Prenatal and Newborn Visit
Anticipatory guidance, physical exam, & developmental milestones
Anticipatory Guidance FAMILY RESOURSES
- For this visit you want help the mother identify resources such as family support system, transition home (assistance after discharge) family resources and the use of community resources.
- Anticipate challenges of caring for the new baby
- Ensure they have a support system at home (Friends, relatives) o Contact community resources for help if they need
- Always want to discuss the purpose and importance of the NB screening test (metabolic, hearing) that will be done in the hospital before the baby is discharge from hospital.
- Discuss routine initiation of immunizations
Parental (Maternal) Well-being
- Tell the mother to always maintain her health by keeping medical appointments, taking vitamins, getting good amount of sleep, exercise and use personal safety measures. Remember pregnant women are more prone to violence by their partners observed who answered all the questions in the interview and how they communicate among each other. All women should be screened at each visit for intimate partner violence.
- Know HIV status
- Consider how the mother if feeling about her pregnancy
- Always ask mom what are you plans for feeding the baby?
- Choose breastfeeding if possible ; use iron-fortified formula if formula feeding
- Always ask mom about any supplement/OTC use
- If mom is concerned about not having money to buy food or infant formula, ask them if they would be interested in resources that would help her.
- Contact WIC/ community resources if needed.
- Use safety belt
- Install a rear-facing car safety seat in the back seat
- Learn about pet risk. If they have a cat, have they been tested for toxoplasmosis antibodies
- Don’t use alcohol/drugs
- Keep home/vehicle smoke free; check home for lead, mold
- Removed guns from home; if gun is necessary, store unloaded and locked with ammunition separate
- Set home water temperature < 120 F, install smoke detectors, CO2 detector/alarm
- Ask for information about practice
- Put the baby to sleep on back; choose crib with slats <2 apart; have baby sleep in your room in own crib
- Wash hands frequently (diaper changes, feeding)
- Limit baby’s exposure to others
Observation of Parent-Child interaction: Do parents recognize and responds to the baby’s needs? Are they comfortable when feeding, holding, or caring for the baby? Do they have visitors or other signs of a support network?
Surveillance of Development: Has periods of wakefulness, is responsive to parental voice and touch, Is able to be calmed when picked up, looks at parents when awake, moves in response to visual or auditory stimuli.
Physical Exam. Complete, including: Measure and plot length, weight, head circumference; plot weight and length. Assess/observe alertness, distress, congenital anomalies; skin lesions or jaundice, head shape/size, fontanelles, signs of birth trauma; eyes/eyelids, ocular mobility. Examine Pupils for opacification, red reflexes. Assess/observe pinnae, patency of auditory canals, pits or tags; nasal patency, septal deviation; cleft lip or palate, natal teeth/HR/rhythm/heart murmurs. Palpate femoral pulses. Examine/Determine umbilical cord/cord vessels descended testes, penile anomalies, anal patency. Note back/spine deformities. Perform Ortolani and Barlow Maneuvers. Detect primitive reflexes.
Anticipatory Guidance Family Readiness
- Accept help from families and friends
- Never hit or shake the baby
- Take care of yourself; make time for yourself and partner
- Feeling tired, blue or overwhelmed in the first weeks is normal. If it continues, resources are available to help.
- Learn baby’s temperament reactions
- Create Nurturing routines; physical contact ( holding, carrying, rocking) helps baby feel secure
- Put baby to sleep on back; don’t use loose, soft bedding; have baby sleep in your own room, in own crib
- Exclusive breastfeeding during the first 4-6 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 =6-8 wet diapers a day, no extra fluids
- If breastfeeding 8-12 feedings in 24 hours. Tell mom to continue prenatal vitamins and avoid alcohol
- If formula feeding; prepare/store formula safely; feed every 2-3 hours; hold baby semi-upright; don’t prop bottle
- Contact WIC if needed as stated before
- Rear-facing car safety seat in back seat; never put baby in front seat of vehicle with passenger air bag. Baby must remain in car safety seat at all times during travel
- Keep hand on baby when changing diaper/clothes o Use all other Safety measures as stated before
Routine Baby Care
- Use fragrance –free soap/lotion, avoid powders; avoid direct sunlight
- Change diaper frequently to prevent diaper rash
- Cord care: “ air drying” by keeping diaper below; call if bad smell, redness, fluid from the area
- Wash your hands often
- Avoid others with cold/flu
First Week Visit
Observation of Parent-Child Interactions: Do parents and newborn respond to each other? Do parents appear content, depressed, angry, fatigued, overwhelmed? Are parents responsive to newborn’s distress? Do the parents’ and newborns interactions around comforting, distressing/ changing diapers, and feeding? Do parents support each other?
Developments milestones: Is able to sustain periods of wakefulness for feeding, will gradually become able to establish longer streach of sleep (4-5hrs) at night. Turns head to parent’s voice, communicates needs through behaviors, has undifferentiated cry. Able to fix briefly on faces or objects, follows face to midline. Can hold head briefly I the prone position.