Pediatric Primary Care Read Online Free PDF Page B

birth weight by 2 weeks of age.
B.  Infant grows 1 in., on average, per month for first 6 months.
C.  Head circumference increases 9 cm in first year.
D.  Has minimal head control.
E.  Looks at person during feeding.
F.  Tracks 45°.
XI.  SOCIAL DEVELOPMENT
A.  Babies have different cries, will fuss/cry 1 to 2 hours/day.
1.  Similar time/pattern daily.
2.  Provide for infant's needs and crying should cease.
3.  Cry gradually decreases by 3 months of age.
B.  Refer all high-risk infants/mothers to social worker before release. High-risk situations include:
1.  Adolescent pregnancy.
2.  No prenatal care.
3.  Consideration about giving up the baby for adoption.
4.  Unwanted pregnancy.
5.  Insufficient support from those at home.
6.  Physical limitations of parent.
7.  Inadequate housing/finances.
8.  Domestic violence.
9.  Positive toxicology.
10.  Incarcerated parent.
11.  Emotional disorders.
12.  Parent with mental retardation.
13.  Multiple small children in home.
XII.  IMMUNIZATIONS (SEE APPENDIX A )
A.  Only monovalent hepatitis B can be used for birth dose. If mother is hepatitis B surface antigen (HBsAg) positive, administer hepatitis B vaccine and 0.5 mL of hepatitis B immune globulin (HBIG) within 12 hours of birth. If mother's HBsAg status is unknown, administer hepatitis B vaccine within 12 hours of birth and determine mother's HBsAg status as soon as possible. If she is then positive, the newborn should receive HBIG within 1 week of life. Monovalent hepatitis B should be given if second dose is given less than 6 weeks of age. Monovalent or combination vaccine can be used to complete series.
XIII.  SAFETY/ANTICIPATORY GUIDANCE
A.  Sleep position “back to sleep.”
B.  Not safe for baby to sleep in adult bed; must discuss with parents.
C.  Use federal motor vehicle safety standards (FMVSS) tested and approved car seat; install properly in backseat, facing backward in automobile. Contact local hospital, fire department, or March of Dimes chapter for car seat rental program. Infants should ride in the rear-facing position in either an infant seat or a convertible car seat until they are at least 1 year of age and 20 lbs.
D.  No smoking around infant.
E.  One-piece pacifiers only.
F.  No corn syrup (Karo) for constipation, but may give 1 oz of sterile water/ 24 hours.
G.  No solids, only breastmilk or formula fed to infant.
H.  When to call healthcare provider.
1.  Breathing difficulties—too fast or too slow or color changes; seizures; irritability; poor feeding; vomiting; no urine in 12 hours; black or decreased bowel movements; reddened, draining umbilical site; jaundice; rash or pustules not present on discharge; concerns.
I.  Give office phone number, explain how to use system.
XIV.  DISCHARGE TO HOME
A.  Review all records/progress.
B.  Repeat complete physical examination.
C.  Identify abnormal findings that require ongoing monitoring.
D.  Review hearing screening results and if not done, schedule before discharge.
E.  Collect newborn blood screen.
F.  Administer hepatitis B immunization.
G.  Complete all consults.
H.  Staff nurses will have covered discharge instructions of bathing, cord care, bulb syringe, diapering, dressing, fingernail care, holding, feeding.
I.  If concerns, infants should be scheduled for office visit within two days, otherwise parents need a two-week follow-up appointment assigned before discharge. Make them comfortable knowing they can call with any concerns.
BIBLIOGRAPHY
Ballard JL, Khoury JC, Wedeg K, et al. New Ballard Score expanded to Include extremely premature infants. Pediatrics. 1991;119:417-423.
Fouzas S, Mantagou L, Skylogianni SM, et al. (2009). Transcutaneous bilirubin levels for the first 120 postnatal hours in healthy neonates. Pediatrics. 2009;125(1):e52-e57. Retrieved from American Academy of Pediatrics website: http://www.pediatrics.org/cgi/content/full/125/1/e52 . Accessed