Free Pediatric Primary Care by Beth Richardson Page A

hot soapy water and bottlebrush to clean nipples and bottles or clean in dishwasher.
G.  No bottle propping. Pacifiers are used for non-nutritive sucking. Breastfeeding should be well established before starting infant on a pacifier, but babies who suck pacifiers are at decreased incidence of sudden infant death.
H.  No smoking or drinking hot beverages while holding baby.
III. ELIMINATION
A.  Should have 1–5 yellow pasty, but formed stools/24 hours.
B.  Breastfed babies may have more stools than bottle-fed babies.
C.  Void every 1–3 hours or with each feeding and diaper change.
IV. SLEEP
A.  Babies sleep 16–18 hours/24 hours. Infant is developing sleep pattern. May sleep through night. May have longer awake periods during day.
B.  Sleep cycles have both active and quiet sleep periods in equal proportions. Each sleep cycle lasts 50–60 minutes. Infants are less efficient with sleep and easily interrupted with noise. Should be alert for feedings, nurse vigorously for 15–20 minutes, and fall back to sleep/stay awake for short periods.
C.  Babies should sleep in own cribs, not with parents, to decrease smothering injury to infant.
1.  Babies should sleep on back in cribs to decrease incidence of sudden infant death syndrome (SIDS).
2.  No pillows/toys that baby could get face against and smother.
V.  GROWTH AND DEVELOPMENT
A.  Growth. Plot length, weight, head circumference, and weight-for-height on the National Center for Health Statistics (NCHS) growth grids. Compare to last visit growth plots.
1.  Babies should gain 0.5–0.75 oz/day or approximately 2 lbs/month for the first 4–5 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.  Holds head upright for short periods. Follows people and looks for voice.
2.  Responds to smiling with return smile.
3.  Babbles and makes sounds with prompt of verbal cue.
4.  Shows interest in what is happening in room.
5.  Moves all 4 extremities, simultaneously.
6.  May cry but parents are learning what each cry means. Crying ceases when needs are met.
VI. SOCIAL DEVELOPMENT
A.  Baby learning to “trust” parent and caretakers to meet needs.
B.  Family is settling into routines with infant.
C.  Listen carefully for frustration, potential for abuse/neglect. Discuss child's unique temperament characteristics, relate to parents' feelings.
D.  Parent should be assessed for sadness, depression, fatigue.
1.  Encourage mother to rest when baby rests/sleeps.
2.  Encourage mother to take breaks away from baby to do self-nurturing (needs designated sitter).
E.  Take baby on selective, limited outings because infant is not fully immunized; will only receive first set today.
F.  Ask about plans for returning to work. Discuss guidelines for selecting sitter/ daycare.
G.  May have “fussy” time of 1–2 hours/day, often in evening. Use “fussy” time as interaction time, not extra feeding. Cry gradually decreases by 3 months of age. Baby may have symptoms of “colic” (starts 2–3 weeks of age, ceases by 12 weeks). Infant cries for prolonged periods, no specific cause or etiology identified. Infant continues to grow well. Infant is alert and playful at other times. Infant may require additional comfort measures to quiet and settle and should be accepted as expected for age.
H.  Should have some supervised, “tummy” play time while awake.
I.  Encourage parent to actively talk, play with infant. Select age-appropriate toys.
VII. IMMUNIZATIONS (SEE APPENDIX A )
A.  Infant will receive first set of immunizations today. Combinations are available that decrease number of injections. Parents trust providers to guide them in their decision to immunize their children. Need to discuss risks and benefits of immunizations and have parent sign consent. The following immunizations are best practice for 2-month-old