Read Online Pediatric Primary Care by Beth Richardson - Free Book Online Page B
Authors: Beth Richardson
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hot beverages while holding baby.
7. One-month old infant will take 4-6 oz/feeding and 5-6 feedings/24 hours (90-120 cal/kg/day).
III. ELIMINATION
A. Should have 1-6 yellow pasty stools/24 hours.
B. With each feeding, breastfed infant may have softer, formed/seedy stools.
C. Void every 1-3 hours or with each feeding.
IV. SLEEP
A. Awake and alert for feedings, every 2-4 hours. Baby will suck vigorously for 15-20 minutes, then fall back to sleep.
B. Babies should sleep in own cribs, not with parents, to decrease risk of smothering or injury.
C. Babies should sleep on back or side in cribs to decrease risk of sudden infant death syndrome (SIDS).
D. No pillows/toys that baby could get face against and smother.
V. GROWTH AND DEVELOPMENT
A. Growth. Weigh infant naked on infant scales. Compare weight to last visit. Calculate rate of gain since last visit. Measure length on length board and head circumference. Plot values on National Center for Health Statistics (NCHS) growth chart. Discuss your findings from the growth charts.
1. Should gain 0.5-1 oz/day or approximately 2 lbs/month for next 4 months.
2. Infant grows, on average, 1 in./month for first 6 months.
3. Head circumference increases 0.5 cm/month in first year.
B. Development. Responds to human face and follows briefly with eyes. Is attentive to sound of parent's voice.
1. May be able to lift head off bed if on tummy.
2. May have a smile.
3. Has positive red reflexes bilaterally and blinks to light. Tear ducts may have tears appear; tear ducts should be patent.
4. Assess scalp for cradle cap and diaper area for dermatitis. Review how to care for baby's skin.
Examine baby's mouth for teeth, intact palate, and presence of thrush. If bottle-feeding and thrush is found, discuss cleaning of pacifiers, nipples. If breastfeeding, review washing nipples before feedings, and applying antifungal (prescription) after feedings.
5. Gently palpate abdomen looking for masses, and location of the liver.
6. Observe movement of all 4 extremities, usually simultaneously. Has a flexed posture and keeps hands fisted.
7. May cry but parents are learning what each cry means; crying ceases with needs being met. Cry gradually decreases by 3 months of age.
8. May have “fussy” time of 1-2 hours/day, often in evening. Use “fussy” time as interaction time, not extra feeding.
9. Baby may have symptoms of “colic” start around 2-3 weeks of age. Infant cries for prolonged periods, no specific cause or pathology identified. Infant requires additional comfort measures to quiet and settle.
VI. SOCIAL DEVELOPMENT
A. Parent should be assessed for sadness, depression, fatigue. Parent should show attentive, animated behavior toward baby. Listen carefully for frustration, potential for abuse/neglect.
B. Parents should hold, cuddle, and talk to infant when awake. Infant should have 15-20 minutes of “tummy time” with supervision, daily.
C. Discourage taking baby to public places or visiting relatives because no immunizations as yet.
D. Encourage mother to rest when baby rests/sleeps.
E. Baby is learning to “trust” parent and caretakers.
VII. IMMUNIZATIONS (SEE APPENDIX A )
A. If mother is HBsAg-, infant may not have received hepatitis B #1 in newborn nursery or at 2-week visit. Will need to get it today.
B. Discuss need for immunizations at next visit. Parents hear many negative remarks from friends and family and the Internet. But they do listen to a trusted healthcare provider.
C. Infants should not have fever or fussiness from immunization.
VIII. SAFETY/ANTICIPATORY GUIDANCE
A. Sleep position “back to sleep.”
B. Protect baby from direct sunlight. Skin is very sensitive and they burn easily.
C. Not safe for baby to sleep in adult bed.
D. Temperature of room comfortable. Discuss type of clothing needed to dress infant for inside, outside, and for bed.
E. A Federal Motor Vehicle Safety
7. One-month old infant will take 4-6 oz/feeding and 5-6 feedings/24 hours (90-120 cal/kg/day).
III. ELIMINATION
A. Should have 1-6 yellow pasty stools/24 hours.
B. With each feeding, breastfed infant may have softer, formed/seedy stools.
C. Void every 1-3 hours or with each feeding.
IV. SLEEP
A. Awake and alert for feedings, every 2-4 hours. Baby will suck vigorously for 15-20 minutes, then fall back to sleep.
B. Babies should sleep in own cribs, not with parents, to decrease risk of smothering or injury.
C. Babies should sleep on back or side in cribs to decrease risk of sudden infant death syndrome (SIDS).
D. No pillows/toys that baby could get face against and smother.
V. GROWTH AND DEVELOPMENT
A. Growth. Weigh infant naked on infant scales. Compare weight to last visit. Calculate rate of gain since last visit. Measure length on length board and head circumference. Plot values on National Center for Health Statistics (NCHS) growth chart. Discuss your findings from the growth charts.
1. Should gain 0.5-1 oz/day or approximately 2 lbs/month for next 4 months.
2. Infant grows, on average, 1 in./month for first 6 months.
3. Head circumference increases 0.5 cm/month in first year.
B. Development. Responds to human face and follows briefly with eyes. Is attentive to sound of parent's voice.
1. May be able to lift head off bed if on tummy.
2. May have a smile.
3. Has positive red reflexes bilaterally and blinks to light. Tear ducts may have tears appear; tear ducts should be patent.
4. Assess scalp for cradle cap and diaper area for dermatitis. Review how to care for baby's skin.
Examine baby's mouth for teeth, intact palate, and presence of thrush. If bottle-feeding and thrush is found, discuss cleaning of pacifiers, nipples. If breastfeeding, review washing nipples before feedings, and applying antifungal (prescription) after feedings.
5. Gently palpate abdomen looking for masses, and location of the liver.
6. Observe movement of all 4 extremities, usually simultaneously. Has a flexed posture and keeps hands fisted.
7. May cry but parents are learning what each cry means; crying ceases with needs being met. Cry gradually decreases by 3 months of age.
8. May have “fussy” time of 1-2 hours/day, often in evening. Use “fussy” time as interaction time, not extra feeding.
9. Baby may have symptoms of “colic” start around 2-3 weeks of age. Infant cries for prolonged periods, no specific cause or pathology identified. Infant requires additional comfort measures to quiet and settle.
VI. SOCIAL DEVELOPMENT
A. Parent should be assessed for sadness, depression, fatigue. Parent should show attentive, animated behavior toward baby. Listen carefully for frustration, potential for abuse/neglect.
B. Parents should hold, cuddle, and talk to infant when awake. Infant should have 15-20 minutes of “tummy time” with supervision, daily.
C. Discourage taking baby to public places or visiting relatives because no immunizations as yet.
D. Encourage mother to rest when baby rests/sleeps.
E. Baby is learning to “trust” parent and caretakers.
VII. IMMUNIZATIONS (SEE APPENDIX A )
A. If mother is HBsAg-, infant may not have received hepatitis B #1 in newborn nursery or at 2-week visit. Will need to get it today.
B. Discuss need for immunizations at next visit. Parents hear many negative remarks from friends and family and the Internet. But they do listen to a trusted healthcare provider.
C. Infants should not have fever or fussiness from immunization.
VIII. SAFETY/ANTICIPATORY GUIDANCE
A. Sleep position “back to sleep.”
B. Protect baby from direct sunlight. Skin is very sensitive and they burn easily.
C. Not safe for baby to sleep in adult bed.
D. Temperature of room comfortable. Discuss type of clothing needed to dress infant for inside, outside, and for bed.
E. A Federal Motor Vehicle Safety
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