Infant Bathing PDF

# Infant Bathing The infant must be kept covered to the extent possible, and the bath should be completed quickly to prevent hypothermia. A sponge bath is recommended until after the umbilical cord separates, usually within 10 to 14 days. After the site is completely healed, a tub bath can be given...

# Infant Bathing The infant must be kept covered to the extent possible, and the bath should be completed quickly to prevent hypothermia. A sponge bath is recommended until after the umbilical cord separates, usually within 10 to 14 days. After the site is completely healed, a tub bath can be given. It is adequate to bathe the infant once or twice a week and as needed when the skin is soiled with body secretions. ## Purpose * Bathing an infant is an excellent time for the nurse to assess the child and to teach the parent. * Bathing cleanses the skin and provides both sensory and social stimulation. ## Expected Outcomes 1. Parents demonstrate ability to safely bathe, handle, and dress the infant while maintaining body temperature. 2. Parents identify ways to provide sensory and social stimulation while bathing the infant. ## Equipment * Washbasin or small tub * Mild soap (type according to agency protocol) * Clean gloves * Three soft washcloths * Towel or cloth diapers * Blanket * Soft-bristled brush or fine-toothed comb * Clothing (shirt, cap, sleeper), as needed * Diaper (disposable or plain cloth and safety pins) * Cord care product as needed (according to agency protocol) ## Steps and Rationale | Steps | Rationale | |---|---| | 1. Inspect the infant's skin for dryness, peeling, or signs of infection. | Care of the skin during and after the bath may need to be altered to prevent infection or the spread of infection. Peeling is common as the skin dries, and many infants are born with peeling skin if they are past the due date. | | 2. Assess the site of the umbilical cord for redness, drainage, drying, and intactness. | If the umbilical cord is still intact, then a sponge bath is indicated. Redness or drainage at the umbilical site may indicate irritation or infection. | | 3. Assess the infant's temperature if he or she is at high risk for hypothermia. | Do not bathe if temperature is below 36.7° C (98° F) or according to agency protocol. | | 4. Assess parents' knowledge of how to give a bath and any cultural deviations that may alter the care of the infant. | This determines the parent teaching needed and how care may need to be altered to respect the parents' cultural diversity. | | 5. Prepare wash basin with warm water at about 36.7° C to 37.8° C (98° F to 100° F). Nurse can test water temperature by placing drops on inside surface of forearm. Water should feel comfortably warm. | This temperature will prevent skin burns or chilling. | | 6. Place infant in crib or bassinet with sides and have all supplies within reach. | This will prevent infant falls and will reduce air currents that could chill some newborns. | | 7. Clean gloves are to be worn if this is the first newborn bath or if the nurse is to come in contact with body secretions during any bath. | Before the first bath, infants are covered with blood, amniotic fluid, maternal secretions, and vernix. These substances can transmit microorganisms. | | 8. Talk to the infant throughout the bath. | This provides appropriate social stimulation for the infant. This will demonstrate for many parents how to talk with an infant. | | 9. Keep infant covered with a *blanket* | This maintains warmth. Newborns are prone to hypothermia, which can be produced by evaporation during the bathing process. | | 10. Cleanse the eyes with plain water. Wash each eye from the inner to the outer canthus, using a clean portion of the washcloth with each swipe. If crusts are present on eyelid margins, apply a moistened washcloth or cotton ball for 1 to 2 minutes before cleansing. | This prevents transferring microorganisms from one eye to the other. | | 11. Cleanse the external ears with plain water and a twisted end of the washcloth. Teach parents not to attempt to clean the internal ear with cotton-tipped applicators. | Cleaning the internal ear with cotton-tipped applicators may cause injury. | | 12. Cleanse the face and neck with plain water. Give special attention to areas behind the ears and creases in the neck. A very small amount of soap may be used for soiled creases, rinsing well after washing. | Use of plain water on face will prevent irritation of the eyes by soap accidentally running into them. Mild baby soap can be used for the soiled creases. | | 13. Dry face and neck with a towel with a gentle patting motion. | Excessive rubbing may cause skin breakdown. | | 14. With fresh washcloth dampened with plain water, cleanse the infant's mouth. Wash inside the lips, cheeks, dorsal surface of the tongue, the roof of the mouth, and all along the upper and lower gum pads. Teach parents to do similar mouth care after feeding the infant. | Good oral hygiene removes excess milk that stays on the infant's gums and may encourage bacteria and plaque and lead to tooth decay. | | 15. Uncover the infant's upper body, keeping the lower body covered with the blanket. | This prevents hypothermia. | | 16. Cleanse infant's upper body with warm water and soap. Quickly rinse soap from the infant's hands. | Infants frequently put a fist in the mouth, which may lead to soap ingestion if the fists are not rinsed. | | 17. Thoroughly rinse the rest of the upper body and dry completely by using a patting motion. | Excessive rubbing may cause skin breakdown. | | 18. Cleanse the abdomen around the umbilicus with warm water, keeping the cord dry. Dry the area. Apply cord care product if required by the agency protocol until area is healed. | Cord care may help the drying process and help prevent infection. | | 19. Cover the upper body with a dry towel or blanket and uncover the lower extremities. | This prevents hypothermia. | | 20. Cleanse the legs and outer buttocks with warm water and soap. Rinse completely. Dry thoroughly with a patting motion. | | | 21. With a fresh washcloth, cleanse the genitalia with plain water. a. For a female infant: Gently retract labia and wash from front to back toward the anus. Use separate portions of the washcloth for each swipe. Wash the outer portions of the labia and the folds in the groin. b. For a male infant: Wash from the urethra outward and down toward the scrotum. Wash scrotum and folds of the groin. In uncircumcised newborns, the foreskin should not be retracted. | This will prevent contamination of the urinary and vaginal areas by anal secretions. The foreskin may adhere to the glans in newborns and should not be forcibly retracted, to avoid injury. | | 22. Cleanse anal area with soap, rinse, and dry. | This should be done as a last step to prevent contamination of the vaginal area or circumcision area. | | 23. Apply clean diaper and remove gloves. | | | 24. Shampoo infant's hair. a. Wrap the infant in a dry blanket. b. Hold the infant over the wash basin in a "football" hold. The infant can also be left in the crib; gently pick up head, supporting it in one hand. A blanket can be placed under the head to catch the water. c. Lather scalp with a small amount of mild soap. A soft washcloth may be used to wash the scalp if there is excess soiling. A fine-toothed comb can be used to comb out excess soil from the hair. d. Rinse the scalp thoroughly by pouring water from a small cup over the infant's scalp into the washbasin or by using a washcloth. e. Dry thoroughly with a towel. f. Comb or brush infant's hair gently. | Holding the infant securely will prevent accidental falls. | | 25. Replace the damp sheets and blankets. Dress the infant. | This prevents hypothermia. | ## Unexpected Outcomes and Nursing Interventions 1. Diaper rash develops. a. Immediately cleanse and thoroughly dry area after each voiding and stooling. b. Expose area to warm air and filtered sunlight. 2. Skin becomes very dry, cracked, and peeling. a. Limit bathing to two or three times per week and use plain water. b. Avoid the use of lotions and products with perfumes or chemicals. 3. Infant has cradle cap. a. Shampoo head daily, allowing shampoo or mineral oil to remain on scalp until crusts are softened. b. Thoroughly rinse scalp of all soap. c. Use a fine-toothed comb or soft brush to gently remove loosened crusts from the strands of hair. 4. Redness or drainage is present around the umbilical site. a. Keep area clean and dry. b. Keep diaper folded below umbilical site to prevent irritation and to expose area to the air. c. Report to health care provider for additional treatment if needed. 5. Infant's temperature falls below 36.7° C (98° F). a. Wrap infant in extra blanket and place cap on head. b. Reassess temperature in 30 minutes. c. If temperature remains low, warm infant according to agency protocol, such as with use of a radiant warmer. 6. Parents are unable to explain and demonstrate proper bath procedure. a. Establish rapport and allow parents to verbalize concerns. b. Reassess teaching techniques and learning levels. c. Assess for unmet needs the parents have that may prevent learning. d. Assess for cultural differences. Build on parents' cultural practices by reinforcing the positive and promoting change only if a practice is harmful. ## Documentation 1. Record before and after bath temperatures on the graphic sheet. 2. Describe skin condition. 3. Record parent teaching and response.