Bright Future – 2 Month Visit

Dec 6, 2019 admin NHI KHOA 0

Bright Future – 2 Month Visit

Health supervision

Surveillance of development

  • Social language and self-help
    • – Smiles responsively; makes sounds that show happiness/upset
  • Verbal language (Expressive and receptive)
    • – Makes short cooing sounds
  • Gross Motor
    • – Lifts head and chest when on stomach
    • – Keeps head steady when held in a sitting position
  • Fine Motor
    • – Opens and shuts hands; briefly brings hands together

Observation of Parent-infant interaction

Are parents responsive to baby’s cues? How do parents interact with baby? What are parents’ appearance and emotional state? Do they support each other and demonstrate confidence with baby?

Complete Physical Examination, including

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

Assess/observe for: Skin lesions/birthmarks/ bruising; fontanelles occipital shape; pupil opacification, red reflexes, visual acuity; heart murmurs; femoral pulses; torticollis, neurologic tone, strength, and symmetry of movements

Perform: Ortolani and Barlow maneuvers

Screening (www.aap.org/periodicityschedule) universal: Depression: Maternal; 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), strengths and protective factors (family support, child care)

  • 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?
  • Handle unwanted advice by acknowledging, then changing,
  • Take time for self, Maintain social contacts.
  • Choose quality child care; recognize that separation is hard.
    How do you feel about leaving your baby with someone else?

 Parent and family health and well-being: Post- partum checkup, depression, sibling relationships

  • Have postpartum checkup; talk with partner about family
  • Anxiety, depression are common after birth; getting 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?
  • Spend time with your other children; engage them in care of baby if appropriate.

Infant behavior and development: Parent-infant relationship, parent-infant communication, sleeping, media, playtime, fussiness

  • Hold, cuddle, talk, sing to baby.
    What do you and your partner enjoy most about your baby? What is challenging?
  • Learn baby’s temperament, personality.
    What do you think your baby is feeling and trying to tell you?
  • Pay attention to baby’s cues for sleep; develop schedule for naps and nighttime Put baby to bed awake but drowsy.
  • Avoid TV and other digital media with baby.
  • Use “tummy time” when awake.
  • Calm baby by stroking head, gentle rocking, walking with baby in stroller.
  • Never hit or shake baby.

Nutrition and feeding: General guidance on feeding and delaying solid foods, hunger and satiety cues, breastfeeding guidance, formula-feeding guidance

  • Exclusive breastfeeding for about the first 6 months of life provides ideal nutrition, supports best growth and development; iron-fortified formula is recommended substitute; recognize signs of hunger, fullness; 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.
  • If breastfeeding: Provide 8 to 12 feedings in 24 hours. Give baby vitamin D (400 IU per day). Mothers should continue prenatal vitamin with iron; healthy diet (fish, protein).
    How is breastfeeding going? Is baby breastfeeding exclusively? If not, what else is baby getting?
  • If formula feeding: Prepare/store formula safely; feed 6 to 8 times in 24 hours; 26 to 28 oz formula total; hold baby semi-upright; don’t prop bottle.
    How is formula feeding going for you and your baby? Have you offered your baby anything other than formula?

Safety: Car safety seats, safe asleep, safe home environment: burns, drowning, and falls

  • 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.
  • Don’t drink hot liquids while holding baby; 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”).

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