Mouth Care Neonatal Clinical Guideline - V1.0 February 2021
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Mouth Care Neonatal Clinical Guideline
V1.0
February 2021Summary
Mouth Care Procedure
Perform hand hygiene and wear clean gloves
Assessment of mouth should be done during daily cares using the
assessment tool. (Unless score=0, mouth care should be given)
Gather articles required for mouth care (cotton tip applicator, gauze,
colostrum, sterile water and paper bag)
Use clean gauze dipped in sterile water to clean lips and a cotton bud
dipped in 0.1ml of colostrum to apply over lips and to coat a thin layer
over buccal cavity and tongue
Discard all used items including excess milk
Document mouth care in intensive care charts, daily feeds/ care record
and badger checklist
Mouth Care Neonatal Clinical Guideline V1.0
Page 2 of 101. Aim/Purpose of this Guideline
Oral hygiene is an integral part of total care. Babies in the neonatal unit are
more susceptible to nosocomial infections as majority of them are premature.
Colostrum is rich in immune agents that can stimulate oropharyngeal associated
lymphoid tissue. When colostrum is placed directly into the oral mucosa it can
be systemically absorbed and help protect vulnerable infants against infections.
Data Protection Act 2018 (General Data Protection Regulation – GDPR)
Legislation
The Trust has a duty under the DPA18 to ensure that there is a valid legal basis to
process personal and sensitive data. The legal basis for processing must be identified
and documented before the processing begins. In many cases we may need consent;
this must be explicit, informed and documented. We cannot rely on opt out, it must be
opt in.
DPA18 is applicable to all staff; this includes those working as contractors and providers
of services.
For more information about your obligations under the DPA18 please see the
Information Use Framework Policy or contact the Information Governance Team
rch-tr.infogov@nhs.net
2. The Guidance
The aim of this document is to outline the advantages of, and provide guidance
on the use of colostrum in mouth care.
This policy applies to all staff that care for babies admitted to neonatal unit.
Oxford dictionary definitions are:
Colostrum– The first secretion from mammary glands after giving birth, rich in
antibodies.
Breastmilk– Milk produced by a woman’s breasts after child birth as food for
her child
2.1. Roles and responsibilities
Health professionals have responsibilities for development, management
and implementation of this guideline as detailed below.
2.1.1. Role of managers
The neonatal ward manager is responsible for ensuring monitoring
and compliance standards are met as specified in the guideline.
2.1.2. Role of individual staff
All neonatal staff members are responsible for practising in
accordance with this neonatal guidance document at all times while
employed in this trust.
Mouth Care Neonatal Clinical Guideline V1.0
Page 3 of 102.2. Standards and practice
2.2.1. The fundamental objective of providing mouth care is to maintain
the oral mucosa, gums, buccal cavity and lips in good condition. It
will also benefit the neonate by:
Keeping the oral mucosa moist, soft and intact, thereby reducing
oral and systemic infections.
Keep lips soft, moist and intact.
Removal of debris without damage to mucosa.
Prevent oral colonisation of gram negative flora
Freshen the mouth and increase the general wellbeing.
In a sick preterm neonate it also benefits by:
o Providing positive oral experience for the neonate.
o Early sensory development of taste and smell.
o Odour and taste of colostrum provides a soothing effect and
decreases cortisol levels.
o Neonate can gain from the advantageous constituents of
maternal breast milk as it gets absorbed through the oral
mucosa.
o Reaffirms mum the importance of her milk as it is a unique
contribution from mums to the treatment of their sick baby.
2.2.2. Factors that compromise the oral wellbeing of neonates include:
Intubated neonates, surgical babies nursed in prone and babies
with jaw abnormalities such as micronathia provides restricted
access to oral mucosa causing difficulty in performing oral
hygiene and thus mucosal deterioration
Hyperthermia can cause dry mouth and coated tongue.
Antibiotics can alter the mouth’s natural flora and increase the
risk of opportunistic infection such as oral thrush.
Some medications and oxygen therapy can cause dry mouth.
2.2.3. Procedure for mouth care
Mouth care should be provided along with the daily cares and
the frequency depends on the individual needs of the babies
based on assessment. It should at least be provided once during
the 12 hour shift.
Gather the articles required for mouth care prior to initiation of
daily care(cotton tip applicator, gauze, colostrum, sterile water
and paper bag)
Colostrum 0.2 – 0.3 ml should be drawn up in a syringe and
labelled properly. It should be used in increments of not more
than 0.1 ml to minimize risk of aspiration. Whenever available
freshly expressed colostrum should always be the first choice for
mouth care. Formula milk should not be used for mouth care.
Perform hand hygiene and wear clean gloves. Suction the oral
cavity if there are excess secretions or pooling of saliva.
Dip clean gauze in sterile water and clean the lips. Discard it in
the paper bag. Never re-dip a used swab.
Mouth Care Neonatal Clinical Guideline V1.0
Page 4 of 10 Dip a cotton bud in 0.1 ml of colostrum and apply over the lips. If
the oral cavity permits roll a thin layer of colostrum over the gum
line, buccal cavity and tongue.
Discard all used items including any excess milk. Sterile water to
be labelled for 24 hours and kept in the baby’s drawer.
Document the mouth care in intensive care charts, daily
feed/cares record and badger checklist.
2.2.4. Oral assessment
Assessment of the oral cavity should be done each time mouth
care is provided and should involve observation of
Lips and corners of mouth – should be smooth, pink and moist
with no signs of dryness, cracks, ulceration and bleeding.
Tongue – should be pink, moist and with a shiny appearance of
papillae. There should be no cracking, splitting, presence of oral
candida, redness and ulceration.
Saliva – should be thin and watery.
Mucous membranes – should be pink and moist. Check for
ulceration or candida.
Assessment of mouth
Undertaken at each mouth care
(Score written on chart where mouth care indicated and care plan)
Lips Observation 0=smooth, pink, moist
1=coated, dry or cracked
2=ulceration or bleeding
Tongue Observation 0=pink, moist papillae
1=coated/shiny + >/4suction)
Consistency of oral Observation 0=Clear and clean
secretions 1=Thin and mucoid
2=thick and discoloured
*Adapted from Jiggins M, Talibot J(1999) mouth care in PICU, pediatric nursing Dec/Jan11;(10):23-26
2.3. Implementation
This policy is to be communicated to all health care staff that have any
contact with the neonates and families.
Neonatal team members have the responsibility of supporting all parents to
be confident in providing mouth care.
All new staffs will be orientated to the policy on initiation of neonatal duty.
Information will be given to the paediatrics team as well to support
appropriate mouth care.
Mouth Care Neonatal Clinical Guideline V1.0
Page 5 of 103. Monitoring compliance and effectiveness
Element to be Compliance with policy
monitored
Lead Neonatal Guidelines Lead- Chris Bell; Neonatal Consultant
Tool Adherence to guidelines will be monitored as part of the ongoing
audit process on a Word or Excel template
Frequency As dictated by audit findings
Reporting Neonatal Audit and Guidelines Meeting
arrangements
Acting on Neonatal Medical and Nursing teams
recommendations
and Lead(s)
Change in Required changes to practice will be identified and actioned within
practice and 3 months, immediately if required. A lead member of the team will
lessons to be be identified to take each change forward where appropriate.
shared Lessons will be shared with all the relevant staff/stakeholders
4. Equality and Diversity
4.1. This document complies with the Royal Cornwall Hospitals NHS Trust
service Equality and Diversity statement which can be found in the 'Equality,
Inclusion & Human Rights Policy' or the Equality and Diversity website.
4.2. Equality Impact Assessment
The Initial Equality Impact Assessment Screening Form is at Appendix 2.
Mouth Care Neonatal Clinical Guideline V1.0
Page 6 of 10Appendix 1. Governance Information
Document Title Mouth Care Neonatal Clinical Guideline V1.0
This document replaces (exact
New
title of previous version):
Date Issued/Approved: January 2021
Date Valid From: February 2021
Date Valid To: February 2024
Directorate / Department
Lekshmi Balakrishnan; Neonatal Staff Nurse
responsible (author/owner):
Contact details: 01872 252667
Guidance on appropriate mouth care for neonatal
Brief summary of contents
inpatients
Suggested Keywords: Mouth care, neonatal
RCHT CFT KCCG
Target Audience
Executive Director responsible
Medical Director
for Policy:
Approval route for consultation
Neonatal Guidelines team
and ratification:
General Manager confirming
Mary Baulch
approval processes
Name of Governance Lead
confirming approval by specialty
Caroline Amukusana
and care group management
meetings
Links to key external standards No
Related Documents: None required
Training Need Identified? No
Publication Location (refer to
Policy on Policies – Approvals Internet & Intranet Intranet Only
and Ratification):
Document Library Folder/Sub
Clinical/ Neonatal
Folder
Mouth Care Neonatal Clinical Guideline V1.0
Page 7 of 10Version Control Table
Version Changes Made by
Date Summary of Changes (Name and Job
No
Title)
Lekshmi
September
V1.0 Initial issue Balakrishnan;
2020
Neonatal Staff Nurse
All or part of this document can be released under the Freedom of Information
Act 2000
This document is to be retained for 10 years from the date of expiry.
This document is only valid on the day of printing
Controlled Document
This document has been created following the Royal Cornwall Hospitals NHS Trust
Policy for the Development and Management of Knowledge, Procedural and Web
Documents (The Policy on Policies). It should not be altered in any way without the
express permission of the author or their Line Manager.
Mouth Care Neonatal Clinical Guideline V1.0
Page 8 of 10Appendix 2. Equality Impact Assessment
Section 1: Equality Impact Assessment Form
Name of the strategy / policy /proposal / service function to be assessed
Mouth Care Neonatal Clinical Guideline V1.0
Directorate and service area: Is this a new or existing Policy?
Neonatal New
Name of individual/group completing EIA Contact details:
Neonatal Guidelines Group 01872 252667
1. Policy Aim
Who is the
strategy / policy / The aim of this document is to outline the advantages of,
proposal / service and provide guidance on the use of colostrum in mouth care.
function aimed at?
2. Policy Objectives
As above
3. Policy Intended
Outcomes
To improve the well-being of patients by offering the appropriate
management of patients
4. How will
you measure Audit/Multidisciplinary team weekly discussion/incidents/risk
the outcome? management
5. Who is intended
to benefit from the Patients and staff
policy?
6a). Who did you Local External
Workforce Patients Other
consult with? groups organisations
x
b). Please list any Please record specific names of groups:
groups who have
been consulted Neonatal Guidelines Group
about this procedure.
c). What was the
outcome of the
consultation?
Approved- 16th September 2020
Mouth Care Neonatal Clinical Guideline V1.0
Page 9 of 107. The Impact
Please complete the following table. If you are unsure/don’t know if there is a negative impact
you need to repeat the consultation step.
Are there concerns that the policy could have a positive/negative impact on:
Protected
Yes No Unsure Rationale for Assessment / Existing Evidence
Characteristic
Age
X
Sex (male, female
non-binary, asexual X
etc.)
Gender
reassignment X
Race/ethnic Any information provided should be in an
communities accessible format for the family’s needs – i.e.
/groups X
available in different languages if required/access
to an interpreter if required
Disability
(learning disability, Those families with any identified additional
physical disability, needs will be referred for additional support as
sensory impairment, appropriate- i.e. to the Liaison team or for
X
mental health specialised equipment.
problems and some Written information will be provided in a format to
long term health meet the family’s needs e.g. easy read, audio etc
conditions)
Religion/
other beliefs X
Marriage and civil
partnership X
Pregnancy and
maternity X
Sexual orientation
(bisexual, gay, X
heterosexual, lesbian)
If all characteristics are ticked ‘no’, and this is not a major working or service
change, you can end the assessment here as long as you have a robust rationale
in place.
I am confident that section 2 of this EIA does not need completing as there are no highlighted
risks of negative impact occurring because of this policy.
Name of person confirming result of initial
Neonatal Guidelines Group
impact assessment:
If you have ticked ‘yes’ to any characteristic above OR this is a major working or
service change, you will need to complete section 2 of the EIA form available here:
Section 2. Full Equality Analysis
For guidance please refer to the Equality Impact Assessments Policy (available
from the document library) or contact the Human Rights, Equality and Inclusion
Lead debby.lewis@nhs.net
Mouth Care Neonatal Clinical Guideline V1.0
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