Bright Future – 9 Month Visit

Dec 6, 2019 admin NHI KHOA 0

Bright Future – 9 Month Visit

Health supervision

Surveillance of development

  • Social language and self-help
    • Uses basic gestures (holding arms out to be picked up, waving bye-bye)
    • Looks for dropped objects; plays game like peekaboo and pat-a-cake
    • Turns consistently when name called
  • Verbal language (Expressive and receptive)
    • Says “Dada” or “Mama” nonspecifically
    • Looks around when hearing things like “Where’s your bottle?” or “Where’s your blanket?”
    • Copies sounds that parent makes
  • Gross Motor
    • Sits well without support
    • Pulls to stand; transitions well between sitting and lying
    • Crawls on hands and knees
  • Fine Motor
    • Picks up food to eat; picks up small objects with 3 fingers and thumb
    • Lets go of objects intentionally; bangs objects together

Observation of Parent-infant interaction

Do parents stimulate infant with language, play? Do parents and infant demonstrate reciprocal engagement during play, feeding, eating? Is infant free to move away from parent to explore and check back with the parent visually and physically? Are parents’ developmental expectations appropriate? How do parents respond to infant’s autonomy or independent behavior within a safe environment?

Complete Physical Examination, including

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

Assess/observe for: Positional skull deformities; ocular motility, pupil opacification, red reflexes, visual acuity; heart murmurs; femoral pulses; developmental hip dysplasia; neurologic tone/ strength/movement, symmetry

Elicit: Parachute reflex

Screening (www.aap.org/periodicityschedule)

Universal: Development; Oral Health

Selective: Blood Pressure; Hearing; Lead; Oral Health; 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 (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.
    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).
  • 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.
    How does your baby adapt to new situations, people, places?
  • Play with cause-and-effect toys; talk/sing/read together; respond to baby’s cues.
    How do you think baby is learning? How is he communicating with you?
  • Avoid TV, videos, computers; consider making a family media use plan (healthychildren.org/MediausePlan).

Discipline: Parent expectations with child’s behavior

  • Use consistent, positive discipline (limit use of the word no, use distraction, be a role model).

Nutrition and feeding: Self-feeding, mealtime routines, transition to solid foods (table food introduction), cup drinking, plans for weaning

  • Gradually increase table foods; ensure variety of foods,
  • Provide 3 meals and 2 to 3 snacks a day.
  • Encourage use of cup; discuss plans for weaning.
  • Continue breastfeeding if mutually desired.

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.
    Does anyone in your home have a firearm? Have you considered not owning a firearm because of the danger to your child and other family members?
  • 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.

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