Discharge Instructions for Mothers with Newborns

Introduction to Newborn Care

The American Academy of Pediatrics recommends that mothers receive comprehensive education on infant feeding, safety protocols, warning signs requiring immediate medical attention, and have confirmed follow-up appointments scheduled within 3-5 days for the newborn and 6-8 weeks for maternal care 1, 2, 3

The American Academy of Pediatrics recommends breastfeeding on demand, with exclusive breastfeeding for 4-6 months providing decreased cardiovascular disease, infection rates, atopic conditions, and childhood obesity while improving cognitive development 1
Mothers should understand that a trained caregiver must directly observe at least one complete breastfeeding session before discharge, documenting successful latch, proper positioning, effective swallowing, and infant satiety 4, 2, 3
Newborns should have at least 6 wet diapers and 3-4 stools daily by day 4-5 of life as evidence of adequate intake 1, 2, 3

Infants must sleep on their backs (supine position) on a firm surface without soft bedding, pillows, or toys, as recommended by the American Academy of Pediatrics 1, 3
Co-sleeping is dangerous and must be avoided, with room-sharing without bed-sharing recommended instead 1, 3
Parents should verify that they have a properly installed car seat and understand it should only be used for travel, not for positioning at home, as recommended by the American Academy of Pediatrics 1, 3

Mothers should be taught to assess for jaundice by pressing on the infant's skin in good lighting, with yellowing that extends below the chest or to extremities requiring immediate evaluation 1, 2
Jaundice typically peaks at days 3-5 and adequate feeding helps prevent severe hyperbilirubinemia 2, 5

Mothers should seek immediate care if the infant develops fever ≥38°C (100.4°F) or temperature <36.5°C (97.7°F), poor feeding, refusal to eat, or weak suck, lethargy, difficulty waking, or decreased responsiveness, rapid or labored breathing, grunting, or blue discoloration, increasing jaundice, especially below the chest, persistent vomiting, or abdominal distention 2, 3

The American Academy of Pediatrics recommends scheduling the newborn visit within 3-5 days (72-120 hours) after discharge, with earlier visits (48-72 hours) required for infants discharged before 48 hours of age 1, 2, 3
The maternal postpartum visit should be scheduled at 6-8 weeks after delivery with an obstetrician, gynecologist, general practitioner, or midwife 3

The American Academy of Pediatrics recommends confirming completion and review of newborn metabolic screening, hearing screening, and critical congenital heart disease screening before discharge 1, 2, 5

The American Academy of Pediatrics recommends administering Tdap vaccine immediately postpartum if not previously received during pregnancy 3

All women require biopsychosocial assessment including screening for postpartum depression during the postpartum period, as recommended by the American Academy of Pediatrics 1
Screen for intimate partner violence, substance use, and assess adequacy of social support systems 2

The American Academy of Pediatrics recommends verifying that both mother and infant have identified a physician-directed source of continuing health care (medical home) with clear instructions on how to reach providers for questions or emergencies 1, 2, 3