Well-Child Care (Anticipatory Guidance) PDF

AZERBAIJAN MEDICAL UNIVERSITY FAMILY MEDICINE DEPARTMENT Well-child care Anticipatory Guidance Ph.D. Dr. Aygun Guliyeva  Nutrition  All mothers should be strongly encouraged to breastfeed their infants. A wide...

AZERBAIJAN MEDICAL UNIVERSITY FAMILY MEDICINE DEPARTMENT Well-child care Anticipatory Guidance Ph.D. Dr. Aygun Guliyeva  Nutrition  All mothers should be strongly encouraged to breastfeed their infants. A widely accepted goal is exclusive breastfeeding for at least the first 6 months of life. Vitamin D supplement (400 U/d) is indicated for breastfed children. Parents who choose to bottle-feed their newborn have several choices in formulas but should avoid cow's milk because of risks such as anemia. Commercial formulas are typically fortified with iron and vitamin D, and some contain fatty acids such as docosahexaenoic acid and arachidonic acid, which are not as yet proven to promote nervous system development. Soy based or lactose-free formulas can be used for infants intolerant of cow's milk formulas.  Nutrition  An appropriate weight gainis 1 oz/d during the first 6 months of life and 0.5 oz/d during the next 6 months. This weight gain requires a daily caloric intake of -120 kcal/kg during the first 6 months and 100 kcal/kg thereafter. Breast milk and most formulas contain 20 cal/oz. Initially, newborns should be fed on demand or, in some cases as for twins, on a partial schedule. Caregivers need to be questioned about the amount and duration of the child's feedings and vitamin D and fluoride intake at every visit.  Nutrition  Healthy snacks and regular family mealtimes may help reduce the risk of obesity. Fruit juice is best avoided altogether; water is preferred for hydration. Ideal calorie intake is somewhat independent of weight but does change according to activity level. Children age 1 year should take in about 900 kcal/d; age 2-3 years, 1000 kcal/d; age 4-8 years, 1200 kcal/d for girls and 1400 kcal/d for boys; age 9-13 years, 1600 kcal/d for girls and 1800 kcal/d for boys; and age 14- 18, 1800 kcal/d for girls and 2200 kcal/d for boys.  Nutrition  Solid foods such as cereals or pureed baby foods are introduced at 4- 6 months of age when the infant can support her or his head and the tongue extrusion reflex has extinguished. Delaying introduction of solid foods until this time appears to limit the incidence of food sensitivities. The child can also continue breast- or bottle- feeding. limited to 30 oz/d, because the solids now provide additional calories. Around 1 year of age, when the infant can drink from a cup, bottle-feeding should be discontinued to protect teeth from caries. No specified optimum age exists for weaning a child from breastfeeding. After weaning, ingestion of whole or 2 % cow's milk may promote nervous system development. Estimated to affect 1- 2 % of children, peanut allergy often is severe and lifelong. Infants with eczema should be started on pureed peanuts as early as 4-6 months.  Older infants can tolerate soft adult foods such as yogurt and mashed potatoes. A well-developed pincer grasp allows children to self-feed finger foods. With the eruption of primary teeth at 8-12 months of age, children may try foods such as soft rice or pastas.  Elimination  Regular patterns for voiding and defecation provide reassurance that the child is developing normally. Newborn infants should void within 24 hours of birth. An infant urinates approximately 6-8 times a day. Parents may count diapers in the first few weeks to confirm adequate feeding. The older child usually voids 4-6 times daily. Changes in voiding frequency reflect the child's hydration status, especially when the child is ill.  Elimination  Routine circumcision of male infants is not currently recommended, so parents who are considering circumcision require additional guidance. Although a circumcised boy has a decreased incidence of urinary tract infections (odds ratio 3-5) and a decreased risk of phimosis and squamous cell carcinoma of the penis, some clinicians raise concerns about bleeding, infection, pain of the procedure, or damage to the genitalia (incidence of 0.2-0.6%). The decision about circumcision is based on the parents' personal preferences and cultural influences. When done, the procedure is usually performed after the second day of life, on a physiologically stable infant. Contraindications include ambiguous genitalia, hypospadias, HIV, and any overriding medical conditions. The denuded mucosa of the phallus appears raw for the first week after the procedure, exuding a small amount of serosanguineous drainage on the diaper. Infection occurs in