For many of us, one joy of general pediatrics is the chance to care for babies. As we welcome them into the world, they seem to bring us hopefulness and renewed faith in the human potential. As Henry David Thoreau said, “Every child begins the world again.”
Note: this is a great topic for you senior residents to lead the discussion!
Materials for this week:
- Attachment: babies thrive when their caregivers are thriving. Given what we now know about neural wiring in the first 1000 days of life, it is critical to support parents’ ability to care for and connect with their infants. Mothers should be screened for post-partum depression and referred for treatment, as needed. Observe and comment on how parents are comforting babies in visits, such as talking and holding (and possibly the 5 S’s-suck, swaddle, swing, shush, side-lying). Help parents beware of how phone use and screen time may interfere with interaction with babies. We have to debunk the misguided idea of “spoiling them” by holding them too much-in fact, we know that infant brains shows positive effects with high nurturing. Promoting First Relationships (PFR) offers a great framework for supporting parents with these concepts in clinic visits. All of the great PFR handouts are available on the TOW mainpage sidebar with your UW NetID here.
- Helping parents be experts: provide parents encouragement, point out what they are doing well to connect and care for babies, and how they are the most important people in their infant’s life. Give them tools (such as PFR handouts) and resources like www.text4baby.com where they can sign up for texts based on baby’s birth date that give tailored resources, reminders, and tips.
- Normal newborn behaviors and findings: parents need to know about common things that can seem worrisome (sneezing, hiccupping, spitting up, primitive reflexes, rashes, crying, etc). Review some common skin findings here.
- Nutrition: helping babies grow/gain weight is a central concern in the first few months of life, and we need to provide guidance and reassurance on appropriate weight gain and support for breastfeeding. Whether breastfed or not, all babies should be cuddled and held with nurturing interactions during feeding. We can teach about reading babies cues of hunger and fullness from the beginning. Breastfed babies (fully or partially breastfed) should be on a vitamin D supplement of 400 IU per day to prevent rickets.
- Sleep: providing a safe sleep environment is key to babies thriving-babies should be on their backs and in their own sleeping unit without extra blankets or stuffed animals to avoid suffocation and SIDS. Co-sleeping/ Bed-sharing is the highest cause of death under 3 months, and is especially dangerous if parents smoke or drink alcohol. Ask open-ended questions about where baby is sleeping and in what position to facilitate honest conversations. Review evidence and encourage room-sharing rather than bed sharing. The AAP has sleep guidelines that recommend co-rooming. Also review positional plagiocephaly and how to avoid it (tummy time, rotate positions in crib and get babies out of containers (e.g. swings, carseats, babyseats) when not sleeping)!