New Born Physical-Powers Development Guide

What to except during a New Born Physical?

Developmental Surveillance

• Social Language and Self-Help
  • Has periods of wakefulness
  • Looks at and studies parent
  • Looks in parent’s eyes
  • Calms when picked up
• Verbal Language
  • Communicates discomfort through crying
  • Facials expressions, Body movements
  • Moves or calms to parent’s voice
• Gross Motor
  • Moves to visual or auditory stimuli
  • Reflexively moves arms and legs
• Fine Motor
  • Keeps hands in fist
  • Automatically grasps others’ fingers

PHYSICAL EXAMINATION

• History
  • Initial
• Measurements
  • Length/Height and Weight
  • Head Circumference
  • Weight for Length
  • Blood Pressure
• PROCEDURES
  • Newborn Blood
  • Newborn Bilirubin
  • Critical Congenital Heart Defect
• SENSORY SCREENING
  • Vision
  • Hearing

Immunization

• 1^st Dose
  • Hepatitis B (HepB)

1. Blood pressure measurement in infants and children with specific risk conditions should be performed at visits before age 3 years. [Reference]
2. Instrument-based  screening may be used to assess risk at ages 12 and 24 months. [Reference]
3. Confirm initial screen was completed, verify results, and follow up, as appropriate. [Reference] 
4. This assessment should be family centered and may include an assessment of child social-emotional health, caregiver  depression, and social determinants of health. [Reference]
5. At each visit, age-appropriate physical examination is essential, with infant totally unclothed and older children undressed and suitably draped. The extent of the physical examination is determined by both the reason for the visit and diagnostic considerations raised during the taking of the history). [Reference]
6. Confirm initial screen was accomplished, verify results, and follow up, as appropriate. //genes-r-us.uthscsa.edu/home
7. Confirm initial screening was accomplished, verify results, and follow up, as appropriate. See “Hyperbilirubinemia in the Newborn Infant ≥35 Weeks’ Gestation: [Reference]
8. Screening for critical congenital heart disease using pulse oximetry should be performed in newborns, after 24 hours of age, before discharge from the hospital. [Reference]
9. Every visit  should be an opportunity to update and complete a child’s immunizations. [Reference]

Newborn Anticipatory Guidance

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)

• Tell me about your living situation. What are your resources for caring for the baby?
  • Community agencies can help you with concerns about your living 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?
  • Programs like WIC and SNAP are available to help you if you have concerns about your food situation.
• Don’t use alcohol/drugs/tobacco/e-cigarettes. Call 800-QUIT-NOW (800-784-8669) for help to quit smoking.
• 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?
  • Ask for help if you are concerned about or have experienced violence from your partner or another significant person in your life.
  • You can also call the National Domestic Violence Hotline toll-free at 800-799-SAFE (7233).
• Is there someone who can help you care for your baby?
  • Accept help from family and friends.
• Parent and family health and well-being:
  • Maternal health and nutrition, transition home (assistance after discharge), sibling relationships
  • Physical contact (holding, carrying, rocking) helps baby feel secure.
• 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 you. 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

• Car Seat
  • Use rear-facing car safety seat in backseat
  • Never put baby in front seat of vehicle with passenger air bag
  • 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 21/s” apart; don’t use loose, soft bedding; have baby sleep in your room in own crib.
• Learn about pet risks.
• What changes have you made in your home to ensure your baby’s safety?
  • Keep home safe for baby.

Goals For New Born Check up:

• Be gentle and patient
• Get more sleep
• Make a budget
• Leave your work at the office
• Focus on self-care
• Meditate as a family
• Find an outlet
• “cell-free” zone
• Spend more time with your partner
• Take more baths
• Have a girls’/boys’ night
• Be more flexible
• See your child for who they are
• Teach your child to speak up
• Help those less fortunate
• Drink more water
• Find 30 minutes a day of “me” time
• Challenge yourself
• Focus on experiences, not things
• Make health a priority
• Start—or finish—a degree
• Inform yourself
• Maintain balance
• Laugh often
• Cook dinner more frequently
• Ask for help
• Have designated “cheat” days
• Stop having FOMO
• Say “I love you” more often