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    By situation · 22 tips

    A new baby

    The shots and checks in the first days, safety and feeding in the first year, the situations that need a hospital the same day, and vaccines and spending.

    1 The first few days

    Caring for a newborn

    Give the first hepatitis B vaccine shot within 24 hours of birth

    A baby should get the first shot of hepatitis B vaccine within 24 hours of birth. Of people infected with hepatitis B in infancy and early childhood, about 95% go on to chronic hepatitis. Most people infected as adults clear it on their own. So the earlier this shot is given, the more it helps. If the mother's hepatitis B surface antigen is positive, the baby also needs hepatitis B immune globulin at the same time, within 12 hours of birth.

    • Top value
    • Evidence A
    • Buys life
    • For: Child under 3, Pregnant or trying
    Caring for a newborn

    Be sure the vitamin K shot is given at birth

    A newborn has very little vitamin K stored. Without a supplement, there can be bleeding, and the late-onset kind is often bleeding in the brain. In Tashkent, where this prevention was not widely done, 478 in every 100,000 (10万) newborns got this bleeding. Prevention is estimated to cut it by more than 78%. If you give birth at home or at an irregular facility, ask on your own whether the shot was given.

    • Top value
    • Evidence B
    • Buys life
    • For: Child under 3, Pregnant or trying
    Pregnancy and childbirth: from the first positive test to discharge paperwork

    Don't refuse the newborn heel-prick blood screening and hearing screening

    One heel-prick blood sample and one hearing test can find hypothyroidism, phenylketonuria and hearing impairment while the baby looks completely normal. By the time symptoms show, the damage to intelligence can no longer be made up.

    • High value
    • Evidence A
    • Buys life
    • For: Pregnant or trying, Child under 3

    2 Sleep and safety

    Caring for a newborn

    Put a baby to sleep on the back, on a firm flat surface, in the same room but not the same bed, with nothing soft in the bed

    While the child is a baby, lay the baby face up on a firm, flat surface that does not tilt; inclined cradles and baby seats can't be used as a bed. Adults share the room with the baby but not the bed. Put no soft things such as pillows, quilts, bumper pads or stuffed toys in the bed. In the U.S. alone, about 3500 babies a year die of sleep-related causes.

    • High value
    • Evidence A
    • Buys life
    • For: Child under 3, Pregnant or trying
    Caring for a newborn

    However tired or angry you are, never shake a baby

    A baby's head is large and the neck has little strength. Shaking hard can cause bleeding in the brain and eyes, and it can kill the baby or leave a lifelong disability. Gently rocking a baby to sleep does not count; the danger is violent shaking you can't control. When you are about to lose your temper, put the baby back in the crib and walk away for a few minutes. Letting the baby cry for a while is safer than holding and shaking.

    • High value
    • Evidence B
    • Buys life
    • For: Child under 3, Pregnant or trying
    Don't die early

    Put children under 4 in a child safety seat in the car, not on your lap

    For infants under 1 riding in a car seat, the chance of a fatal injury in a crash is about 70% lower. For children aged 1 to 4, it is about half. Holding a child on your lap gives no such protection.

    • High value
    • Evidence A
    • Buys life
    • For: Child under 3, Child aged 3–18, Pregnant or trying
    Don't die early

    If there are small children at home, put window stops on windows and balcony doors; a window screen is not protection

    A pair of stops costs a few dozen CNY. New York City installed window guards free in high-risk households and visited to explain how to use them; in one borough, reported child falls dropped by half over 3 years. New York later passed a law requiring landlords to put guards on apartments where children aged 10 and under live. A window screen does not count as protection.

    • High value
    • Evidence B
    • Buys life
    • For: Child under 3, Child aged 3–18
    Caring for a newborn

    When you get things for a baby, don't buy a walker with wheels; if you want the baby to sit and play, switch to a stationary play station or a playpen without wheels

    A baby sitting in a walker can dash more than 0.9 meters in 1 second, and in most injuries an adult was right there watching. In the U.S. from 1990 to 2014, about 230,000 (23万) emergency room visits were for children hurt in walkers; 90% of the injuries were to the head and neck, mostly from falling down stairs along with the walker. Walkers also don't teach a child to walk.

    • High value
    • Evidence B
    • Buys life
    • For: Child under 3, Pregnant or trying
    Caring for a newborn

    When bathing a baby, run cold water first and then add hot, and test it with the inside of your wrist or your elbow before putting the baby in; if your water heater lets you set the output temperature, set it below 50 ℃

    Water at 65 ℃ touching the skin for 2 seconds gives most adults a third-degree burn, and a baby's skin is thinner. Put cold water in the tub first, then add hot, mix it well, test it with the inside of your wrist or your elbow before putting the baby in, and don't wash the baby under a running tap. After one U.S. state lowered the factory setting on water heaters to 49 ℃, hospital admissions of children for hot-water scalds fell by more than half.

    • Moderate value
    • Evidence B
    • Buys life
    • For: Child under 3, Pregnant or trying

    3 Feeding

    Caring for a newborn

    Feed only breast milk for the first 6 months, not even water, start solid foods at 6 months and keep breastfeeding

    Start feeding in the first hour after the baby is born. For the first 6 months, feed only breast milk, not even water. From 6 months, add solid foods, with an iron-rich animal food every day, and keep breastfeeding until 2 years or longer. If there is not enough milk or you can't breastfeed, use formula.

    • Moderate value
    • Evidence A
    • Buys life
    • For: Child under 3, Pregnant or trying
    Caring for a newborn

    Mix formula with water above 70 ℃, let it cool before feeding, and throw away what is left

    Formula is not sterile, and it may carry a kind of bacterium. If a newborn is infected, between 40% and 80% die. When you mix, first pour hot water into the bottle, wait until it cools to about 73.8 ℃, and then add the powder. In most cases that kills this germ down to less than one hundred-thousandth (十万分之一) of the original. Hot water leaves a little less vitamin C, but the formulas that were tested still met the standard. Let it cool after mixing before you feed, and throw away what is left.

    • High value
    • Evidence A
    • Buys life
    • Disputed
    • For: Child under 3, Pregnant or trying
    Caring for a newborn

    Do not give honey to a child under 1 year old

    Do not give honey to a child under 1 year old. This includes honey water, honey stirred into solid food, and pastries made with honey. Honey can carry bacteria that cause botulism. The gut flora of an adult can hold them down, but an infant's cannot.

    • High value
    • Evidence A
    • Buys life
    • For: Child under 3, Pregnant or trying
    Caring for a newborn

    If a child has severe eczema or an egg allergy, don't avoid peanuts: add them early as the doctor directs, but never give whole peanuts

    Babies with severe eczema or an egg allergy who ate peanut regularly from 4 to 11 months old had a peanut allergy rate of only 1.9% by age 5, versus 13.7% for those who avoided it completely. For children who already showed some reaction on a skin test, the figure was 10.6% for those who ate it and 35.3% for those who avoided it. Take the child to the doctor before adding it. Never give a whole peanut, because it can block the windpipe.

    • High value
    • Evidence A
    • Buys life
    • For: Child under 3, Pregnant or trying
    Caring for a newborn

    If you are vegetarian while pregnant or breastfeeding, take vitamin B12 every day; the child's solid foods need animal foods, and if you insist on fully vegan, see a doctor first

    Vitamin B12 is found almost only in meat, eggs and dairy, so a fully vegan person has to rely on fortified foods or supplements. If the mother is fully vegan and does not supplement, a breastfed child is easily short of it. Problems mostly show up at 4 to 8 months of age: failure to grow, delayed development, and, if it drags on, nerve damage that may not be reversible. The child's solid foods need an animal food every day.

    • Moderate value
    • Evidence B
    • Buys life
    • Disputed
    • For: Pregnant or trying, Child under 3
    Caring for a newborn

    Give the child 400 international units (IU) of vitamin D every day from birth, and don't skip it especially if breastfed; a full-term baby generally doesn't need extra calcium within the first 6 months

    Breast milk has very little vitamin D, and babies shouldn't get much sun, so it has to be given every day. In rural Turkey, 3.8% of children who were not given it developed rickets within a year, and none of those who were given it did. Give the dose as the doctor says. A normal full-term baby generally doesn't need extra calcium within 6 months.

    • Moderate value
    • Evidence B
    • Buys life
    • For: Child under 3, Pregnant or trying

    4 When to go to the hospital right away

    Caring for a newborn

    If a baby under 3 months has a temperature of 38 ℃, go straight to the hospital and don't watch at home

    If a child under 3 months has a temperature of 38 ℃, go straight to the hospital. Don't watch at home, and don't give fever medicine first and wait and see. The American Academy of Pediatrics has set out a specific management plan for feverish babies who look reasonably well, so "looks alert enough" is no reason to wait at home. The UK guideline also classes a child under 3 months with a temperature of 38 ℃ as at high risk of serious illness.

    • High value
    • Evidence A
    • Buys life
    • For: Child under 3, Pregnant or trying
    Caring for a newborn

    Watch for the signs of newborn jaundice: if the baby is yellow within 24 hours of birth, or can't be woken or won't feed, go to the hospital the same day; if it is getting more yellow or the stool is pale, get it checked as soon as possible

    More than 80% of newborns turn a little yellow. If the baby is yellow before 24 hours old, or is yellow and also sleepier than usual and hard to wake, won't feed, or is limp or stiff, go to the hospital right away. If the baby gets more yellow after 24 hours, or the stool turns pale, get it checked as soon as possible; pale stool may mean biliary atresia. Too much bilirubin can damage the brain and leave a lifelong disability.

    • High value
    • Evidence B
    • Buys life
    • For: Child under 3, Pregnant or trying
    Emergencies: what to do first

    If a baby under 1 year old is choking and can't cry, lay the baby face down and give 5 back blows, turn the baby over and give 5 chest pushes, alternating, and don't press the belly

    If the baby can still cough and cry out, let the baby cough on their own and stay beside them watching. If the baby can't make a sound and the face is turning purple, have someone call 120 (China's ambulance number), lay the baby face down along your forearm, and give 5 blows with the heel of your hand between the two shoulder blades. If it hasn't come out, turn the baby over and give 5 quick pushes in the center of the chest, and alternate the two, without pressing the belly. If the baby stops responding, switch to CPR.

    • Top value
    • Evidence B
    • Buys life
    • For: Child under 3, Pregnant or trying
    Emergencies: what to do first

    If a baby under 1 year old is unresponsive and not breathing normally, put the phone on speaker and call 120 (China's ambulance number), and give infant CPR: 30 pushes and 2 breaths

    If tapping the sole of the foot brings no response and the baby isn't breathing normally, put the phone on speaker and call 120 (China's ambulance number), and keep your hands going. Encircle the chest with both hands and press with two thumbs, or if you can't encircle it, use the heel of one hand, pressing down about 4 centimeters, about 2 times a second. After every 30 pushes, cover the child's mouth and nose with your mouth and give 2 breaths. A baby's heart most often stops because of not being able to breathe, and more survive when the CPR includes breaths.

    • High value
    • Evidence B
    • Buys life
    • For: Child under 3, Pregnant or trying

    5 Vaccines and spending

    Caring for a newborn

    Get all the vaccines in the national immunization program on schedule, which are free all the way, and if you miss one, only catch up on the doses not yet given

    Vaccines in the national immunization program are free all the way, and the vaccination unit cannot charge. When a child enters nursery or school, the immunization certificate is checked, and missed shots will be found and made up. If you missed some, only the doses not yet given need to be caught up, with no need to start over, and you can continue even if the maker has changed.

    • High value
    • Evidence A
    • Buys life
    • For: Child under 3, Child aged 3–18, Pregnant or trying
    Caring for a newborn

    For diapers, don't go by brand; look at three things: the fit, how often you change, and whether the product has been named in a spot-check report

    No official body has ranked "which brand is best." The only things you can check are two: the product-quality spot-check reports from the State Administration for Market Regulation (市场监管总局), and the regulators' investigations of specific incidents. Expensive does not mean safe, and imported does not mean up to standard. Buy a small pack first and try it for a week, check whether the child gets a red bottom or marks from elastic, and stock up if it fits.

    • Moderate value
    • Evidence C
    • Saves money
    • For: Child under 3, Pregnant or trying
    Caring for a newborn

    For big items, think in the order borrow, buy used, buy new, and don't buy everything at once

    A stroller, a swaddle blanket and toys are used for a short time, so borrow first, buy used if you can't borrow, and buy new last. A used car seat must be confirmed to have no serious crash history, no recall and all parts present; if you can't confirm that, don't use it. In one Scottish study, sleeping regularly on a mattress another child had used came with about 3 times the risk of sudden death, but it is unclear whether the mattress caused it. It is best to buy a new mattress.

    • Moderate value
    • Evidence C
    • Saves money
    • For: Child under 3, Pregnant or trying

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