Pediatric Primary Care (16 page)

B.  Books.

Biancuzzo M,
Breastfeeding the Newborn: Clinical Strategies for Nurses. 2nd ed.
St. Louis, MO: Mosby; 2003.

Hale TW.
Medications and Mother's Milk.
14th ed. Amarillo, TX: Hale Publishing, L.P.; 2010.

Lauwers J, Swisher A.
Counseling the Nursing Mother: A Lactation Consultant's
Guide. 5th ed. Sudbury, MA: Jones & Bartlett Learning; 2011.

Newman J, Pitman T.
The Ultimate Breastfeeding Book of Answers.
NY: Three Rivers Press; 2006.

Riordan J, Wambach K.
Breastfeeding and Human Lactation.
14th ed. Sudbury, MA: Jones & Bartlett Learning; 2010.

Wilson-Clay B, Hoover K.
The Breastfeeding Atlas.
4th ed. Manchaca, TX: LactNews Press; 2008.

C.  Online resources.

American Academy of Breastfeeding Medicine:
www.bfmed.org

American Academy of Pediatrics:
www.aap.org

Breastfeeding Pharmacology (Dr. Thomas Hale):
http://neonatal.ttuhsc.edu/lact/

Human Milk Banking Association of North America:
www.hmbana.com

La Leche League International:
www.lalecheleague.org

UNICEF's 10 Steps to Successful Breastfeeding:
www.unicef.org/newsline/tenstps.htm

U.S. Breastfeeding Committee:
www.usbreastfeeding.org

World Alliance for Breastfeeding Advocacy:
http://waba.org/my/

BIBLIOGRAPHY

Academy of Breastfeeding Medicine. ABM Clinical Protocol #8: Human Milk Storage Information for Home Use for Full-Term Infants (original Protocol March 2004 Revision #1 March 2010). Academy of Breastfeeding website:
http://www.bfmed.org/Resources/Protocols.aspx
. Accessed September 2, 2010.

American Academy of Breastfeeding Section on Breastfeeding. Breastfeeding and the use of human milk.
Pediatrics.
2005;115(2):496-506.

American Academy of Family Physicians. Position Paper on Breastfeeding. American Academy of Family Physicians website:
http://www.aafp.org/online/en/home/policy/policies/b/breastfeedingpositionpa-per.html
. Accessed September 2, 2010.

American Academy of Pediatrics Committee on Drugs. The transfer of drugs and other chemicals into human milk.
Pediatrics.
2001;108(3):776-789.

American Academy of Pediatrics. Wagner CL, Greer FR, and the Section on Breastfeeding and Committeee on Nutrition. Clinical report–Prevention of rickets and vitamin D deficiency in infants, children, and adolescents.
Pediatrics.
2008;122(5):1142-1152. doi:10.1542/peds.2008-1862.

Riordan J, Wambach K.
Breastfeeding and Human Lactation.
4th ed. Sudbury, MA: Jones & Bartlett Learning; 2010.

Hale TW.
Medications and Mother's Milk.
14th ed. Amarillo, Texas: Hale Publishing, L.P.; 2010.

International Lactation Consultant Association.
Clinical Guidelines for the Establishment of Exclusive Breastfeeding.
2nd ed. 2005:
http://www.ilca.org/files/education_and_research/independent_study_modules/ILCA%20documents/Doc%20ClinicalGuidelines2005.pdf
. Accessed September 2, 2010.

Lu MC, et al. Provider encouragement of breast-feeding: Evidence from a national survey.
Obstet Gynecol.
2001;97(2):290 -295.

Marks JM, Spatz DL. Medications and lactation: What PNPs need to know.
J Pediatr Health Care
2003;17(6):311-319.

NAPNAP Position statement on breastfeeding.
J Pediatr Health Care.
2007;21:39A-40A.

Newman J, Pitman T.
The Ultimate Breastfeeding Book of Answers.
New York: Three Rivers Press; 2006.

U.S. Breastfeeding Committee.
Breastfeeding in the United States: A National Agenda.
Rockville, MD: U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau; 2001.

U.S. Department of Health and Human Services.
HHS Blueprint for Action on Breastfeeding.
Washington, DC: U.S. Department of Health and Human Services, Office on Women's Health; 2000.

U.S. Dept of Labor-Wage and Hour Division (WHD). Fact Sheet #73: Break Time for Nursing Mothers under the FLSA.
http://www.dol.gov/whd/regs/compliance/whdfs73.htm
. Accessed September 1, 2010.

World Health Organization. The launch of the WHO Child Growth Standards.
http://www.who.int/childgrowth/launch/en/index.html
. Accessed September 3, 2010.

CHAPTER 6

Two-Week Visit

Candace F. Zickler

I.  GENERAL IMPRESSION

A.  Parents are settling in with 2-week old; each getting acquainted with other. If infant was still losing weight at discharge, the bilirubin was above 10 mg/dL, or the infant had a heart murmur, he/she needs to be seen in the office within 2 days.

B.  Infant should have a naked weight, length on length board, and head circumference performed. Compare the birth weight and the discharge weight with the weight obtained today. Determine daily weight gain since discharge.

C.  A brief exam noting muscle tone, symmetry, and heart sounds, murmurs should be done. Check for hip clicks by doing the Orolani and Barlow tests.

D.  At 2 weeks of age, the infant's cord should have fallen off or be dry and looking like it will likely fall off soon.

E.  Jaundice should be resolved except in some breastfed infants. If unresolved, do a transcutaneous bilirubin.

F.  Newborn screen results should be reviewed and be negative. Share report with parents.

G.  Review the newborn hearing screen. If hearing is within normal limits, share with the parents. If abnormal, schedule baby for an auditory brainstem response (ABR) or an otoacoustic emissions test (OAE) before leaving the office.

H.  Reflexes present should be rooting, Galant's (trunk incurvation), placing and stepping, Landau (infant lifts head when suspended in prone position), asymmetric tonic neck.

II. NUTRITION

A.  Breastfeeding is encouraged for all newborns. If mother is breastfeeding, ask specific questions:

1.  Does the baby latch on well?

2.  How long does the baby nurse at one time?

3.  How frequently are you nursing the baby?

4.  How many wet diapers?

5.  How many stools?

6.  Are you having any irritation or pain from your nipples?

Review all medications that mother may be taking (see
Chapter 5
). If mother expresses concerns about the nursing, observe a nursing session, give suggestions, and obtain a lactation consult from the hospital lactation resource.

B.  If baby is bottle fed, review preparation and number of feedings, how much the baby is taking each time, number of wet diapers, and number of stools per day. Commercially prepared, iron-fortified formulas come in powder, concentrate, ready-to-feed. Do not dilute ready-to-feed. Follow directions for mixing concentrate and powder.

1.  Do not reuse bottle if more than 4 hours since opened.

2.  Mix formulas with bottled water for first month, continue to use bottled water if house is on well/unsure of water quality. Store mixed and open formula in refrigerator; do not feed formula that has been premixed and in the refrigerator longer than 24-36 hours. Specialized formulas have similar preparation directions; read labels. Goat's milk, whole cow's milk, rice milk have inadequate amounts of vitamins and minerals.

3.  Serve formula at room temperature. Do not microwave to heat. Do not let formula sit out to warm for more than 15-20 minutes.

4.  Clean technique is sufficient for mixing formulas. Clean off cans with soap and water before opening. Use hot soapy water and bottlebrush to clean nipples, bottles or clean in dishwasher.

5.  Hold infant in upright, semi-reclined position; burp every 1-2 oz. No bottle propping. Babies will suck and then rest during the entire feeding. Encourage mother to let her husband/partner feed the baby at least once during the day.

6.  No smoking or drinking hot beverages while holding baby. Limit noise in the immediate area when doing feeding, and focus on baby. Talk or sing to the baby.

7.  Infant should take in 90 of feeding in first 20 minutes. Two-week old infant takes 3-5 oz/feeding, 5-6 feedings/24 hours (90-120 cal/kg/day).

III. ELIMINATION

A.  Bowel movements should be formed or soft with no green color. Infant should have 1-6 yellow pasty stools/24 hours. Breastfed infant may have upper range of frequency with less formed texture. Void every 1-3 hours or with each feeding and diaper change.

IV. SLEEP

A.  Awake and alert for feedings, every 2-4 hours. Should nurse vigorously for 15-20 minutes, then fall back to sleep.

B.  Babies should sleep in own cribs to decrease smothering or injury. Babies should sleep on their back in cribs to decrease incidence of sudden infant death syndrome (SIDS).

V.  GROWTH AND DEVELOPMENT

A.  Growth.

1.  Should regain birth weight by 2 weeks. Should gain 0.5-1 oz/day or approximately 2 lbs/month for next 5 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.

1.  Moves all 4 extremities, keep hands fisted, and has flexed posture.

2.  Has startle response to noises.

3.  May have a smile. May begin to look for “who is talking.”

4.  May have “fussy” time of 1-2 hours/day, often in evening.