1st question to ask parents 

Do you have any concerns today?

Disease Detection 

2 techniques 

1. Surveillance 

2. Screening 

Surveillance 

A continuous process where the HCP perform skills observations of children 

-- eliciting/attending to parental concerns 

--obtain relevant history

--making accurate/informative observations of children

--sharing opinions/concerns 

Screening 

 the formal process that employs a standardized tool to detect a particular disease state 

--can be for all or only one patient 

--selective screening is performed on patients for whom a risk assessment suggests a concern 

Universal screening for 1 year old 

Anemia

-check Hgb/Hct 

Anemia risk assessment for 2-year-old 

-dietary history 

-family history 

-knowledge of SE factors 

Disease prevention 

Primary - prevention activities applied to a population

secondary - prevention aimed at patients with specific RF 

Back to Sleep

Essential disease prevention for the care of an infant 

Health Promotion 

Activities that focus the visit on the wellness 

The Encounter includes

Disease detection, disease prevention, and health promotion 

New health promotion theme added to BF 

Promoting lifelong health for families and communities 

HCP assess emerging issues that a child and family face while giving advice that is developmentally consistent 

--needs to be timely, appropriate and relevant 

The timing of the visit 

15-18 minutes for face to face encounter 

5 additional priorities for each visit 

1. history

2. surveillance and development

3. ROS

4. parent/child interaction

5. physical exam 

Assessment of growth <2 years old 

weight, length, head circumference, and weight for length 

Assessment of growth > 2 years old 

Weight, height, BMI 

BMI 

< 5th % underweight

>5% <85 % health

> 85% < 95% overweight

> 95% obesity 

Universal screening 

Applied to each child at the

visit 

Selective screening

Only if risk assessment is (+) 

Examination of infant 

-Examine in front of parents

(so HCP can see interaction)

-HCP can reinforce positive interaction between parent and child 

Examination in early childhood 

-Ordered approach 

-Younger children will want close contact with a parent 

-Older children make take lead 

Middle Childhood 

-identification of learning barriers or mental health problems are important at this age because these can influence lifelong habits 

-children are developing a growing consciousness of their bodies (privacy is important) 

Examination of adolescence 

-major growth/hormonal changes (important to follow growth parameters) 

-health-risk behaviors (sex, sexually-related issues, contraception, STIs) 

-screening for CV risk to help prevent onset of disease in early adulthood 

prenatal visit 

recommended for all expectant families to establish a child's medical home 

Infancy: Prenatal visit

*Surveillance of development 

Question "What have you heard about what newborns can do at birth?" 

-Newborns can smell, hear voices, see up to 1st in front of them

-Communication through crying

-There is a lot to learn living outside of the womb 

Infancy: prenatal visit 

Screening 

Inform parents of newborn blood screening (metabolic, endocrine, hemoglobinopathy, jaundice, congenital heart disease, and hearing) 

-Inquire about maternal prenatal testing (AFP, diabetes, hep B, STDs, group B strep) 

Discussing immunizations 

<6 months are too young for flu vaccination - encourage caregivers of infants to get vaccination though! 

-recommend Tdap (pertussis) for adults who will be caring for the infant 

-CDC rec. every pregnant woman receive Tdap with pregnancy after 20 weeks 

Social Determinants of health 

Risks: Living situation and security 

Tell me about your living situation? Do you have things at home to take care of a baby (crib, car seat, diapers) 

Do you have enough heat, water, electricity? 

Have you ever been worried you'll run out of food? 

Pregnancy: substance abuse 

Mental health screening

Anticipatory guidance for mental health 

-Although a baby is a wonderful experience, it's important to not ignore the stress that often occurs during parents a newborn

-Common for women to feel depressed and even fathers 

-Emphasize healthy behaviors: sleep, eating healthy, finding time for light physical activity 

Diet: balance with a prenatal vitamin containing folic acid, Vit D, choline, and iron 

-200 to 300mg of PUFA, DHA

-1 to 2 three oz portions of seafood are sufficient for DHA 

-Avoid fish high in mercury (tilefish, swordfish, shark and king mackerel) 

-Activity 5x/week for 30 minutes 

-eating a small serving of fish

-avoid fish high in mercury

-consuming milk, eggs or meat every day is recommended

-talk with HCP about physical activity 

Newborn care 

Introduction to the practice as a medical home 

-Concerns about caring for a new baby? 

-Challenges as new parents?

AG: learn as much about the baby as possible

-we will provide you information regarding practice

-help other children adapt to new baby 

Iron-fortified formula is recommended for 1st year of life 

Car Seat Safety 

<2 years p;d should ride rear-facing in back seat of car 

-do not use extra products that did not come in the box with the car safety seat (just tuck a blanket around the baby over the straps) 

-bring home in rear-facing carseat 

-never put rear facing carseat in the front 

-never leave a child alone in the car 

-start developing habits to check back of the seat (putting a purse in back) 

-check back seat every time 

How to prevent SIDS 

-Back to sleep 

-Avoid using wedges, position devices 

-bed sharing is NOT recommended

Swaddling 

-Ok calming technique if infant is AWAKE

-NOT recommended for sleep

-< 2 months of age, should be encouraged to remove wrap

-> 2 months of age, swaddling should never be used for sleep 

-Tight swaddling could cause hip dysplasia 

Sleep 1st 6 months

-Baby should sleep in your room in their own crib, NOT in bed

-Consider when the crib was made d/t railings