CHILD HEALTH

CLINICAL PRACTICE GUIDELINES

Subject/Title: Reference Number:
2-B-2
BATHING: NEONATAL
Authorization: Date Date
Neonatal Nurse Managers and Instructors (INN) (Sept 17, 2009) Established Reviewed:
Calgary Neonatal Care Committee (CNCC) (Oct. 28, 2009) Oct 28,
Infection Prevention and Control (Acute Care) (Oct. 19, 2009) 2009

Classification: Page:
Guidelines 1 OF 2

GUIDELINES
1. When possible, bathe the infant when the family may be present for teaching and enjoyment
of the event.
2. Ensure that bath equipment is disinfected before and after each use.
3. Use universal precautions, including wearing gloves, until after the infant’s first bath4.
4. Implement environmental controls to create a neutral thermal environment and to minimize
neonatal heat loss during bathing including:
4.1. Prewarm towels for drying.
4.2. Minimize air currents and convective heat loss; close room door, draw bedside curtains,
etc.
4.3. Ensure that the infant’s temperature is 36.3 – 37.2 0C
5. Use plain water, or select skin cleaners with the least irritating formulation.
• Select milk cleansing bars or liquid cleansers that have a neutral pH (pH 5.5-7.0).
• Preference should be given to products that are free of preservatives, perfumes, and
dyes6,7.
• Infants with significant breaks in skin integrity should not be bathed until the skin is
healed.
6. Monitor and document the infant’s vital signs, including temperature, before the bath and
every 30minutes x2 following the procedure.
7. Monitor the infant closely during the bath for signs of intolerance such as excessive crying,
increased respiratory effort, change of color, etc.
8. Document the procedure according to unit specific documentation, including the infant’s
tolerance to the procedure, parent education, and recommendations for future bath
management for the infant.

CHILD HEALTH
 CHILD HEALTH
CLINICAL PRACTICE GUIDELINES
Subject/Title: Date Date Page:
Established: Reviewed: 2 of 3
BATHING: NEONATAL Oct. 28,
2009

ROUTINE BATHING
1. Bath to remove debris and/or for the purpose of general hygiene, keeping in mind that:
1.1. Bathing is not an innocuous procedure2. The benefits of daily bathing have not been
clearly justified.
1.2. Under normal circumstances, neonates need not be bathed more frequently than
approximately every other day. Decisions about the frequency of bathing should be
based on the individual neonate’s needs and consideration of family beliefs and values.
2. Use warm tap water for routine bathing.
3. Use skin cleanser sparingly.
4. Select mild cleansing bars or liquid cleansers that have a neutral pH.
5. For preterm infants less than 32 weeks of gestation:
5.1. During the first week of life, clean skin surfaces gently using soft materials such as
cotton balls and warm water only (no cleanser).
5.2. Avoid rubbing of the skin; water can be squeezed onto the skin during rinsing.
5.3. If areas of skin breakdown are evident, use warm sterile water to cleanse.

IMMERSION BATHING
1. Consider immersion bathing as a safe and effective method to achieve and maintain infant
hygiene4.
2. Select appropriate candidates for immersion bathing based on assessment of individual
conditions and needs:
2.1. Stable preterm infants after all central lines are discontinued.
2.2. Infants with peripheral intravenous catheters if the line can be kept dry throughout the
procedure.
2.3. Presence of an umbilical clamp is not a contraindication for immersion bathing.
3. Ensure water temperature and environmental recommendations are in place as stated
above.
4. Use enough water to allow the infant to settle with her/his shoulders well covered.
5. Remove the infant’s clothing and diaper while still inside the isolette/cot. Wrap the infant in
a towel or receiving blanket.
6. Transfer the infant into the tub of water while he/she is still wrapped in the towel.
7. Once the infant is fully immersed, unwrap the towel, but do not remove it.
8. Proceed to bathe the infant, starting with the face, and cleanse gently from head to toe.
9. After the bath:
9.1. Lift the infant from the bath, leaving the towel behind.
9.2. Dry the infant immediately, replace the diaper, place a hat on his/her head and double
wrap in warm blankets.
9.3. Within approximately 10 minutes after the bath, dress the infant, change the hat and
wrap him/her in dry, warm blankets.
10. Educate parents about bath safety and identify positive aspects of immersion bathing for
their infant’s comfort and development.

CHILD HEALTH
 CHILD HEALTH
CLINICAL PRACTICE GUIDELINES
Subject/Title: Date Date Page:
Established: Reviewed: 3 of 3
BATHING: NEONATAL Oct. 28,
2009

REFERENCES
1. Eichenfield LF, Frieden IJ, & Esterly NB (2001) Textbook of Neonatal Dermatology, W.B.
Saunders Company.
2. Lund CH, Kuller J, Lane A et al. (1999) Neonatal skin care: The scientific basis for practice.
JOGNN, 28(3), 241-254.
3. Lund CH, Osborne JW, Kuller J et al. (2001) Neonatal skin care: Clinical outcome of
AWHONN/NANN evidence-based clinical practice guidelines. Journal of Obstetrical
Gyncological Neonatal Nursing, 30: 41-51.
4. Neonatal Skin Care, Second Edition – Association of Women’s Health, Obstetric and
Neonatal Nurses. 2007. pg 4-52.
5. Quinn D, Newton N, Piecuch R. (2005) Effect of less frequent bathing on premature infant
skin. JOGNN, 34(6), 741-746.
6. Trotter S. (2002) Skin care for the newborn: Exploring the potential harm of manufactured
products. RCM Midwives, 5, p. 76-8.
7. Yosipovitch G, Maayan-Metzger A, Merlob P, & Sirota L. (2000) Skin barrier properties in
different body areas in neonates. Pediatrics. 106(1), 105-108.

CROSS REFERENCES
MANUAL: NUMBER: SUBJECT/TITLE:
Child Health 2-S-1 Skin and Wound Care: NICU
Child Health 2-T-3 Thermoregulation: Neonatal

DISCLAIMER
All content in this policy and/or procedure is © copyright, Calgary Health Region. All rights reserved. This information, and as
amended from time to time, was created expressly for use by Calgary Health Region staff and persons acting on behalf of the
Calgary Health Region for guiding actions and decisions taken on behalf of the Calgary Health Region. The Calgary Health Region
accepts no responsibility for any modification and/or redistribution and is not liable in any way for any actions taken by individuals
based on the information herein, or for any inaccuracies, errors, or omissions in the information in this policy and/or procedure. Any
modification and/or adoption of this policy and/or procedure are done so at the risk of the adopting organization.

CHILD HEALTH