First Office Visit, 3-5 Days

Assess

Head circumference, weight, and length

• Plot measurements on growth charts
• Birth weight will likely not be regained until 7 to 14 days after birth, particularly for breastfed newborns.
  • The newborn weight tool provides hour-by-hour weight loss norms based on data from more than 100,000 exclusively breastfed newborns.
  • Weight loss of >10% of birth weight requires further evaluation.
• Jaundice, which is often associated with dehydration and hypernatremia.
• Overall hydration, particularly for breastfed newborns.
• Patterns of stooling and voiding, which are good indicators (after the first few days after birth) of the adequacy of milk intake.
  • Initially, urination may be infrequent because of the relative dehydration of the newborn, but immature renal concentrating ability may result in continued voiding despite dehydration.
  • Urine may initially be dark or contain uric acid crystals, but by day 4 or 5, a newborn should pass 6 or more clear, dilute urines each day.
  • Initial elimination of meconium may be unrelated to feeding, but the transition to human milk stool is a key indicator of intake.

Screen for food insecurity using the validated 2-question Hunger Vital Sign tool.

• 1 in 7 children live in a household experiencing food insecurity.
• Rates of food insecurity are higher in households with children younger than 6 years, single-parent households, and immigrant, Black, or Latinx families.
  • Provide resources for families experiencing food insecurity. (Table 3)

Discuss

• Describe hunger cues and the potential of overfeeding formula-fed newborns.
• Confirm formula-fed newborns are receiving iron-fortified formula.
• Confirm vitamin D supplementation for breastfed newborns.
• Stool patterns.
  • Stools of the typical human milk–fed newborn are often loose and may be confused with diarrhea if parents are accustomed to seeing the firm, brown stools typical of formula-fed newborns.
  • Once a newborn has good milk intake, stool will begin to transition in color from black to brown to green and then to yellow, seedy stools by day 4 or 5 after birth.
  • Well-nourished breastfed newborns usually pass a medium-sized yellow stool at least 3 to 4 times per day, or as often as with every feeding.
• Reinforce the importance of care of the mother.
  • Remind the mother to eat when hungry and drink when thirsty.

Calculations

Estimated energy requirements (kcal/d) for infants 0 to 2.99 months (weight in kg; height in cm)

• Males: −716.45 − (1.00 × age) + (17.82 × height) + (15.06 × weight) + 200
• Females: −69.15 + (80.0 × age) + (2.65 × height) + (54.15 × weight) + 180