nursing policy on handling infant that is not bathed

[kms6417]

We have recently been having more and more parents who request their newborn NOT to receive an admission bath and shampoo. Sometimes these infants are not bathed for their entire stay. We do follow universal precautions, but I am wondering if any other hospital has developed a policy on how to handle these infants. We are considering a crib tag that states "contact precautions". I work at a hospital with over 4000/deliveries a year. I appreciate anyone's input on how this situation is handled at your hospital. Thanks!

[imintrouble, BSN, RN]

:eek: I'm not OB/GYN was just surfing. Why in heaven's name would anyone refuse their baby a bath???? What's the rationale? The bigger question is why would the hospital comply?

Strike the last question. Customer service.

[Double-Helix, BSN, RN]

It seems that contact precautions would be warranted. After all, the baby could have blood and body fluid on the skin that could cause infection. Particularly the blood is concerning.

I'm curious too as to what the rationale is. Is it cultural? Religious? I've heard to parents wanting to perform the first bath themselves, but not the child going two-three days after birth without being cleaned. I think the more important issue would be to find out why the baths are refused and try to work around that.

[LibraSunCNM, BSN, MSN, CNM]

When patients request this at my hospital (we also do about 4000 deliveries/year), we just tape an index card to the baby's bassinet that says "no bath" and everyone knows to always wear gloves when handling the baby. Some people have a lot of reasons for not wanting baths, it doesn't really bother me.

[ericaej]

To each their own, right? Interesting that they wouldn't want their baby bathed. Are they worried about the baby getting cold? Religious reasons?

[Esme12, ASN, BSN, RN]

Ok I'm curious....why no bath???

[kids]

I'm guessing it has to do with the belief, in some circles, that it's healthier to the baby to delay washing off the vernix (it holds moisture and has antibacterial properties). Even those who advocate for it say it's mostly absorbed in the first 24 hours so after that it's ok to bathe the baby.

Interestingly enough, when my babies were born 27+ years ago they didn't get bathed at the hospital (3 hospital on opposite coasts) until their 2nd day, they were just wiped down with warm water after being born..

Google "vernix benefits".

This is a link to one of the first entries that comes up. It's actually pretty well presented and cites some research. http://birthbliss.wordpress.com/2010/09/01/benefits-of-vernix-its-amazing-stuff/

This might be interesting information to bring to your unit manager(s) or educators, I can't help but think that promoting/providing the information (along with the bathing after 24 hours) might be a good thing. It might help to provide a meeting in the middle with a lot of parents who defer bathing.

[sommeil, ASN, RN]

We didn't have our babies washed because we didn't feel that they needed it. Vernix has good anti-microbial properties (see journal article, Antimicrobial polypeptides of human vernix caseosa and amniotic fluid: implications for newborn innate defense). In addition to that we just didn't want any additional stress on our baby. I love taking a shower but I hate getting out into the cold bathroom. And i'm WELL able to regulate my body temperature. So yeah.. we didn't give our babies their first baths until their umbilical cord stump came off.

Hope this helps shed some light on why moms might refuse the bath.

[Double-Helix, BSN, RN]

sommeil, I'm curious, did you allow your baby to be wiped with warm cloths? Hair washed? Or was it straight from the womb, towel-dried and that was it? In the hospital where I did clinicals, the baby was placed under a radiant warmer and skin temp was monitored while the extremities and core was washed and dried. Then the baby was dressed, swaddled, and the hair was washed, immediately dried and a hat put on.

I am planning on asking the nursery to delay my baby's first bath, because I'd like to be the one to do it. So they will be bathed, but not immediately. I just can't imagine not washing the vernix off from the hair, behind the ears, in the neck folds, etc. It's interesting to hear another perspective.

[Elvish, BSN, DNP, RN, NP]

We just use universal precautions and put a piece of tape at the foot of the crib that says "Not bathed". Personally I prefer to have a hospital gown to put on over my scrubs as well when handling, in case an errant hand or foot catches me. Never had a parent have a problem with any of that. It's not that big a deal. I don't see that 'contact isolation' would be warranted solely based on the fact that infant hasn't been bathed.

[RNsRWe, ASN, RN]

I don't understand how washing the crud, blood, etc off a newborn with warm cloths and then immediately placing the infant in a warmer bassinet is more stress than the child should bear. Especially when compared with having staff hold the child at arm's length with gloves and gown to keep any part of its skin from touching them because the infant is covered in potentially infectious (to the staff) material. Seems more stressful to the infant to miss out on comforting holding opportunities, imho.

Delaying the bath for a short while for the parents to do, fine. Indefinitely (till the stump comes off?!) seems very excessive.

[CanadianGirl79]

I wear gloves whenever I touch baby anyhow, bathed or not, so this isn't really an issue for me. Plus, we know if Mom has anything communicable anyhow. It's manadatory testing at my hospital, and all results are visible and in the front of the chart. If she's positive for anything, it's always passed on in report.