Bright Future – First Week Visit (3 to 5 days)

Dec 6, 2019 admin NHI KHOA 0

Bright Future – First Week Visit (3 to 5 days)

Health supervision

Surveillance of development

  • Social language and self-help
    • – Sustains periods of wakefulness for feeding
  • Verbal language (Expressive and receptive)
    • – Cries with discomfort
    • – Calms to adult voice
  • Gross Motor
    • – Lifts head briefly when on stomach and turns it to the side
    • – Reflexively moves arms and legs, observed in the Moro and tonic neck reflexes
  • Fine Motor
    • – Keeps hands in a fist

Observation of Parent-Newborn interaction

Do parents and newborn respond to each other? Do parents appear content, at ease? Tearful, anxious, fatigued, overwhelmed, uncomfortable? Are parents aware of, responsive to, and effective in responding to newborn’s distress? What are parents’ and newborn’s interactions around comforting, dressing/changing diapers, feeding?

Are both parents present, and do they support each other or show signs of disagreement?

Complete Physical Examination, including

Measure and plot: Recumbent length, weight, head circumference, and weight-for-length

Assess/observe for: Alertness, congenital anomalies, dysmorphic features; rashes, jaundice, hydration; head shape/size/fontanels, signs of birth trauma; eyes/eyelids, pupil opacification/red reflexes, visual acuity; heart murmurs; femoral pulses (compare against upper extremity pulses); umbilical cord/ umbilicus; abdominal masses; testes, external female genitalia; spine/back, posture, neurologic tone, activity level, movement symmetry, neonatal reflexes, state regulation (alertness, orientation, regulatory capacity)

Perform: Ortolani and Barlow maneuvers

Screening (www.aap.org/periodicityschedule) Universal: Hearing; Newborn: Blood
Selective: Blood Pressure; Vision

Immunization

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), strengths and protective factors (family support)

  • Community agencies can help you with concerns about your living situation.
    Tell me about your living situation. What are your resources for caring for the baby?
  • Programs like WIC and SNAP are available to help you if you have concerns about your food situation.
    Within the past 12 months, were you ever worried whether your food would run out before you got money to buy more? Within the past 12 months, did the food you bought not last and you did not have money to get more?
KEy = Guidance for parents, questions
  • Don’t use tobacco/e-cigarettes. Keep car/home free of tobacco smoke/e-cigarette Call 800-Quit-NoW (800-784-8669) for help to quit smoking.
  • Reach out to and accept help from family and friends.

Parent and family health and well-being:

Transition home, sibling adjustment

  • Ask for help from family or friends.
  • Rest and sleep when baby sleeps.
  • Spend time with your other children; maintain family routines to help them adjust to baby.

Newborn behavior and care: Early brain development, adjustment to home, calming, when to call (temperature taking) and emergency readiness (CPR), illness prevention (handwashing, outings) and sun exposure

  • Sing/talk/read to baby; avoid TV and other digital media.
  • Help baby wake for feeding by patting/diaper change/undressing.
  • Calm baby with stroking head or gentle
  • Never hit or shake baby.
    What do you do to calm your baby? What do you do if that doesn’t work?
  • Take temperature rectally, not by ear or skin.
    What type of thermometer do you have? Do you know how to use it?
  • Create emergency preparedness plan (first aid kit, list of telephone numbers).
  • Wash hands often; avoid crowds.
  • Avoid sun; use infant sunscreen.

Nutrition and feeding: General guidance on feeding (weight gain, feeding strategies, holding, burping, hunger and satiation cues), 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 cloth diapers per day or 5 to 6 wet disposable diapers, 3 to 4 stools per day; give no extra fluids.
    How do you know if your baby is hungry? How do you know if your baby has had enough to eat?
  • If breastfeeding: Feed every 1 to 3 hours daytime and every 3 hours nighttime for 8 to 12 feedings in 24 Begin giving baby vitamin D (400 IU per day). Mothers should continue prenatal vitamin with iron; eat a healthy diet (vegetables/fruit/whole grains/low-fat or nonfat dairy/fish/lean protein).
    How is breastfeeding going? What concerns do you have about breastfeeding?
  • if formula feeding: Prepare/store formula safely; feed 2 oz every 2 to 3 hours, more if still seems hungry; hold baby semi-upright; don’t prop bottle.

Safety: Car safety seats, heatstroke prevention, safe sleep, safe home environment: burns

  • Use rear-facing car safety seat in backseat; never put baby in front seat of vehicle with passenger air Keep baby in car safety seat at all times during travel.
  • Use seat belt; don’t drive under the influence of alcohol or
  • Prevent heatstroke; never leave 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.
  • Don’t drink hot liquids while holding baby; set home water temperature less than 120°F.

BÀI LIÊN QUAN