Newborn Umbilical Cord Care Instructions
Dry cord care is the recommended approach for healthy full-term infants in high-resource settings, as it promotes natural colonization with non-pathogenic bacteria and provides the fastest and safest umbilical cord healing. 1
Proper Umbilical Cord Care Technique
Dry Cord Care Method
- Keep the cord clean and dry
- Expose the cord to air by folding the diaper down below the umbilical stump
- Apply a sterile gauze around the base of the umbilical cord on the first day of life 2
- Allow natural drying and separation without application of any antiseptics or topical agents
- Avoid covering the cord with diapers to promote air circulation
Cleaning Instructions
- If the cord becomes soiled with urine or stool, gently clean the area with water and mild soap
- Pat dry thoroughly after cleaning
- Do not submerge the umbilical area in water until the cord falls off and the area is completely healed
Expected Timeline and Normal Appearance
- Average cord separation time with dry cord care is approximately 10 days 2
- The cord will gradually dry, shrink, and turn from yellowish-green to black
- Some small spots of blood may appear when the cord is separating - this is normal
When to Seek Medical Attention
Parents should contact their healthcare provider if they notice:
- Foul-smelling discharge from the cord
- Redness or swelling around the base of the cord (periumbilical erythema)
- Bleeding that doesn't stop with gentle pressure
- Pus or yellowish discharge
- Signs of infection such as fever or irritability in the infant
Special Considerations
High-Risk Settings
- In low-resource settings or areas with high infection rates, application of 4% chlorhexidine solution or gel to the umbilical cord stump is recommended 1
- Chlorhexidine has been shown to reduce omphalitis (RR: 0.48) and neonatal mortality (RR: 0.81) in these settings 1
Materials to Avoid
- Traditional materials such as ash, herbal poultices, or human milk should be avoided as they may introduce pathogenic bacteria 1
- Alcohol (70%) is no longer recommended as it delays cord separation (average 12 days vs. 10.1 days with dry care) without providing additional benefits 2
Risk Factors for Complications
- Non-sterile hands of caregivers
- Unplanned home birth or birth in non-hygienic conditions
- Low birth weight
- Prolonged rupture of membranes
- Umbilical catheterization
- Chorioamnionitis 1
Common Pitfalls to Avoid
- Excessive cleaning or manipulation of the cord
- Using alcohol or other antiseptics unnecessarily in high-resource settings
- Covering the cord with tight diapers or clothing
- Delaying medical attention when signs of infection appear
The American Academy of Pediatrics and World Health Organization both support dry cord care in developed countries with adequate obstetric care and low neonatal mortality rates 3, 4. This approach has been shown to be easy, straightforward, and safe for healthy newborn infants born in high-income hospital settings 2.