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Growing Up with Vaccines: What Should Parents Know?

Portofino Pediatrics, supports without exception and without revision the Vaccine Schedule of  ACIP recommended by CDC,  AAP, NIH, WHO

Portofino Pediatrics, apoya sin excepcion o revision el Programa de Vacunacion de ACIP recomendado por CDC, AAP, NIH, WHO

 

Vaccine Schedule 0-6 years

Vaccine Schedule 7-18 years

Programa de Vacunacion 0-6 años

Programa de Vacunacion 7-18 años

 

2 months

INITIAL HISTORY

MEASUREMENTS:

  • Length/Height and Weight
  • Head Circumference
  • Blood Pressure (if risk factors)

SENSORY SCREENING:

  • Vision/Hearing (if risk factors)

DEVELOPMENTAL/BEHAVIORAL HEALTH:

Developmental Surveillance: DENVER

Nutrition:

Discuss With Parents of All Infants

  • Growing infants are more easily distracted during feeding and need gentle, repetitive stimulation (rocking, patting, stroking) or feeding in a room with fewer distractions (lights, noise, other people).
  • Indications of colic (crying inconsolably for several hours and passing a lot of gas). (If the mother is breastfeeding, recommend short, frequent feedings.)
  • Forgoing foods other than breast milk or infant formula until their infant is developmentally ready (at about age 4–6 months, when the sucking reflex changes to allow coordinated swallowing and the infant is sitting with support and has good head and neck control).
  • Adding cereal to their infant’s diet will not help the infant sleep through the night.
  • Playing with their infant (encouraging the infant to follow objects with his eyes) to stimulate the nervous system and help develop head and neck control and motor skills.
  • Encouraging “tummy time” to promote head control and gross motor development.

Discuss With Parents of Breastfed Infants

  • Breastfeeding their infant 8 to 12 times in 24 hours, and feeding more frequently during growth spurts.
  • By age 3 months, feeding their infant every 2 to 3 hours, but they may have one longer stretch of 4 to 5 hours at night between feedings.
  • Stools may be as infrequent as once every 3 days.

Discuss With Parents of Formula-Fed Infants

  • Feeding their infant on average 26 to 28 oz of formula, but the infant may consume up to 32 oz of formula in 24 hours (infants feed every 3–4 hours, with one longer stretch at night of up to 5 or 6 hours between feedings). Psychosocial/Behavioral Assessment: Parent Screening Questionnaire (SEEK)

Maternal Depression Screening: Edingburg

In the past 7 days:

  1. Have you been able to laugh and see the funny side of things?
  2. Have you looked forward with enjoyment to things?
  3. I have blamed myself unnecessarily when things went wrong?
  4. I have been anxious or worried for no good reason?
  5. I have felt scared or panicky for no good reason?
  6. Things have been getting on top of me?
  7. I have been so unhappy that I have had difficulty sleeping?
  8. I have felt sad or miserable?
  9. I have been so unhappy that I have been crying?
  10. The thought of harming myself has occurred to me?

PHYSICAL EXAMINATION

PROCEDURES:

Immunization : Dtap, Hep B,IPV, Hib, PCV13, Rota)

Hepatitis B: This infection can lead to vomiting, stomach pain, jaundice (yellow skin and eyes), permanent liver damage, liver cancer, cirrhosis and death. Approximately 25% of children who develop lifelong hepatitis B infection die of related liver disease as adults.

DTaP (Diphtheria, Tetanus, Pertussis): This vaccine works to prevent three infections.

  • Diphtheria may cause a sore throat, suffocation, paralysis, heart failure, coma and even death. Before the vaccine, diphtheria caused more than 15,000 deaths in children each year.
  • Tetanus causes severe muscle spasms (including the mouth and jaw), breathing problems, severe heart damage, lung infections, coma and death.
  • Pertussis causes “Whooping Cough.” It may lead to severe coughing, pneumonia, seizures, brain damage, and death. Pre-vaccine, over 200,000 cases and up to 9,000 deaths were reported each year.

Hib (Haemophilus Influenzae type b): This infection may lead to breathing problems, meningitis, blindness, brain damage, paralysis, hearing loss and death. Before the vaccine, Hib meningitis killed 600 children each year and left many other children with deafness, seizures and mental retardation.

IPV (Polio): This infection leads to paralysis, difficulty breathing and death. Before the vaccine, 20,000 cases of polio were reported each year in the United States. Many children were left on crutches, in wheelchairs and on iron lungs.

Prevnar (Pneumococcus): This infection leads to ear infections, sinus infections, pneumonia, meningitis, sepsis (infection of the blood) and brain damage.

RotaTeq (Rotavirus): This infection may include fever, vomiting, upset stomach, and watery diarrhea that can last from 3 to 9 days, and can quickly lead to dehydration (loss of body fluids).

ANTICIPATORY GUIDANCE

  • The first priority is to attend to the concerns of the parents. In addition, the Bright Futures Infancy
  • Expert Panel has given priority to the following topics for discussion in this visit:
  • Social determinants of health: Risks (living situation and food security), strengths and protective Factors (family support, child care)
  • Community agencies can help you with concerns about your living situation.
  • Programs like WIC and SNAP are available to help you if you have concerns about your food situation.
  • Handle unwanted advice by acknowledging, then changing, subject.
  • Take time for self, partner. Maintain social contacts.
  • Choose quality child care; recognize that separation is hard.
  • Parent and family health and well-being: Postpartum checkup, depression, sibling relationships
  • Have postpartum checkup; talk with partner about family planning.
  • Anxiety, depression are common after birth; getting enough sleep/physical activity and eating healthy helps. Talk with me if feelings last more than 2 days.
  • Spend time with your other children; engage them in care of baby if appropriate.
  • Infant behavior and development: Parent-infant relationship, parent-infant communication, sleeping, media, playtime, fussiness
  • Hold, cuddle, talk, sing to baby.
  • Learn baby’s temperament, personality.
  • Pay attention to baby’s cues for sleep; develop schedule for naps and nighttime sleep. Put baby to bed awake but drowsy
  • Avoid TV and other digital media with baby.
  • Use “tummy time” when awake.
  • Calm baby by stroking head, gentle rocking, walking with baby in stroller.
  • Never hit or shake baby.
  • Safety: Car safety seats, safe asleep, safe home environment: burns, drowning, and falls
  • Use rear-facing car safety seat in backseat; never put baby in front seat of vehicle with passenger air bag. Keep baby in car safety seat at all times during travel.
  • Use seat belt; don’t drive after using alcohol or drugs.
  • Put baby to sleep on back; choose crib with slats less than 2⅜" apart; don’t use loose, soG bedding; have baby sleep in your room in own crib.
  • Don’t drink hot liquids while holding baby; set home water temperature less than 120°F.
  • Don’t leave baby alone in tub, high places (changing tables, beds, sofas); keep hand on baby (“touch supervision”).