INITIAL HISTORY

MEASUREMENTS :

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

SENSORY SCREENING

• Vision/Hearing (if risk factors)

DEVELOPMENTAL/BEHAVIORAL HEALTH

Psychosocial/Behavioral Assessment: Parent Screening Questionnaire (SEEK) Developmental Screening: ASQ-3

Nutrition:

Discuss With Parents of All Infants

• Gradually introducing their infant to solid textures to decrease the risk of feeding problems, such as rejecting certain textures, refusing to chew, or vomiting. (It may take 10–15 attempts before an infant accepts a particular food.)
• Understanding that infants will become more interested in food their parents eat and less interested in breastfeeding or bottle-feeding. Nevertheless, infants should receive breast milk, infant formula, or both through the first year of life.
• Offering soft, moist foods as their infant gradually moves from gumming to chewing foods.
• Offering small pieces of soft foods as their infant gains more control over picking up and holding food.
• Placing their infant in a high chair (using a safety belt) to sit with the family during mealtime.
• 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.
• Avoiding feeding their infant sweetened beverages, such as sodas and fruit drinks.
• Providing their infant snacks midmorning, in the afternoon, and in the evening. (Most 9-month-olds are on the same eating schedule as the family: breakfast, lunch, and dinner.)

Discuss With Parents of Breastfed Infants

• Encouraging the mother to breastfeed for the first year of the infant’s life.
• Providing vitamin D supplement (400 IU/day).
• Providing an iron supplement (1 mg/kg of body weight/day) if the infant does not consume sufficient iron-rich foods.
• Feeding the 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 iron-fortified infant formula appropriate for growth.

PHYSICAL EXAMINATION

PROCEDURES:

Immunization (if delayed)

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

Lead testing

ORAL HEALTH

Fluoride Varnish

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 (intimate partner violence), strengths and protective factors (family relationships and support)
• 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 ).
• Make time for self, partner; maintain social contacts.

Infant behavior and development

• Changing sleep pattern (sleep schedule), developmental mobility and cognitive development, interactive learning and communication, media
• Keep consistent daily routines.
• Provide opportunities for safe exploration; be realistic about abilities.
• Recognize new social skills, separation anxiety; be sensitive to temperament.
• Play with cause-and-effect toys; talk/sing/read together; respond to baby’s cues.
• Avoid TV, videos, computers; consider making a family media use plan ( www.healthychildren .org/MediaUsePlan ).

Discipline

• Parent expectations with child’s behavior
• Use consistent, positive discipline (limits use of the word no, use distraction, be a role model).

Safety

• Car safety seats, heatstroke prevention, firearm safety, safe home environment: burns, poisoning, drowning, falls
• Use rear-facing car safety seat in backseat until child is at least 2 years old; never put baby in front seat of vehicle with passenger air bag.
• Use seat belt; don’t drive under the influence of alcohol or drugs.
• Avoid heatstroke; never leave baby in car alone.
• Remove firearms from home; if firearm necessary, store unloaded and locked, with ammunition locked separately.
• Do home safety check (stair gates, barriers around space heaters, cleaning products, electric cords).
• Don’t leave heavy objects, hot liquids on tablecloths.
• Put Poison Help number ( 800-222-1222 ) at each telephone, including cell.
• Use “touch supervision” near water, pools, bathtubs.
• Install operable window guards.