Bright Future – 1 Month Visit
Health supervision
Surveillance of development
- Social language and self-help
- Looks at parent; follows parent with eyes
- Has self-comforting behaviors, such as bringing hands to mouth
- Starts to become fussy when bored; calms when picked up or spoken to
- Looks briefly at objects
- Verbal language (Expressive and receptive)
- Makes brief short vowel sounds
- Alerts to unexpected sound; quiets or turns to parent’s voice
- Shows signs of sensitivity to environment (excessive crying, tremors, excessive startles) or need for extra support to handle activities of daily living
- Has different types of cries for hunger, tiredness
- Gross Motor
- Moves both arms and both legs together
- Holds chin up when on stomach
- Fine Motor
- – Opens fingers slightly when at rest
Observation of Parent-infant interaction
Do parents respond to baby and to each other? Does mother engage with infant while feeding? Do parents attend to and support baby? How do parents respond to infant’s cues? Do any parent behaviors or expressions indicate stress?
Complete Physical Examination, including
Measure and plot: Recumbent length, weight, head circumference, and weight-for-length
Assess/observe for: Skin lesions/birthmarks/ bruising, skull deformities; fontanels; eyes/eyelids, visual acuity, pupil opacification, red reflexes; heart murmurs; femoral pulses; abdominal masses, umbilicus; neurologic asymmetries, movement quality/tone/posture, tone and neurodevelopmental status; testicular position
Perform: Ortolani and Barlow maneuvers
Screening (www.aap.org/periodicityschedule)
Universal: Depression: Maternal; Hearing; Newborn: Blood
selective: Blood Pressure; Tuberculosis; 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, 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.
Tell me about your living situation. Do you have the things you need for the baby? Are you worried about having enough money for food/infant formula? - 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.
Do you always feel safe in your home? Has your partner ever hit, kicked, or shoved you, or physically hurt you or the baby? Would you like information on where to go or who to contact if you ever need help? - 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 con- fident about returning to I can provide information and resources.
- Have postpartum checkup.
- Anxiety, depression are common after birth; get- ting enough sleep/physical activity and eating healthy Talk with me if feelings last more than 2 days.
Over the past 2 weeks, have you ever felt down, depressed, or hopeless? Over the past 2 weeks, have you felt little interest or pleasure in doing things? - 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.
- What do you do to calm your baby? What do you do if that doesn’t work?
- Avoid TV and other digital media with baby.
- Start “tummy time” when awake.
- Take temperature rectally, not by ear.
What type of thermometer do you have? Do you know how to use it? - Call office anytime with questions.
- Wash hands often.
Nutrition and feeding: Feeding plans and choices, 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, fulness; expect 6 to 8 wet cloth diapers per day or 5 to 6 wet disposable diapers, 3 to 4 stools per day; no extra fluids; burp baby at natural breaks in feeding.
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/ every 3 hours nighttime for 8 to 12 feedings in 24 Give baby vitamin D (400 IU per day). Mothers should continue prenatal vitamin with iron; 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 24 to 27 oz formula per day; hold baby semi-upright; don’t prop bottle.
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 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.