Bright Future – 6 Month Visit
Health supervision
Surveillance of development
- Social language and self-help
- Pats or smiles at own reflection
- Looks when name is called
- Verbal language (Expressive and receptive)
- Babbles; makes sounds like “ga,” “ma,” or “ba”
- Gross Motor
- Rolls over from back to stomach
- Sits briefly without support
- Fine Motor
- Passes a toy from one hand to another
- Rakes small objects with 4 fingers
- Bangs small objects on surface
Observation of Parent-infant interaction
Are parents and infant mutually responsive? Do parents show comfort and confidence with infant?
Does parent-infant relationship demonstrate comfort, adequate feeding/eating, and response to infant’s cues? Do parents appear to be happy, content, at ease? Do parents support 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; ocular mobility, pupil opacification, red reflexes, visual acuity; heart murmurs; femoral pulses; developmental hip dysplasia; neurologic tone, strength, movement symmetry
Screening (www.aap.org/periodicityschedule) universal: Depression: Maternal; Oral Health
Selective: Blood Pressure; Hearing; Lead; Oral Health; 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; tobacco, alcohol, and drugs; parental depression), strengths and protective factors (family relationships and 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? - Don’t use tobacco/e-cigarettes/alcohol/drugs. Call 800-Quit-NoW (800-784-8669) for help to quit smoking.
- Ask for help if you feel depressed, overwhelmed.
What are some of your best, and most difficult, times of day with baby? How are you feeling emotionally? - Depend on your social network.
Who are you able to go to when you need help with your family? - Choose trusted, responsible child care provider.
Infant behavior and development: Parents as teachers, communication and early literacy, media, emerging infant independence, putting self to sleep, self-calming
- Use high chair/upright seat so baby can see you.
- Engage in interactive, reciprocal Talk/sing/ read to, play games with baby.
How does your baby communicate or tell you what he wants and needs? - Avoid TV and other digital media with baby.
- Continue regular daily routines; put baby to bed awake but drowsy.
- Continue calming strategies when baby is fussy.
Oral health: Fluoride, oral hygiene/soft toothbrush, avoidance of bottle in bed
- Assess fluoride source.
- Clean teeth/gums 2 times per day with soft cloth/ toothbrush and small smear of fluoridated tooth- paste (no more than a grain of rice).
- Don’t prop bottle or use bottle in bed.
- Avoid baby foods/juices that baby sucks out of bag or pouch.
- Don’t share spoons; don’t clean pacifier in your mouth.
Nutrition and feeding: General guidance on feeding, solid foods, pesticides in vegetables and fruits, fluids and juice, breastfeeding guidance, formula-feeding guidance
- Exclusive breastfeeding for about the first 6 months, then breast milk and solid foods from about 6 to 12 months, is ideal; iron-fortified formula is recommended substitute.
- Position baby for feeding so you can see/talk to each other.
- Determine whether baby is ready for solids; introduce single-ingredient foods one at a time; provide iron-rich foods; respond to hunger, fullness cues.
- Wash vegetables and fruits before serving; limit juice to 2 to 4 oz per day.
- If breastfeeding: Continue as long as mutually Continue vitamin D/iron supplementation.
- If formula feeding: Don’t switch to Contact WIC/community resources for help.
Safety: Car safety seats, safe sleep, safe home environment: burns, sun exposure, choking, poisoning, drowning, falls
- Use rear-facing car safety seat in backseat; never put baby in front seat of vehicle with passenger air bag.
- Infants who reach maximum height/weight allowed by their rear-facing–only car safety seat should use a convertible or 3-in-1 seat approved for use rear facing to higher weights/heights (up to 50 lb and 49 in).
- Put baby to sleep on back; choose crib with slats less than 2⅜” apart; don’t use loose, soft bedding; lower crib mattress; never leave baby in crib with drop side down; choose mesh playpen with weave less than ¼”.
- Do home safety check (stair gates, barriers around space heaters, cleaning products).
- Don’t leave baby alone in tub, high places (changing tables, beds, sofas).
- Keep household products (cleaners, medicines) locked and out of baby’s Put Poison Help number (800-222-1222) at all telephones, including cell.
- Keep baby in high chair/playpen when in kitchen.
- Avoid burn risk (drinking hot liquids, cooking, ironing, smoking); set home water temperature less than 120°F.
- Keep small objects, all plastic bags away from baby.
- To prevent choking, limit finger foods to soft bits.
- Avoid sun exposure; use hat/infant sunscreen.