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(305) 246-1030
6 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

  • Introducing solid foods when 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).
  • Introducing one single-ingredient food at a time, and observing their infant for 3 to 5 days for possible allergic reactions.
  • Introducing iron-fortified, single-grain infant rice cereal as the first supplemental food, because it is least likely to cause an allergic reaction.
  • Introducing a variety of pureed or soft meats, fruits, and vegetables after cereals.
  • Not forcing their infant to eat a new food if the infant does not like it. (It may take 10–15 attempts before an infant accepts a particular food.)
  • Serving only 100% fruit juice in a cup as part of a meal or snack, and limiting juice to 4 to 6 oz per day.
  • Placing their infant in a high chair (using a safety belt) to sit with the family during mealtime.
  • Talking with their infant during feedings. (As infants develop, they increasingly respond to social interaction.)
  • Infants benefit from playing with toys for stacking, shaking, pushing, or dropping and from playing with others. Discuss With Parents of Breastfed Infants
  • Encouraging the mother to breastfeed for the first year of the infant’s life.
  • Providing a vitamin D supplement (400 IU/day).
  • Providing an iron supplement (1 mg/kg of bodyweight/day) if the infant does not consume sufficient iron-rich foods.

Discuss With Parents of Formula-Fed Infants

  • Feeding their infant when the infant is hungry, usually 5 to 6 times in 24 hours.
  • Vitamin supplements are not needed if the infant is consuming an adequate amount of 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, flu)

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).

Influenza: This infection causes high fever, chills, severe muscle aches, headaches, pneumonia, swelling of the brain and death. There are still thousands of deaths every year in the U.S. from influenza related complications

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; tobacco, alcohol, and drugs; parental depression), strengths and protective factors (family relationships and 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.
  • Don’t use tobacco/e-cigarettes/alcohol/drugs. Call 800-QUIT-NOW (800-784-8669) for help to quit smoking.
  • Ask for help if you feel depressed overwhelmed.
  • Depend on your social network.
  • Choose trusted, responsible child care provider.
  • Infant behavior and development: Parents as teachers, communication and early literacy, media, emerging infant independence, putting self to sleep, self-calming
  • Use high chair/upright seat so baby can see you.
  • Engage in interactive, reciprocal play. Talk/sing/ read to, play games with baby.
  • Avoid TV and other digital media with baby.
  • Continue regular daily routines; put baby to bed awake but drowsy.
  • Continue calming strategies when baby is fussy.
  • Oral health: Fluoride, oral hygiene/soft toothbrush, avoidance of bottle in bed
  • Assess fluoride source.
  • Clean teeth/gums 2 times per day with soft cloth/ toothbrush and small smear of fluoridated toothpaste (no more than a grain of rice).
  • Don’t prop bottle or use bottle in bed.
  • Avoid baby foods/juices that baby sucks out of bag or pouch.
  • Don’t share spoons; don’t clean pacifier in your mouth.
  • Safety: Car safety seats, safe sleep, safe home environment: burns, sun exposure, choking, poisoning, drowning, falls
  • Use rear-facing car safety seat in backseat; never put baby in front seat of vehicle with passenger air bag.
  • Infants who reach maximum height/weight allowed by their rear-facing–only car safety seat should use a convertible or 3-in-1 seat approved for use rear facing to higher weights/heights
  • (up to 50 lb and 49 in).
  • Put baby to sleep on back; choose crib with slats less than 2⅜" apart; don’t use loose, soG bedding; lower crib mattress; never leave baby in crib with drop side down; choose mesh playpen with weave less than .".
  • Do home safety check (stair gates, barriers around space heaters, cleaning products).
  • Don’t leave baby alone in tub, high places (changing tables, beds, sofas).
  • Keep household products (cleaners, medicines) locked and out of baby’s sight. Put Poison Help number (800-222-1222) at all telephones, including cell.
  • Keep baby in high chair/playpen when in kitchen.
  • Avoid burn risk (drinking hot liquids, cooking, ironing, smoking); set home water temperature less than 120°F.
  • Keep small objects, all plastic bags away from baby.
  • To prevent choking, limit finger foods to soft bits.
  • Avoid sun exposure; use hat/infant sunscreen.