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
- Their infant’s increasing appetite during growth spurts,between ages 6 and 8 weeks.
- 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).
- Helping their infant focus on feeding by rocking, patting, stroking, or swaddling the infant or feeding in a room with fewer distractions (lights, noise).
- Indications of colic (crying inconsolably for several hours and passing a lot of gas). (If the mother is breastfeeding, recommend short, frequent feedings.)
Discuss With Parents of Breastfed Infants
- Their infant is getting enough milk if there are 6 to 8 wet diapers and 3 or 4 stools in 24 hours and the infant is gaining weight as expected.
- When appropriate, introducing a bottle by someone other than the mother when their infant is neither extremely hungry nor full and allowing the infant to explore the bottle’s nipple and put it in his mouth.
Discuss With Parents of Formula-Fed Infants
- Feeding their infant on average 24 to 27 oz of formula, but the infant may consume 20 to 31 oz of formula in 24 hours (Infant needs to feed every 3–4 hours.)
Psychosocial/Behavioral Assessment: Parent Screening Questionnaire (SEEK) Maternal Depression Screening: Edingburgh
In the past 7 days:
- Have you been able to laugh and see the funny side of things?
- Have you looked forward with enjoyment to things?
- I have blamed myself unnecessarily when things went wrong?
- I have been anxious or worried for no good reason?
- I have felt scared or panicky for no good reason?
- Things have been getting on top of me?
- I have been so unhappy that I have had difficulty sleeping?
- I have felt sad or miserable?
- I have been so unhappy that I have been crying?
- The thought of harming myself has occurred to me?
PHYSICAL EXAMINATION
Procedures:
- Newborn Blood Newborn Bilirubin
-
Immunization (Hepatitis B)
- 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.
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, environmental tobacco exposure, dampness and mold, radon, pesticides, intimate partner violence, maternal alcohol and substance use), strengths and protective factors (family support)
- Community agencies, WIC, and SNAP can help you with concerns about your living situation and having enough food.
- Don’t use tobacco/e-cigarettes. Keep car/home free of tobacco smoke/e-cigarette vapor. Call 800-QUIT-NOW (800-784-8669) for help to quit smoking.
- Check home for mold, radon; avoid using pesticides.
- Ask for help if you are concerned about or have experienced violence from your partner or another significant person in your life.
- You can also call the National Domestic Violence Hotline toll-free at 800-799-SAFE (7233).
- Don’t use alcohol/drugs.
- Ask about community resources for child care.
Parent and family health and well-being
- Postpartum checkup, maternal depression, family relationships
- Finding good child care can help you feel confident about returning to work. I can provide information and resources.
- Have postpartum checkup.
- 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.
- Find time for self, partner.
Infant behavior and development
- Sleeping and waking, fussiness and attachment, media playtime, medical home after-hours support
- Put baby in crib awake/drowsy to help with transition; keep room temperature comfortable.
- Consider offering pacifier.
- Calm baby with stroking head or gentle rocking.
- Never hit or shake baby.
- Avoid TV and other digital media with baby.
- Start “tummy time” when awake.
- Take temperature rectally, not by ear.
- Call office anytime with questions.
- Wash hands often.
Safety
- Car safety seats, safe sleep, preventing falls, emergency care
- 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 soft bedding; have baby sleep in your room in own crib.
- Keep hand on baby when changing diaper/ clothes; keep bracelets, toys with loops, strings/ cords away from baby.
Learn infant first aid/CPR; know emergency numbers; make emergency plan
