.

 CARE AT BIRTH
1. Wipe mouth and nose for secretions after delivery of head with clean sterilize
gauze pad.

2. Deliver the baby onto a warm, clean and dry towel or cloth and keep on mother’s
abdomen or chest (between the breasts).

3. Position: Trendelenburg- Head lower than body. Side lying position – to permit
drainage of mucus from the mouth. Place a small pillow or rolled towel at the
back to prevent newborn from rolling back to supine position.

4. Gently suction with the bulb syringe and short catheter from mouth first then
nose to prevent aspiration of fluid into the lungs.

5. Wipe both the eyes separately with sterile swab.

 CONT….

6. Clamp and cut the umbilical cord after 1

minute, if baby breathing well.

7. Immediately dry the baby with a warm clean

towel or piece of clean cloth.

8. Assess the baby’s breathing while drying.

9. Leave the baby between the mother’s breast to

start skin-to-skin contact for at least an hour.
 CONT….
[Link] the baby’s head with a cap. Cover the
mother and baby with a warm cloth.

[Link] an identity label/band on the baby.

[Link] mother to initiate breastfeeding (within

half an hour of birth in normal delivery and after 2
hours in LSCS).
 LATER CARE OF NEWBORN
• Objectives:

 To receive the baby in postnatal ward.

 To initiate feeding.

 To prevent infection.

 To maintain personal hygiene.

 To observe for early signs of disease or congenital anomalies.

• To provide parental teaching.

 WARMTH
 Warmth is provided by keeping the baby dry with
adequate clothing.
 Baby should be kept to the side of the mother, so that the
mother’s body temperature can keep the baby warm.
 Baby can be placed in skin to skin contact with mother
(kangarooing) to maintain temperature of infant and
facilitate breast feeding.
 Bathing at first day is avoided to prevent hypothermia.
ESTABLISH NORMAL BREATHING
BREAST FEEDING

 The baby should be put to mother’s

breast within half an hour of birth as
soon as possible, The mother has
recovered from exertion of labour.
 Colostrum feeding must be offered.

 Mother should be informed about the

importance and techniques of breast
feeding.
 CONT….
 Demand feeding should be encouraged.

 Exclusive breastfeeding procedure should be explained to mother

and family members.
 SKIN CARE AND BABY BATH
 The baby must be cleaned off blood, mucus and
meconium.
 No vigorous attempts should be met remove vernix
caseosa, as it provides protection to the delicate
skin.
 Baby bath can be given in the hospital by using
warm water in a warm room gently and quickly.
 Bathing should be avoided in open place.
 CONT….

 During winter months the baby should have sponge bath rather than deep
bath to avoid hypothermia.
 Use of olive oil or coconut oil can be allowed 3-4 weeks of age. Oil massage
improves circulation and muscle tone.
 Oil massage should be given before birth.

 Exposure to morning sunrays is an important source of Vitamin D and

warmth.
 The talcum powder should be applied over the axillae, groin and buttocks.
 CARE OF UMBILICAL CORD
 The umbilical cord is cut about 2-3 inches from the navel with
aseptic precaution during delivery and tied with cotton thread or
disposable plastic drip.
 The cotton must be inspected for bleeding afterwards which
commonly occurs due to shrinkage of cord and loosening of ligature.
 No dressing should apply and the cord should be kept open and dry.

 Normally it falls off after 5-10 days.

 Application of triple dye or junction violet is not advocated as

routine any more.
 CARE OF EYES
 Eye should be cleaned at the birth and once every
day using sterile cotton swabs soaked in sterile
water.

 Each eye should be cleaned using a separate swab.

 Application of Kajal in the eyes must be avoided

to prevent infection or lead poisoning.

 The eye should be observed for redness, discharge

or the excessive tearing for early detection of
problems and prompt management.
CLOTHING OF BABY
 The baby should be dressed with loose, soft and cotton
cloths.

 Large buttons, synthetic frock and plastic or nylon napkins

should be avoided.

 A triangular shaped, soft, absorbent cloth should be used

as napkin.

 The cloths should not be tight especially around the neck

or abdomen.

 In winters, woolen clothing should be used.

 GENERAL CARE
• The newborn should be kept with the mother for continuous rooming
in a well-ventilated room.
 CONT….
 Baby should be handled with gentle approach after hand washing.

 No infected person should take care or touch the baby.

 Baby should be allowed to sleep in supine position which can

prevent sudden infant death syndrome.
 General cleanliness is to be maintained and surrounding to be kept
clean.
 Wet nappies should be changed immediately.
 OBSERVATION
 The baby should be thoroughly observed twice
daily for early detection of any abnormalities.
 Temperature, pulse, respiration, feeding
behavior, stool, urine and sleep pattern should
be assessed.

• Mouth, eyes, cord, and skin should be looked

for any infections.
 WEIGHT RECORDING
 Assess daily weight gain in healthy term babies which is
about 30gm/day.
 Most infants double their weight by 4-5 months but in first
week of life there is physiological loss of body weight
because of removal of vernix caseosa, mucus, blood, passage
of meconium and reduction of extracellular blood volume and
also due to adaptation to new environment.
 With adequate breastfeeding majority of babies regain the
weight within 7-10 days of birth.
IMMUNIZATION
 The mother should be informed about national
immunization schedule and explanation should be
given about importance of complete immunization
and all possible reactions of following vaccines.
 In institutional deliveries all neonates should be
immunized with BCG vaccine and zero polio.

• In outside or home deliveries the BCG and OPV

should be given.
 FOLLOW UP AND ADVISES
 Each infant should be followed up, at least once every month for first 3
months and subsequently 3 months interval till one year of age.
 Follow up is necessary for assessment of growth and development, early
detection and management of health problems.
 Health education should be given regarding exclusive breast feeding,
warmth, hygiene, rooming in, clothing, immunization and follow up.
 Harm full cultural practices should be discouraged.

• Care at home should be discussed and demonstrate to the mother and

family.
 PARENTING PROCESS
• Parents are usually the first people a child learns to trust. Parents and
families are the most important people in children’s lives. The many
different relationships people form over the course of the life span,
the relationship between parent and child is among the most
important.
 DEFINITION
• The parent child relationship consists of a combination of behaviors,
feelings and expectations that are unique to a particular parent and a
particular child. The relationship involves the full extent of a child’s
development.
 TYPES OF PARENT CHILD RELATIONSHIP
• There are mainly four categories of parent child relationship:
SECURE RELATIONSHIPS

• This is the strongest type of

attachment. A child in this
category feels he can depend
on his parent or provider. He
knows that person will be
there when he needs support.
 AVOIDANT RELATIONSHIPS

This is one category of attachment that is not

secure. Avoidant children have learned that
depending on parents won’t get them that
secure feeling they want, so child learn to take
care of themselves. Avoidant children may seem
to independent and usually do not build strong
relationships.
 AMBIVALENT RELATIONSHIPS
• Ambivalence is another way a child may be insecurely attached to his
parents. Child notice what behavior got their parents’ attention in the
past and use it over and over. children are always looking for that
feeling of security.
DISORGANIZED RELATIONSHIPS
• Disorganized children don’t
know what to expect from
their parents. Children with
relationships learn to predict
how his parent will react,
whether it is positive or
negative. Child also learns that
doing certain things will make
their parents do certain things.
 PARENTING

• It is the process of promoting and supporting the physical, emotional,

social, and intellectual development of a child from infancy to
adulthood.
 PARENTING STYLES
• It means a psychological construct representing standards and strategies
that parents use in their child rearing.

• There are four main styles of parenting:

a) Authoritarian.

b) Authoritative.

c) Permissive/ Indulgent.

d) Detached.
 AUTHORITARIAN PARENTS
• The parent is demanding but not
responsive. These parents are rigid
in their rules; they expect absolute
obedience from the child without
any questioning. Authoritarian
parents are strict disciplinarians.
AUTHORITATIVE PARENTS

• Authoritative parents show

respect for the opinions of
their children. Authoritative
parents are both responsive
and demanding; they are
firm, but they discipline
with love and affection,
rather than power.
 PERMISSIVE/ INDULGENT PARENTS
• Permissive parents have little or no
control over the behavior of their
children. Indulgent parents are
responsive but not especially
demanding. They have a few
expectations of their children and
impose little or inconsistent
discipline. There are empty threats
of punishment without setting
limits.
DETACHED PARENTS

• Detached parents are neither

responsive nor demanding.
They may be careless or
unaware of the child’s needs
for affection and discipline.
 CHARACTERISTICS OF A PARENT-CHILD
RELATIONSHIP
1. Flexible/Adaptable: Good parents must be flexible and adaptable. They
have ability to recognize and accommodate the child’s need. Help the
child by giving clear directions, offering opportunities to choose and
negotiate.

2. Connected: Parents should have ability to differentiate the child’s worth

from his/her behavior, and create a reward-oriented environment in which
consequences are positive outcome. Respond to a child’s problem or
feelings with acceptance, support and validation.
 CONT…..
3. Open Communicator: The way the parent and child communicate sets the tone
for the relationship. The healthy parent-child relationships use positive
communication that separates the child’s worth from behavior.

4. Appropriate Boundaries: The parent-child relationship includes various

boundaries. Healthy boundaries consider that what the parent and the child want in
a positive way to find a mutually agreeable solution or limit.

5. Discipline: For healthy parent child relationship discipline also very important
aspect. To finding the solution of conflicts and behavioral problem helps to
encourage the strong relation rather than punishing children in an attempt to teach.
 FACTORS INFLUENCING PARENT-CHILD
RELATIONSHIP
 Family structure.

 Social and community support.

 Relationship history.

 Emotional system.

 Temperament.

 Parenting experiences.

 Intellectual capacity.

 Education (formal and informal).

• Cultural context and experiences.

 METHODS TO IMPROVE PARENT CHILD
RELATIONSHIPS

 Play games with child.

 Casual conversation.

 Bring the child new places.

• Rewarding.
 A-Z OF PARENTING
A. Accept your child for the wonderful person he or she is.

B. Be a good role model in all you say and do.

C. Communicate respectfully and listen attentively to your child.

D. Discipline fairly, firmly and with love.

E. Encourage good eating habits.

F. Find ways to get and stay fit together.

G. Give chores that built responsibility.

H. Hug your child to build self -worth.

 CONT….
I. Instill respect for other people.

J. Join PTMs and other school activities to assess child’s progress.

K. Keep your promise or do not make them.

L. Laugh together and enjoy each other’s company.

M. Make family rules and enforce them consistently.

N. Never use physical force on your child.

O. Offer your help whenever needed.

P. Praise your child for achievements as well as for efforts.

Q. Quickly stop your child from harmful activities.

 CONT….
R. Read together often and make reading fun.

S. Show patience and remember nobody is perfect.

T. Teach health and safety rules.

U. Use every opportunity to show your love.

V. Value your child’s thoughts and opinions.

W. Wait until you cool down before disciplining your child.

X. Xerox and save records of your child’s achievements.

Y. You can make a difference in your child’s life…so parent with pride.

Z. Zoom over this ABC again and again.

 CONCLUSION

• ­The health of a neonate is very important following delivery and in the rest of
the neonatal period as it may determine the subsequent status of the baby
throughout life. Therefore, after delivery a careful examination, assessment and
care of the baby should be carried out to determine science or complications
which need further assessment or management either primarily from the
pediatrician or from other specialities to ensure proper growth and development
of the baby.
• The parent child relationship consists of a combination of behaviours, feelings
and expectations that are unique to a particular parent or a particular child.
Whereas, parenting is the process of promoting and supporting the physical,
emotional, social and intellectual development of a child which is having
different styles of child rearing.
 SUMMARY
• In this presentation on Observation and care of Newborn and
Parenting process, we discussed about;
 Introduction.
 Definition of Neonate, Neonatal period, New born care.
 Types of newborn care.
 Elements of newborn care.
 APGAR scoring.
 Objectives of immediate newborn care.
 Care at birth.
 CONT….
 Objectives of later care of newborn.
 Later care of newborn.
 Follow up advises.
 Parenting process.
 Types of parent child relationship.
 Parenting styles.
 Characteristics of a healthy parent child relationship.
 Factors influencing parent child relationship.
 Methods to improve parent child relationship.
 A-Z of parenting.
 RECAPITUALIZATION

 Define newborn care.

 What are elements of new born care?
 What is the maximum and minimum scoring of newborn care?
 What are the factors influencing parent child relationship?
 What are the methods of parent child relationship?
 BIBLIOGRAPHY
• Book reference:

 Pal Panchali, Textbook of Pediatric Nursing for Nursing Students, 2 nd Edition. New Delhi; CBS
Publishers and Distributors Pvt. Ltd.; 2021. P. 131-158.
 Dutta DC, Textbook of Obstetrics including Perinatology and Contraception, 8 th Edition. New
Delhi; Jaypee Brother’s Medical Publishers (P) Ltd. 2015. P. 517-519.

• Net References:

 [Link]
 [Link]
WBORN-CARE
 [Link]
