Warmth and Temperature Regulation

Babies are not as adaptable as adults to temperature change. A baby's body surface is about three times greater than an adult's, compared to the weight of his/her body. Babies can lose heat rapidly, as much as four times more quickly than adults. Premature and low-birthweight babies usually have little body fat and may be too immature to regulate their own temperature, even in a warm environment. Even full-term and healthy newborns may not be able to maintain their body temperature if the environment is too cold.

When babies are cold-stressed, they use energy and oxygen to generate warmth. If skin temperatures drop just one degree from the ideal 97.7° F (36.5°C), a baby's oxygen use can increase by 10 percent. By keeping babies at optimal temperatures, neither too hot or too cold, they can conserve energy and build up reserves. This is especially important when babies are sick or premature.

Ways to keep babies warm

There are several ways to keep babies warm, including the following:

• Immediate drying and warming after delivery. A baby's wet skin loses heat quickly by evaporation and can lose 2° to 3°F. Immediate drying and warming can be done with warm blankets and skin-to-skin contact with the mother, or another source of warmth such as a heat lamp or over-bed warmer.

• Open bed with radiant warmer. An open bed with radiant warmer is open to the room air and has a radiant warmer above. A temperature probe on the baby connects to the warmer to regulate the amount of warming. When the baby is cool, the heat increases. Open beds are often used in the delivery room for rapid warming. They are also used in the NICU for initial treatment and for sick babies who need constant attention and care. Babies on radiant warmer beds are usually dressed only in a diaper.

• Incubator/isolette. Incubators are walled plastic boxes with a heating system to circulate warmth. Babies are often dressed in a T-shirt and diaper.

Once a baby is stable and can maintain his/her own body temperature without added heat, open cribs or bassinets are used. Babies are usually dressed in a gown or T-shirt, a diaper, and a hat. A baby can lose large amounts of heat through his/her head. Often, a blanket is wrapped snugly around the baby. This is called swaddling.

To reduce the risk for sudden infant death syndrome (SIDS), the American Academy of Pediatrics recommends that parents and caregivers avoid overbundling, overdressing, or covering an infant's face or head to prevent him or her from getting overheated.