Bright Future – 4 Month Visit

Dec 6, 2019 admin NHI KHOA 0

Bright Future – 4 Month Visit

Health supervision

Surveillance of development

  • social language and self-help
    • Laughs aloud
    • Looks for parent or another caregiver when upset
  • Verbal language (Expressive and receptive)
    • Turns to voices
    • Makes extended cooing sounds
  • Gross Motor
    • Supports self on elbows and wrists when on stomach
    • Rolls over from stomach to back
  • Fine Motor
    • Keeps hands unfisted; plays with fingers in midline; grasps objects

Observation of Parent-infant interaction

Are parents and baby mutually responsive? Do the parents attend to and support infant during the examination? How do the parents interact with each other?

Complete Physical Examination, including

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

Assess/observe for: Skin lesions/birthmarks/ bruising; positional skull deformities; pupil opacification, red reflexes, visual acuity; heart murmurs; femoral pulses; developmental hip dysplasia; neurologic tone/strength/movement symmetry, diminishing primitive reflexes

Screening (www.aap.org/periodicityschedule) universal: Depression: Maternal

selective: Anemia; Blood Pressure; Hearing; 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 (environmental risk: lead, work-related exposures), strengths and protective factors (family relationships and support, child care)

  • Reduce lead exposure at home.
  • Maintain social contacts; make time for self, partner; spend time with your other children.
  • Make quality child care arrangements.

Infant behavior and development: Infant self-calming, parent-infant communication, consistent daily routines, media, playtime

  • Continue calming strategies when baby is fussy.
    What do you do to calm your baby? What do you do if that does not work? Do you ever feel that you and/or other caregivers may hurt the baby?
  • Spend time talking/playing with baby.
  • Create daily routine for feeding/naps/bedtime.
  • Avoid TV and other digital media with baby.
  • Use quiet (reading, singing) and active (“tummy time”) playtime; provide safe opportunities to explore.

Oral health: Maternal oral health, teething and drooling, good oral hygiene (no bottle in bed)

  • Don’t share spoons; don’t clean pacifier in your mouth; maintain good dental hygiene.
  • Use cold teething ring to relieve teething pain.
  • Don’t put baby in crib with a bottle; never prop bottle when feeding.
  • Clean teeth/gums 2 times per day; use soft cloth/ toothbrush with tap water and small smear of fluoridated toothpaste (no more than a grain of rice).

Nutrition and feeding: General guidance on feeding, feeding choices (avoid grazing), delaying solid foods, breastfeeding guidance, supplements and over-the-counter medications, formula- feeding guidance

  • Exclusive breastfeeding for about the first 6 months is ideal; iron-fortified formula is recommended substitute.
  • Delay solid foods until baby is 6 months old.
  • If breastfeeding: Recognize growth Give baby vitamin D (400 IU per day). Begin infant iron supplementation. Discuss safe pumping/ storing breast milk. Report any medications/ supplements/herbs/vitamins.
  • if formula feeding: Prepare/store formula safely; 8 to 12 times in 24 hours; 30 to 32 oz total; hold baby semi-upright; consider contacting WIC.

Safety: Car safety seats, safe sleep, safe home environment

  • 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 drugs.
  • Put baby to sleep on back; choose crib with slats less than 2⅜” apart; don’t use loose, soft bedding.
  • Avoid burn risk while holding baby (drinking hot liquids, cooking, ironing, smoking); set home water temperature less than 120°F.
  • Don’t leave baby alone in tub, high places (changing tables, beds, sofas); keep hand on baby (“touch supervision”).
  • Keep small objects, plastic bags away from Avoid infant walkers.

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