Baby’s First Bath: A Family-Centered Approach

By: Alecia Rickenbach, 1LT AN

Benefits of Bathing Infants at the Bedside

• Educational opportunity for New Parents• Bonding experience • A great way to involve the father or other family members in

infant care• Skin to skin contact following the bath improves infant

stabilization• Faster and easier than bathing infants in the treatment room• Builds rapport with the family and your patient• Supports the Patient Caring Touch System• Supports the Texas Ten Step Star Achiever Initiative

How Do Bedside Infant Baths Support PCTs?

• Patient Centered Practice: Allowing parents to experience their baby’s first bath provides a learning and bonding experience.

• Evidence-Based Practice: Skin to skin contact provides better physiological stabilization benefits than a radiant warmer.

How do Bedside Infant Baths Support Texas Ten Step Star Achiever Initiative?

• Step 7 of the initiative is to allow mothers and their babies to remain together as much as possible during their hospital stay.

• In the event babies demonstrate hunger cues after or during the bath they have the opportunity to breastfeed while in skin to skin contact.

Comparing the Infant Warming Options

Skin to Skin Contact• When performed with mother—

adjusts per infant’s specific need (Dabrowski, 2007)

• Stabilizes infant heart rate and respiratory rate (Moore, 2007)

• Increases infant blood glucose compared to infants in an open crib (Moore, 2007)

• Decreases infant crying and grimacing (Elliott, 2000)– Can be used to console infant during

or after hep B vaccine

Radiant Warmer• Infant temperature

continues to increase (unless attached to servo)

• Continued warmth can be delivered during actual bathing of infant

Setting Your Bath up for Success• Turn up the temperature in the

room to 80°F about thirty minutes prior to the bath

• Educate parents on the importance (and safety) of skin-to-skin after the bath– Emphasize keeping infant skin-to-

skin for at least ten minutes or until infant’s temperature is within parameters

• Educate parents on the importance of bathing the infant thoroughly and quickly – Infant should be fully exposed for no

longer than five minutes

Encouraging Parental Participation• Parents can be a great help

during the infant’s bath!• Often times new parents are a

little scared of the first bath. They don’t want to do it “wrong”. To allow them to feel involved without overwhelming them, you might try offering them a specific task:– “Would you like to hold the baby or

wash his/her hair?”– “Would you like to soap the baby or

rinse him/her?”

Suggested Supplies• Two towels• One blue chux pad• Sponge• Baby Soap• Rinse Bottle• Emesis Basin• New Diaper• Family Member to perform

skin-to-skin contact – Doesn’t have to be Mom, a lot

of fathers enjoy this experience as well!

Step 1: Set up your supplies• Double layer the towels

and place next to the sink with the blue chux pad on top

• Fill rinse bottle with warm water

• Prepare emesis basin with warm soapy water

• Ensure baby’s initial temperature is within parameters

Step 2: Wash Baby’s Hair

• Leave the newborn swaddled and hold the baby while a family member washes the baby’s hair.

Step 3: Wash Baby’s Body

• Place baby on the blue chux and remove blanket

• Soap and rinse baby with parent(s) assistance

• Dry thoroughly

Step 4: Place Skin to Skin• Place infant in direct

contact with the family member’s skin. – Mothers need to unbutton

their hospital gown – Fathers will need to

remove their shirts to provide sufficient skin to skin contact

– Cover baby with a blanket to prevent body heat from escaping

What Skin to Skin Should Look LikeYES! Infant is in direct contact with the skin!

NO! Infant is not in direct contact with the skin.

Step 5: Check Temperature• Check an initial post-bath temp

when baby is initially placed skin to skin. If this temperature is within parameters no additional checks are needed as long as baby remains skin to skin for ten minutes.

• If the initial temperature is below parameters, recheck after ten minutes of skin to skin contact.

• If the baby’s temperature is still lower than 97.7, keep baby skin to skin and recheck in another twenty minutes.

What if my baby is cold?

• If baby’s temperature has not recovered thirty minutes after the bath, notify the pediatrician as the newborn may need to be warmed under the radiant warmer and/or may need a spot glucose check.

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 3297

97.5

98

98.5

99

99.5

MBU 21JUN-04AUG 2014 PRE and POST Infant Bath Temperatures

PrePost

Number of Infants

Infa

nt T

empe

ratu

re

1 2 397

97.2

97.4

97.6

97.8

98

98.2

98.4

98.6

Effects of Skin to Skin on Infant Temperature

PrePostSTS 10Min

Number of Infants

Infa

nt T

empe

ratu

re

Interpreting Our Results

• Time period data collected: 21JUN2014-04AUG2014• 32 baths were performed at the bedside during this

time period.– 29 infants were within parameters immediately following

the bath– 3 infants were below parameters immediately following

the bath, all three of these infants were within parameters after ten minutes of skin to skin contact

Continuing Our Research for Process Improvement

• A newborn temperature tracker will be left with the charge nurse

• After you perform an infant bath please, please record your results!

• Thank you for support in this transition!

• Please refer questions to CPT Alsup-Morton or the Ten Steps Committee Representatives:– 1LT Rickenbach– Mrs. Sheedy

References• Dabrowski, G. (2007). Skin to skin contact: Giving birth back to mother and

babies. AWHONN, 11(1), 66-71.• Elliott, B., Larry, G., & Lisa, W. (2000). Skin-to-skin contact is anaglesic in

healthy newborns. Pediatrics: Official Journal of the American Academy of Pediatrics, 105(1), 1-6.

• Medves, J., & O'Brien, B. (2004). The effect of bather and location of first bath on maintaining thermal stability in newborns. JOGNN, 33(2), 175-182.

• Moore, E., Anderson, G., & Bergman, N. (2007). Early skin-to-skin contact for mothers and their healthy newborn infants. The Cochrane Library, (3), 1-40.

• Texas Ten Step Star Achiever Training Toolkit. (2014, January 1). Retrieved September 29, 2014, from http://texastenstep.org/

• MBU Pictures: Thomas Murgel and Morgan Harper