Home visits after birth (HBNC): a complete guide for ASHAs

The first six weeks of life are the most dangerous time for a baby. Most newborn deaths happen in the first month, and many of them happen at home, after the family has left the hospital. Home-based newborn care (HBNC) means that you, the ASHA, visit the mother and baby at home on fixed days, check them carefully, teach the family simple care, and send them to a health facility early when something is wrong.

When to visit

Visit every newborn in your area on these days after birth:

• Baby born in a hospital: day 3, 7, 14, 21, 28 and 42 (6 visits).
• Baby born at home: also visit on day 1, as soon as possible after birth (7 visits).
• Low birth weight (less than 2.5 kg), preterm or sick babies: visit more often, as your ANM advises.

What to check in the baby at every visit

1. Feeding: is the baby breastfeeding well, 8 to 12 times in 24 hours, day and night? Watch one feed and check the attachment: mouth wide open, lower lip turned out, chin touching the breast.
2. Warmth: touch the baby's belly and feet. Cold feet and a cold belly mean the baby is too cold.
3. Breathing: count the breaths for one full minute while the baby is calm. 60 or more in a minute is fast breathing.
4. Cord: it should be clean and dry. Redness around the cord or pus is a sign of infection.
5. Skin and eyes: look for yellow colour, many pus-filled spots, or pus from the eyes.
6. Weight: weigh the baby with the HBNC weighing scale and record it. A healthy baby regains its birth weight by about two weeks.
7. Urine and stool: a well-fed baby passes urine 6 or more times a day.

Danger signs: refer at once

• Not able to suck or not feeding well
• Fits (convulsions)
• Fast breathing (60 or more per minute) or the lower chest going inside with each breath
• Body very cold or very hot
• Baby very sleepy, limp, or does not move unless touched
• Yellow palms and soles, or yellow colour in the first 24 hours
• Red, swollen or pus-filled cord, or many skin boils
• Weight below 1.8 kg, or the baby is losing weight

Teach the family: warmth, feeding and hygiene

• Start breastfeeding within one hour of birth. The first yellow milk (colostrum) protects the baby; do not throw it away.
• Give only breast milk for six months: no water, honey, ghutti, tea or other milk.
• Keep the baby warm: dress in layers, cover the head and feet, and keep the baby next to the mother. Delay the first bath.
• Small babies need Kangaroo Mother Care: the baby, wearing only a nappy and cap, is kept skin-to-skin on the mother's chest for as many hours as possible.
• Keep the cord clean and dry. Do not apply oil, ash, cow dung or any powder.
• Everyone must wash hands with soap before touching the baby.

Do not forget the mother

At every visit, also ask the mother how she feels. Refer her at once if she has heavy bleeding (a pad soaked in less than 5 minutes), fever, foul-smelling discharge, severe belly pain, fits, or if she seems very sad and is not caring for the baby. Remind her to take one IFA tablet daily, eat an extra meal, and talk to the ANM about family planning.

Record every visit

Fill the HBNC format at each visit: date, weight, temperature, feeding, danger signs and what you advised. Your records help the ANM follow up sick babies and are needed for your HBNC incentive as per your state's rules.

Common questions

Should I visit even if the baby looks healthy?

Yes. Many dangerous problems, such as infection or poor feeding, start quietly. Regular visits catch them early.

Can the baby be given water in summer?

No. Breast milk has enough water for the first six months, even in hot weather.

The family wants to bathe the baby daily. What should I say?

Ask them to delay the first bath and then keep baths short and warm, drying the baby quickly. Small babies should not be bathed until they are bigger, as your ANM advises.