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
drying. The initial bath is given, when the infant’s skin temperature is 36.50c (970f) or
the core temperature is 370c (980f).
 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 purpose
A tray containing:
 Bath basin or a tub To bath the bath
 Jugs 2 To keep hot and cold water
 Buckets 2 One for collecting the dirty water and another for soiled

 Makintosh and towel
 Bath blanket
 Towels big 1,
 Towels small 1
 Soap in a soap dish
 Boiled Cotton balls, Rag
pieces cotton wisps and
a forceps in a bowl
 Cotton balls in a
container
 Oil in a container
 Baby powder
 Dress for the baby (cap,
nappy, baby frock,
socks)
 Kidney tray
 Paper bag
 Apron 1
linen
To protect the table
To wrap the baby
To wrap the baby during the bath
To dry the baby
To remove the dirt
To clean eyes, ear, nose and mouth
To use as ear plug
For oil massage
To prevent bad odour
To prevent baby from chill
To collect waste
To collect waste
To prevent wetting of cloth of care giver

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 of indicated. They can break when the baby
cotton, and gently introduced into moves, causing injury to the mucus
the nostrils and rotate. The baby membrane. 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
thoroughly. To have the water clean and at correct
 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,
fingers and toes. And rinse well. To prevent falling or slipping of the baby into
 Turn the baby carefully hold the baby tub and get injured.
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), (6th edition)“Principles and practice of nursing”, Indore:
NR brothers. PP: (289-293)

 Wilson David, Hockenberry Marilyn. J.Wong’s, (2009)(8th edition),Essentials of

pediatric nursing, st Louis, Missouri : Mosby Elsevier publications, PP (701).