Initial history
Measurements:
- Length/Height and Weight
- Head Circumference
- Blood Pressure
SENSORY SCREENING
- Vision/Hearing
DEVELOPMENTAL/BEHAVIORAL HEALTH
Developmental Surveillance: DENVER
Nutrition:
Discuss With Parents of All Infants
- Signs of hunger include putting the hand to the mouth, sucking, rooting, pre-cry facial grimaces, and fussing (crying is a late sign hunger).
- Waking their infant for feeding if the infant sleeps more than 4 hours.
- Helping their infant focus on feeding by rocking, patting, stroking, or swaddling the infant or feeding in a room with fewer distractions (lights, noise).
Discuss With Parents of Breastfed Infants
- Feeding their infant immediately after birth, preferably in the delivery room.
- Feeding their infant when she is hungry, usually every 2 to 3 hours, about 8 to 12 feedings in 24 hours.
- 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.
- Avoiding artificial nipples (pacifiers, bottles) and supplements (unless medically indicated) until breastfeeding is well established; this occurs at around age 4 to 6 weeks. (Some infants never use pacifiers or bottles.)
- Waiting until breastfeeding is well established before introducing infant formula (for mothers combining breastfeeding and formula-feeding).
Discuss With Parents of Formula-Fed Infants
- Feeding their infant on average 20 oz of formula in 24 hours (2 oz of infant formula every 2–3 hours at first and more formula if the infant seems hungry).
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
- Umbilical cauterization
Anticipatory Guidance - Newborn
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 risks, pregnancy adjustment, intimate partner violence, maternal drug and alcohol use, maternal tobacco use), strengths and protective factors (becoming well informed, family constellation and cultural traditions)
Community agencies can help you with concerns about your living situation.
Programs like WICa and SNAP are available to help you if you have concerns about your food situation. Eating nonfood substances can harm you and your baby.
Take advantage of support from family and friends and community groups.
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/tobacco/e-cigarettes. Call 800-QUIT-NOW (800-784-8669) for help to quit smoking.
Parent and family health and well-being
Maternal health and nutrition, transition home (assistance after discharge), sibling relationships Continue taking your prenatal vitamin with iron.
Accept help once you get home so you can recover from the delivery and focus on the baby. Spend time with your other children; help them adjust to baby.
Newborn behavior and care
Infant capabilities, baby care (infant supplies, skin and cord care), illness prevention, calming your baby Baby is beginning to know you. Learn baby’s temperament, reactions.
Create nurturing routines; physical contact and talking helps baby feel secure and learn. Use fragrance-free soap/lotion; avoid powders; avoid direct sunlight.
Change diaper frequently to prevent diaper rash.
Cord care: Air-dry by keeping diaper below navel; call if bad smell, redness, fluid from the area. Wash your hands often.
Avoid others with colds/flu. Never hit or shake baby.
Nutrition and feeding
General guidance on feeding, breastfeeding guidance, formula-feeding guidance
Exclusive breastfeeding for about the first 6 months provides ideal nutrition, supports best growth and development; iron-fortified formula is recommended substitute; recognize signs of hunger, fullness; develop feeding routine; adequate weight gain is 6 to 8 wet diapers a day; give no extra fluids.
If breastfeeding
Provide 8 to 12 feedings in 24 hours; should not hurt; continue prenatal vitamin; avoid alcohol.
If formula feeding
Prepare/store formula safely; feed on cue, at least 8 times in 24 hours; hold baby semi-upright; don’t prop bottle. Safe sleep, pets, safe home environment
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.
Always use seat belt; do not drive under the influence of alcohol or drugs. Prevent heatstroke; never leave your baby alone in a car.
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.