Activities and Exercise

Maintenance of a clear airway is critical. Many infants need suctioning to remove mucus from the nose and mouth. Newborns are obligate (necessary or required) nose breathers; they must be able to breathe through the nose while suckling. Therefore, the nasal passageway must be kept open and free from mucus. A small 

bulb syringe is commonly used. Compress it before insertion and then gently release it to suction secretions. Explain to parents the use of the bulb syringe before the first feeding. For the first few days, a bulb syringe should always be kept with the newborn, particularly during feeding.

Crying is the newborn’s only means of communication. The cry can indicate hunger, pain, the need for attention, or fussiness. The newborn’s cry should be strong, vigorous, and of medium pitch. As mother and infant become more adept at interpreting each other’s behavior, some mothers are able to distinguish the reason for crying. The following report indicates that mother and baby are communicating effectively:

• I can tell when she’s hungry. Crying starts in a plaintive [sorrowful, sad] way and then becomes more and more demanding. When she is hurt, she lets out a startled yell as though she couldn’t believe it was happening to her. Sometimes when she is put down to sleep, she starts a kind of talking cry, jerky and demanding: it gets louder, and if nothing happens, fades away in little spurts. The fussy cry is the hardest to take—nothing seems to work; like a complaining that goes on and on.

A high-pitched cry may indicate neurologic problems and should be observed further and evaluated by a physician. See the Patient Teaching box for infant quieting techniques.

Parent-Child Attachment

The human infant is born defenseless and could not survive without a caregiver. The parents are responsible for the infant’s physical and psychological development.

Parenting is not instinctive; a new parent must bond with the baby first. Parent-child attachment (bonding) is defined as the initial phase in a relationship characterized by strong attraction and a desire to interact (Figure 27-12). Without bonding, parents find the energy needed to meet the newborn’s needs difficult to maintain. The nurse cannot make bonding occur but can facilitate its development.

Early contact with the infant is important to establish bonding. A new mother normally wishes to touch and explore her baby. Holding the infant close and looking eye to eye (the en face position) helps bonding occur (Figure 27-13). It is normal for a new mother to talk in high-pitched tones to the baby. Encourage early and frequent interaction between the newborn and the parents (Figure 27-14). Attachment increases when the infant begins to respond.

The newborn has amazing capabilities. The infant is a socially responsive human who can probably learn better on the first day of life than ever again. Immediately after birth, the baby stares intently at the parents’ faces and sees them. In fact, the newborn prefers looking at the mother’s face, especially the eyes, to looking at other objects. The newborn also can recognize an approaching object as a threat and turns away to avoid it. He or she reaches for an object and usually comes close to touching it. The newborn imitates another person’s facial expressions, such as sticking out the tongue, opening the mouth, and pursing the lips. Newborn babies are active stimulus seekers where repetition and the level of stimulation are important. The baby is capable of shutting out stimuli and may even turn his or her head at the sound of the mother’s voice.