Bright Future – Newborn Visit
Health supervision
Surveillance of development
- Social language and self-help
- Has periods of wakefulness; looks at and studies parent when awake; looks in parent’s eyes when being held
- Calms when picked up; responds differently to soothing touch and alerting touch
- Verbal language (Expressive and receptive)
- Communicates discomfort through crying and behaviors such as facial expressions, body movements, movement of arms and legs
- Moves or calms to parent’s voice
- Gross Motor
- Moves in response to visual or auditory stimuli
- Reflexively moves arms and legs, observed in the Moro and tonic neck reflexes
- Fine Motor
- – Keeps hands in fist; automatically grasps others’ fingers or objects
Observation of Parent-Newborn interaction
Who asks/who responds to questions? Do the verbal/nonverbal behaviors/communication between family members indicate support, under- standing, differences of opinion/conflicts? Do parents recognize and respond to baby’s needs? Are they comfortable when feeding/holding/ caring for baby? Do they have visitors, other signs of support network?
Complete Physical Examination, including
Measure and plot: Length, weight, head circumference, and weight-for-length
Assess/observe for: Alertness, distress; congenital anomalies; skin lesions or jaundice; head shape/ size, fontanels, signs of birth trauma; eyes/eyelids,pupil opacification, red reflexes, visual acuity; pinnae, patency of auditory canals, pits or tags; nasal patency, septal deviation; cleft lip/palate, natal teeth, Epstein pearls; heart rate/rhythm/sounds, heart murmurs; femoral pulses; umbilical cord/cord vessels; descended testes; penile anom- alies, labial/vaginal anomalies, anal position and patency; back/spine/foot/arm/hand deformities; clavicles for crepitus; primitive reflexes, limb symmetry, extremity movement, muscle tone
Perform: Ortolani and Barlow maneuvers
Screening (www.aap.org/periodicityschedule)
Universal: Hearing; Newborn: Bilirubin; Newborn: Blood; Newborn: Critical Congenital Heart Disease
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, intimate partner violence, maternal alcohol and substance use), strengths and protective factors (family support, parent- newborn relationship)
- 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? - Don’t use alcohol/drugs/tobacco/e-cigarettes. Call 800-Quit-NoW (800-784-8669) for help to quit smoking.
- 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).
- Accept help from family and friends.
Is there someone who can help you care for your baby? - Physical contact (holding, carrying, rocking) helps baby feel secure.
Parent and family health and well-being: Maternal health and nutrition, transition home (assistance after discharge), sibling relationships
- Continue taking your prenatal vitamin with iron.
- Accept help once you get home so you can recover from the delivery and focus on the baby.
- Spend time with your other children; help them adjust to baby.
Newborn behavior and care: Infant capabilities, baby care (infant supplies, skin and cord care), illness prevention, calming your baby
- Baby is beginning to know Learn baby’s temperament, reactions.
- Create nurturing routines; physical contact and talking helps baby feel secure and learn.
- Use fragrance-free soap/lotion; avoid powders; avoid direct sunlight.
- Change diaper frequently to prevent diaper rash.
- Cord care: Air-dry by keeping diaper below navel; call if bad smell, redness, fluid from the area.
- Wash your hands often.
- Avoid others with colds/flu.
- Never hit or shake baby.
What do you do to calm your baby? What do you do if that doesn’t work?
Nutrition and feeding: 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, fullness; develop feeding routine; adequate weight gain is 6 to 8 wet diapers a day; give no extra fluids.
- If breastfeeding: Provide 8 to 12 feedings in 24 hours; should not hurt; continue prenatal vitamin; avoid alcohol.
- if formula feeding: Prepare/store formula safely; feed on cue, at least 8 times in 24 hours; hold baby semi-upright; don’t prop bottle.
Safety: Car safety seats, heatstroke prevention, safe sleep, pets, 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.
- Always use seat belt; do not drive under the influence of alcohol or drugs.
- Prevent heatstroke; never leave your 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.
- Learn about pet risks.
- Keep home safe for baby.
What changes have you made in your home to ensure your baby’s safety?