Free Pediatric Primary Care by Beth Richardson Page B

infants.
1.  Hepatitis B 2: After the birth dose, the hepatitis B series can be completed with either monovalent HepB or a combination vaccine containing HepB. Administer 4 doses of HepB to infants if combination vaccines with HepB are given after the birth dose.
2.  DTaP #1 (diphtheria-tetanus-acellular pertussis). Minimum age of 6 weeks.
3.  IPV #1 (inactivated poliovirus). Minimum age of 6 weeks.
4.  Hib #1 (Haemophilus influenzae type b). Minimum age of 6 weeks.
5.  PCV #1 (pneumococcal conjugate). Minimum age of 6 weeks.
6.  RV (rotavirus vaccine). Minimum age of 6 weeks. Maximum age of 14 weeks and 6 days to start series.
B.  Giving acetaminophen prophylactically after immunizations may decrease the response to the vaccine. Few infants run fevers after immunizations.
VIII. SAFETY/ANTICIPATORY GUIDANCE
A.  Needs safe sleep position “back to sleep.”
1.  Not safe for baby to sleep in adult bed.
2.  Discuss temperature of room, temperature of water, bathing safety guidelines.
3.  Discuss appropriate amount of clothing to keep baby comfortable in varied environments.
B.  Never leave baby unattended near pet or sibling.
C.  Keep hand on baby when on changing tables, sofas, avoid risk of falling.
D.  Review need for car seat that is Federal Motor Vehicle Safety tested and approved, installed properly in backseat, facing backward in automobile. Contact local hospital, fire department, or March of Dimes chapter for car seat rental program.
E.  No smoking around infant.
F.  To treat constipation, advise giving extra water (no more than 1 oz/day).
G.  No solids should be offered. Offer pacifier if acting “hungry” or going to nap.
H.  Make sure smoke detectors are installed and functioning in home. Home should have working fire detectors, a fire evacuation plan, and periodic drills to ensure preparedness.
I.  Limit sun exposure, use sunscreen with SPF rating of at least 15 if out for even 15 minutes of direct sun exposure. Protect babies by using hats and long sleeve shirts and pants.
J.  Baby will be seen for regular appointment again at 4 months. Discuss skills infant will acquire and how to work with baby to learn them: babbling, cooing, trying to roll over, and more. Discuss second set of immunizations, similar to what baby had at this visit.
K.  Remind parents of when and how to call the healthcare provider.
1.  Breathing difficulties.
2.  Seizures.
3.  Irritability.
4.  Poor feeding, vomiting.
5.  No urine output in 12 hours, black/decreased bowel movements.
6.  Any fever.
7.  Praise the parents for all that they are doing for the infant.
BIBLIOGRAPHY
Back to Sleep, Tummy to Play. Healthy Child Care America; 2009: http://www.healthychildcare.org/pdf/SIDStummytime.pdf . Accessed June 2, 2011.
Car Safety Seats: A Guide For Families 2011. American Academy of Pediatrics Healthy Children website: http://www.healthychildren.org/English/safety-prevention/on-the-go/Pages/Car-Safety-Seats-Information-for-Families.aspx . Accessed July 20, 2011.
Centers for Disease Control and Prevention. Growth Charts for Birth through 36 Months. CDC website: http://www.cdc.gov/growthcharts/clinical_charts.htm . Accessed June 2, 2011.
Dowshen S. Choosing Child Care. KidsHealth from Nemours; 2007: http://kidshealth.org/parent/positive/amily/child_care.html . Accessed June 2, 2011.
Hagan JF, Shaw JS, Duncan P, eds. Bright Futures Guidelines for Health Supervision of Infants, Children, and Adolescents. 3rd ed. American Academy of Pediatrics;2008: http://brightfutures.aap.org/3rd_Edition_Guidelines_and_Pocket_Guide.html . Accessed June 2, 2011.
Oral Health Initiative: Protecting All Children's Teeth: Nonnutritive Sucking, Pacifiers. American Academy of Pediatrics; 2010: http://www.aap.org/oralhealth/PACT/ch8_sect1b.cfm . Accessed June 2, 2011.
Port Washington Fire Department. E.D.I.T.H. Exit Drills in the Home. http://www.pwfd.com/content/850_fs3.html . Accessed August 9, 2011.
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