Newborn Baby Care: Feeding, Danger Signs & Vaccines — Guide

What does it mean?

The first month of a baby's life — the neonatal period — is when babies are most vulnerable. Newborns cannot tell you what is wrong; their only signals are feeding poorly, breathing fast, feeling too cold or too hot, or becoming unusually still. In Pakistan, where many births still happen at home and harmful traditional practices (applying oil, surma, or ash to the cord; giving ghutti or water) persist, simple evidence-based care saves lives: keep the baby warm against the mother's skin, feed only breast milk, keep the cord clean and dry, and know the danger signs. This article covers the essentials for the first 28 days.

Common causes

• 1Feed only breast milk for the first 6 months.
  WHO recommends exclusive breastfeeding for 6 months — no water, no ghutti, no formula, no honey — starting within the first hour after birth. Breast milk alone meets all nutrition and fluid needs and protects against infection (WHO IMNCI counselling guidance). Feed as often and as long as the baby wants, day and night.
• 2Know the newborn danger signs — any ONE means urgent referral.
  WHO's postnatal danger signs: stopped feeding well, convulsions, fast breathing (>60 breaths/min), severe chest indrawing, no spontaneous movement, fever (>37.5°C), low body temperature (<35.5°C), any jaundice in the first 24 hours of life, or yellow palms and soles at any age (WHO newborn danger signs review). Mothers should also return immediately for: movement less than normal, poor drinking, unusually cold or hot feel, difficult breathing, blood in stool, bulging fontanelle, or redness/pus around the cord (WHO IMNCI chart booklet).
• 3Cord care: keep it clean and dry — put nothing on it.
  WHO recommends clean, dry cord care for facility births and home births in low-mortality settings: no oil, no surma, no ash, no cow dung — applying substances increases infection risk (WHO cord-care evidence review). The stump falls off on its own, usually within 1–2 weeks; fold the nappy below it and let air reach it. One exception — babies born at home: in high-newborn-mortality settings like Pakistan, WHO recommends applying chlorhexidine to the cord stump of home-born babies (daily for the first week of life) to protect against cord infection — if your baby is born at home, ask the lady health worker or dai (midwife) about chlorhexidine cord care.
• 4Keep the baby warm — skin to skin.
  WHO's "First Embrace": dry the baby thoroughly at birth, then immediate skin-to-skin contact with the mother — it transfers warmth, supports feeding, and protects against infection (WHO essential newborn care). Dress the baby in one or two layers more than an adult, cover head and feet in cool weather, and keep mother and baby in the same room 24 hours a day. Delay the first bath until after 24 hours (at least 6 hours if cultural reasons prevent waiting) — early bathing causes dangerous heat loss (WHO postnatal cord-care guidance).
• 5Vaccinate on Pakistan's EPI schedule — free at government centres.
  Birth: BCG, OPV-0, Hepatitis B → 6 weeks: pentavalent-1, OPV-1, PCV-1, rotavirus-1 → 10 weeks: second doses → 14 weeks: third doses plus IPV-1 → 9 months: measles-rubella-1, typhoid conjugate vaccine, IPV-2 → 15 months: measles-rubella-2 (Pakistan EPI schedule guide). These protect against 12 diseases including TB, polio, pneumonia, diarrhoea, and measles. Keep the vaccination card safe. One dose deserves special attention: every medically stable newborn should receive the first dose of the monovalent hepatitis B vaccine within 24 hours of birth — confirm it has been given before you leave the birth facility, or arrange it straight away after a home birth.

When to worry

Prevention & practical tips

• ✓In the first hour: put the baby skin-to-skin on the mother's chest, dry the baby, and start breastfeeding when the baby shows cues (rooting, sucking hand).
• ✓Breastfeed exclusively for 6 months — on demand, 8–12 times a day is normal. No water, no ghutti, no honey (honey can be dangerous for infants). If feeding is difficult, seek help from a lady health worker or clinic early — don't wait.
• ✓Cord: keep clean and dry, nothing applied — the one exception is chlorhexidine for home births (see above); wash hands before touching it. Watch for redness spreading to surrounding skin or pus — that needs same-day care.
• ✓Warmth: skin-to-skin as much as possible in the first days; hat and socks in cool weather; no early bath (wait 24 hours). If the baby feels cold to touch or the armpit temperature is low, warm skin-to-skin and seek advice.
• ✓Hygiene: everyone washes hands with soap before handling the baby; keep the baby's sleeping area clean; avoid kissing the newborn's face/mouth (infection risk).
• ✓Follow the vaccine schedule above at your nearest EPI centre or Basic Health Unit — free of charge. If a dose is missed, go as soon as possible; the vaccinator will advise catch-up.
• ✓Go for postnatal checkups for both mother and baby in the first week — many problems (jaundice, feeding difficulty, cord infection, maternal bleeding) appear in days 2–7.

FAQs

References

• WHO IMNCI counselling guidance: https://platform.who.int/docs/default-source/mca-documents/policy-documents/operational-guidance/zwe-ch-14-01-operationalguidance-2016-eng-imnci-chart-booklet.pdf
• WHO newborn danger signs review: https://pmc.ncbi.nlm.nih.gov/articles/PMC5078951/
• WHO cord-care evidence review: https://pmc.ncbi.nlm.nih.gov/articles/PMC6953818/
• WHO essential newborn care: https://www.who.int/frenchpolynesia/news/detail-wpro/15-01-2019-who-recommended-newborn-care-cuts-life-threatening-infections-by-two-thirds
• WHO postnatal cord-care guidance: https://jesse.tg/ngc-archive/summary/10309
• Pakistan EPI schedule guide: http://www.emro.who.int/pak/programmes/expanded-programme-immunization.html