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Breast feeding, bottle feeding, talking about developmental milestones and immunizations. Reviewing nutrition: breast. Children have adequate iron stores for the first four to six months of life. In my practice I like to add a poly-vitamin at two months of age that has iron in it. Now you are going to say why? Because I will forget to switch at four months or six months. It's just a quirk of my practice. Nutritionally these newborns need 120 calories per kilogram per day. Formula has 20 calories per ounce. Breast milk about 17 calories per ounce. This is for them to maintain weight and to grow. Vitamin D and iron supplementation, as we discussed. How about fluoride? How many of you know the fluoride content of the water supplies in your communities? Most of you. If your water supply has greater than 0.6 parts per million of fluoride you’ll never need fluoride supplementation. Otherwise this is the direction you are going to need to consider, and that’s particularly true in rural areas where you have some of your families that will be on well water where there is no fluoride infant, fluoride, breast feeding, developmental milestones, immunization, vaccine, vacine
Developmentally: blinks to light, quiets to sounds, lifts head and reflexes are present. Moro, tonic neck reflex. Movement should be infant, fluoride, breast feeding, developmental milestones, immunization, vaccine, vacine
Nutrition, accident prevention, immunization schedule and certainly in our day and age there is a much more emphasis on the car seat than there has been in the past. Are all of you using hepatitis B vaccine as a routine vaccine? I hear mostly yes. It is now recommended as a routine vaccine by the CDC and the ACIP. There are a lot of different schedules for it, but basically three doses. You can give it at birth, you can give it at one month. You have to have at least one month
Nutritional supplementation: pretty straightforward. At two months: coos, social smile, regards face and can grasp a rattle in the hand. The second hepatitis B. It is now recommended - and I think on page 18 of the handout I’ve included is a schedule of the 1998 recommendations by the HIB and polio: One of the major changes that has happened in the last year with immunizations is the polio vaccine. It is now recommended or can be given that all four doses can be given as inactivated polio vaccine. You can give the first two as oral polio and the last two as inactivated or vice-versa, or the four as oral polio. Most pediatricians, most people that are experts in immunization practices are advising to move toward inactivated polio vaccine.
I spend a lot of time with my mothers talking about anticipatory guidance: sleep, future development, future immunization schedule, how to get a hold of me if they have questions or problems. Interestingly enough, although we focus most of our time at these visits on medically related problems, the parental concerns in many
Now, I talk with my parents about nutrition a lot. The lot I like to spend is that through the first year of life, because of the calorie density of formula or breast milk, that is the predominant nutritional source for growth. It also has the right fat content for brain development and neurologic development. However, as we all
At four months: raises to prone, may roll prone to supine, follows an object past 180 degrees, plays with hands, smiles responsively and laughs. At five months of age, five to six months of age, if they have not been able to control their head there is a developmental red flag. Something should go off in your mind that
Pertussis. Seven years ago these were absolute contraindications, now they are minor side effects. There are some major side effects. These are not contraindications but again, when I counsel we talked about these and every time I have parents come back for a follow-up visit, ask them about reactions to immunizations. And document them if they have them. The top two: encephalitis within seven days of immunization or frank anaphylaxis are the only two absolute contraindications to DPT. We should see less of all of these using the absorbed, acellular pertussis. These are not contraindications to
We are about six months and we are moving through that first year to get that tree out there on the straight an narrow, but we can’t quite see toward our goal. Of course some days I feel like I’m up on top of that mountain. Six months: calorie content decreases a little bit, and
Nine months of age. How many here still have their children back for a nine-month visit? Looks like about one-third, one fourth. Why do you have them back? Does somebody want to volunteer? Keep an eye on them. Shots? There aren’t any shots. Catch-up shots? Okay. Great. I think one of the things is that every one of these visits you are following height, weight, head circumference and you are asking and looking for developmental milestones. I think there is a good
At twelve months, I’m moving on, they can stop the formula, they can stop breast feeding. Or if they want to they can continue it if they like to. My recommendation at that point is whole milk. Why? We know from recent scientific studies that the brain continues to develop well after the first year of life and into the second year of development. And the brain needs high fat content for it to fully mature. The pediatric cardiologists and the pediatricians who deal with
Hepatitis B, if you haven’t given it earlier. At 12 months of age now we can give the HIB, the varicella and the MMR. How many out in the audience are giving the varicella on a routine basis now? Seven? I’m a recent converter this year. I think there is no real reason not to. Looking again through the literature the risk is so low, the coverage is very high and the concern about … my concern, why I did not go before, was the concern about the varicella having to leak through it in the adolescent and the young adult years, like MMR. The studies are now out about 15 years and show that there isn’t a leak through or another recurrence of varicella. I do know that the transition has gone from nobody giving it, about two years ago, to maybe ten in the audience giving it. I think that you’ll find most of
Fifteen month visit is not one that I include routinely in my practice, but if I have not gotten all the immunizations up to date, or we need to give the last dose of HIB because I didn’t give it at 12 months, we’ll go ahead and add it in here. Developmentally we talked about those milestones. Walking by 15 months, running
Eighteen month developmental guidelines. I have in here "walks" because if they don’t walk by 15 months you should have a huge red flag. If they are certainly not walking by 18 months you’ve got some significant problems developmentally. Hopefully if you have been following the rest of the developmental milestones
Okay, so here we are. The clouds have cleared, we’ve got a brisk mountain stream, it’s a beautiful day and this young child is well on its way to the early toddler years, with good nutritional parameters. Height, weight and head circumference are where you would like them to be, and remember on that growth curve that