![if !IE]> <![endif]>
Six Week Check
· Looking for problems that may not have been present at birth (ie don‟t check for imperforate anus, they‟d be dead by now!)
· The main aim of the 6 week check is to:
o Detect abnormalities in the baby that may have become clinically detectable since birth
o Explain the advantages of immunisation for the baby and offer immunisation
o Check the psychological and physical well-being of the mother
o Promote breast feeding and healthy attachment
· Checks for the baby:
o General well-being including sleeping and feeding
o Growth: check serial measurements in the Child Development Book
o General physical inspection, including fontanelles
o Neurological milestones:
§ Sight (do they follow an object, smile at a face, etc): at risk if premature or birth asphyxia
§ Hearing (startles with loud noise, etc): at risk if family history, rubella, CMV, toxoplasmosis, <1500 gm, severe asphyxia
§ The mother is likely to be aware of the presence of absence of these
o Heart: Ausciltate for murmurs, look for pallor, dyspnoea with feeds, failure to thrive (1% affected, VSD in 30% of these)
o Hip dislocation: unstable hips may not present until after birth. 0.4%, girls = 5 * boys. Need to treat before they begin to walk. Investigate with US and Xray. Treat with Pavlik harness
o Genitals: Check boys for undescended testes (cryptorchidism) – 2%, especially if premature, spontaneous descent unlikely beyond 3 months, surgery at 9 – 12 months.
· Checks for the mother:
§ General well-being
§ Signs of post-natal depression or adjustment disorder: poor sleep or appetite, feeling „low‟, anxious or guilty, thoughts of harming herself or the baby. Complete a screening survey such as the Edinburgh Postnatal Depression Questionnaire.
§ Breastfeeding: Is this going well?
§ Bowel and urine continence – encourage pelvic floor exercises
§ Perineum: pain, dyspareunia, etc
§ Review of pregnancy and child-birth experience
§ Weight: loss of 60% of weight gained during pregnancy
§ Examine breasts for infection or cracked nipples
§ Abdominal exam: involution of the uterus – should be at or approach pre-pregnant size
§ Pelvic exam: healing of laceration or episiotomy, lochia assessed, size and tenderness of uterus
§ Cervical smear if not up-to-date
§ Check of other complications that may have arisen in pregnancy: BP, diabetes, anaemia, UTIs, etc
· Contraceptive advice:
o Low levels of sexual interest common
o Return of fertility is variable. If not breastfeeding ovulation can occur as soon as 28 days
o Complete breast feeding provides 98% protection for the first 6 months (provided they continue to have amenorrhoea). Normally start contraception at 3 months
o POP: Start in early puerperium. Very effective in conjunction with breast-feeding. Start CoC when feeding frequency has ¯ by half, when solid food started or with first bleed (whichever first).
o Amount transferred to baby over 2 years = 1 tablet‟s worth
o COC: alters quantity and quality of milk. If not breast feeding start on day 21 (¯thrombosis risk and won‟t have ovulated yet)
o IUCD: Insert 4 - 8 weeks postpartum (higher expulsion rates if inserted after 3rd stage, and C-section scar will have healed by then)
o Sterilisation: wait a while – may change their mind
o Natural family planning: problematic due to variable effect of lactation on periods
· Immunisation is recommended for Diphtheria, Tetanus, Pertussis, Haemophilus Influenza type B, Hepatitis B and polio vaccine. If the mother is concerned about the baby being unsettled afterwards, prophylactic oral paracetamol can also be offered.
Copyright © 2018-2023 BrainKart.com; All Rights Reserved. Developed by Therithal info, Chennai.