Newborn Assessment for Nurse Practitioners
The first newborn visit can feel intimidating—especially when you're a new nurse practitioner and suddenly responsible for evaluating a patient who is only a few days old. I basically all-out panicked when I was a brand new NP when I saw them on my schedule, but with some practice and supportive resources (that I mention in this video), I've felt so much more confident with time.
The good news is that you don't need to approach the visit as one giant newborn checklist. A few key questions can help you organize the assessment: How did the birth and hospital course go? Is the baby feeding and hydrating appropriately? What is happening with their weight and bilirubin? Did they pass their newborn screenings? Does anything on today's exam need follow-up? And how is the family doing at home?
In the video below, I walk through the step-by-step approach I use for the first outpatient newborn visit.
Editor’s note (August 2026): We’ve reviewed this episode for current guidance, and the overall approach still stands. We’ve added a few important updates and clarifications below the video.
Watch
In this episode, you’ll learn:
How to structure the first newborn visit after hospital discharge
What to review from the birth and hospital course
How to assess newborn feeding, weight, hydration, stooling, and jaundice
What to include in the newborn physical exam
The most important anticipatory guidance and follow-up considerations for new parents
Key Takeaways
Start the newborn visit by reviewing the birth and hospital course, including gestational age, birth/discharge weight, significant complications, newborn screening results, and anything requiring follow-up.
Assess feeding, weight change, hydration, urine and stool output, and jaundice together rather than looking at any one finding in isolation.
Use a consistent head-to-toe newborn exam and pay particular attention to findings that may require follow-up after discharge.
Check in on parent wellbeing, support at home, and social needs as part of the newborn assessment.
Prioritize the anticipatory guidance families need right now, including safe sleep, fever precautions, feeding, car-seat safety, and when to seek care.
Make the follow-up interval individualized based on feeding, weight trajectory, jaundice, exam findings, and family needs.
A few updates since this video was recorded
The overall approach I teach in this episode still stands, but there are a few places where current guidance has changed or where I would teach the topic a little differently today.
Newborn weight loss
Some weight loss after birth is expected, but I would no longer describe a 10% weight loss as simply expected or normal.
Weight loss greater than 10% of birth weight warrants further evaluation. Most newborns regain their birth weight within about 7–14 days.
When weight loss is greater than expected, look at the whole clinical picture: feeding effectiveness, urine and stool output, hydration, jaundice, and the infant's overall appearance.
Feeding and diaper output
Rather than focusing only on how many minutes a newborn feeds or an exact interval between every feeding, assess whether feeding is frequent and effective.
Ask about feeding frequency, latch and milk transfer when breastfeeding, formula intake when applicable, whether the infant wakes appropriately to feed, and whether urine and stool output are progressing as expected.
By approximately day 4–5, a newborn should generally be producing at least 6 clear, dilute urines per day. Stool should also be transitioning from meconium toward the expected milk stool.
Jaundice follow-up has changed
The AAP updated its neonatal hyperbilirubinemia guideline in 2022.
Rather than using the older bilirubin “risk zones,” follow-up is now based on the difference between the infant's bilirubin level and the phototherapy threshold for their age, gestational age, and applicable neurotoxicity risk factors.
I’ll be covering newborn jaundice separately because bilirubin interpretation and follow-up deserve their own walkthrough. Stay tuned.
Safe sleep
The basic advice from the original episode still applies, but I now teach safe sleep more explicitly:
Place the baby on their back for every sleep on a firm, flat sleep surface in their own crib, bassinet, or play yard. Keep pillows, blankets, bumpers, stuffed animals, and other soft objects out of the sleep space. Room sharing is recommended; bed sharing is not.
Don't forget vitamin D
Breastfed and partially breastfed newborns should receive 400 IU of vitamin D daily.
What to focus on at the first newborn visit
For a healthy newborn coming in after hospital discharge, I organize the visit around:
Birth and hospital course
Weight and growth
Feeding and hydration
Urine and stool output
Jaundice
Newborn screening results and follow-up
Complete newborn physical exam
Parent and family wellbeing
Safe sleep and other anticipatory guidance
Follow-up plan
The goal isn't to memorize every possible newborn problem. It's to have a consistent approach that helps you recognize when the baby is progressing as expected—and when something needs a closer look.
Newborn Visit Cheat Sheet
Want a quick-reference guide to use during newborn visits? The Newborn Visit Cheat Sheet inside the Digital NP Binder walks you through what to review from the hospital course, feeding and weight assessment, newborn screening, the physical exam, anticipatory guidance, and follow-up—so you have a practical checklist to reference during the visit.Purchase yours here.
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well hey there it's liz rohr from real
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world np
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and you're watching np practice made
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simple the weekly videos to help save
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you time
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frustration and help you learn faster so
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you can take the best care of your
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patients
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so in this week's video i'm going to be
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talking about a type of visit that
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really scared me
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as a new nurse practitioner and that is
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newborn visits so that day three to five
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first initial visit after discharge from
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the hospital
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i have to be really honest i still find
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them a little bit intimidating
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but in this video i'm going to go
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through the kind of step by step that i
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follow every time
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and that i recommend you do as well so
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one of those super helpful things if you
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have a
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baby who is discharged from the hospital
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setting
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usually they either bring some sort of
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discharge information with you
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or like your hospital system will be
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able to
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have electronic access to the discharge
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records where the neonatologist the
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the provider that assesses them after
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birth gives a really detailed rundown of
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their physical exam
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and all the things that happened there
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so usually i start
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by i think it's really hard not to get
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sucked right into all the details of the
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visit but i really try to start by
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mothering the mother um i mean there are
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actually
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there are many different kinds of
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families that come in with newborn
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babies and not necessarily like a cis
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female
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but typically that's who i see in
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primary care whoever your parent is you
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know mothering the parent
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because for them this is a really
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overwhelming typically
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experience and just checking in with
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them first before you dig into all of
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the kind of assessment details to make
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sure that you've gotten all your ducks
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in a row
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this is certainly easier if you've had
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your own child before but
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i did not when i was a brand new grad so
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um so yeah so once i
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checked in and see how the the family is
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doing whoever the family is there i kind
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of see
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how it went for them how they're feeling
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now
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if this a lot of times birth can be
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pretty traumatic for a family member and
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the
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and the person who's delivering um the
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baby so
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um it's really important to check in
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with that it's helpful if you have a
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rapport with them in the first place
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but at the very least if you've asked
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once you can kind of or
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multiple times in the first visit rather
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the first time meeting them
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it opens the door that if they don't
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fully disclose their experience that
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time
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they can kind of continue on with that
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so
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um kind of after getting to know them
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where they live who they live with what
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support they have at home
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if it's their first child or not those
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are really helpful contextual pieces of
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information
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our clinic also has a standardized
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standardized standardized procedure
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where we ask patients about social
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determinants of health
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and if they have any issues with housing
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with meals like things like that and
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that can kind of help fill in those
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further contextual details
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so as i'm talking about this i
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acknowledge that our visits are pretty
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short
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um mine are about 15 minutes and i have
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to be honest most of the time i go over
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because
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it's a lot to talk about in this visit
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and i hope that you actually get a
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little bit more time closer to the 20 or
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30 minute mark
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but anyway if you have your if as once
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you've checked in with the family
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you can look at your hospital records
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and see you know what is
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uh usually there's a detailed birth
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history document in my ehr
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it doesn't let you chart without it and
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so i'm usually starting with their date
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of birth
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their time of birth which is really
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important when it relates to jaundice
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if they have jaundice the first thing to
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start with
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when if hopefully you have those
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hospital records in front of you
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and if you don't just try your very best
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to get the information from the
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the parents that are there or the family
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members that are there
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but um the first thing you want to think
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about is kind of the the
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history of the delivery and also the
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prenatal care
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did mom have um again i'm saying mom
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because it's usually
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a mom that's there with their newborn
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that is just delivered um
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did did they have prenatal care and did
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they have any infections or
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medical conditions during their
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pregnancy like gestational diabetes
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or other things like that did they take
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any medications during pregnancy
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um and then when can when it comes to
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the actual delivery
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um did they have a vaginal birth did
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they have a cesarean
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emergent scheduled did they have any um
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assistive delivery devices in the cert
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in the delivery with the vaginal birth
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either
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forceps or suction were they induced
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that's all important information what
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was the estimated due date and the date
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at time of delivery were they 40 weeks
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was the baby 40 weeks 39 term baby
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pre-term like that kind of thing
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did the baby have any uh fetal distress
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um any nicu stays
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any things like that were anything any
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complications during the
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the delivery including like a fever
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during the delivery
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um from the from the mom um and so after
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you've kind of gotten your like labor
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history how long the labor was prolonged
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rupture of membranes i'm trying not to
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go too too big into this video but those
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are the general highlights
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if you're touching on that topic you can
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kind of consult and work through your
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brain of what you already learned and
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also what you have of the resources
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there to put all those pieces together
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so again just kind of like recapping
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there's a lot of stuff right checking in
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with the family
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how are you doing do you have records
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what was the prenatal care
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what was the delivery like and then what
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day of birth are we at right now
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and one of the kind of main orienting
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things that is really helpful really
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with all pediatrics but especially with
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newborn babies or
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babies of any age is kind of these
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orienting questions right
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um eating eating elimination
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sleep behavior alertness other kind of
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like ros
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general symptoms nausea vomiting
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diarrhea that whole stuff well not
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really for babies
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right but anyway so checking in with
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those kind of main pillars of pediatric
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wellness right
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how much are they eating and are they
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breastfeeding or formula feeding or both
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because a lot of people do both
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um what are their desires right are they
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hoping to breastfeed are they having a
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hard time
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did they meet with anybody yet i could
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get into a whole different video about
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breastfeeding and and
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that whole thing i'll leave it at that
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but kind of checking in to see
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how that's going for them how often the
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baby is eating
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um and then the next question usually
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typically about that time it should be
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about
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every one to two hours every time they
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cry um
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on demand and then usually in the first
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couple of days to like the first week
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they really should be eating about every
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one to two hours
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with like a stretch of three hours it's
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really hard for the families to do that
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but that's usually what the babies need
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because their tummies are so small when
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they're first born
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so checking in with their nutritional
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kind of intake
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elimination is the next question so how
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many diapers a day
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and usually by the time you're seeing
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them it's day three or four
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of life and at that time between day
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three to four they should have about six
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to eight wet diapers in a 24 hour period
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and they should be stooling by day two
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and
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an important question is in addition to
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how many wet diapers
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how many stooling diapers and it can be
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as often as every time they eat
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or infrequently as every couple of days
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at this point though you want to have
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seen
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some stool and you actually want to also
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document the color too which is kind of
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like a weird gross question right but
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you're trying to assess
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has it changed from meconium to like
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either breast milk
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um stool or formula stool the next thing
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is about sleep
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um and you know it's it's a difficult
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topic and again this is easier if you
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have your own children if you've had a
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child before um or cared for a child
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before especially a newborn baby but
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um sleep is typically they're awake all
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night because their butt like
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in utero they're used to the the mother
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being
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um you know the parent being asleep
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during the night and then
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lulled to sleep with their movements
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during the day so um
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so anyway that can be a difficult
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transition and that's completely normal
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so that's a lot of reassurance for them
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and again they really only have like a
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three hours
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window of time where they sleep like one
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time in 24 hours for the parents to kind
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of catch up
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because they need to eat so often
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because the risk there is dehydration
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you don't necessarily want to scare the
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parents by talking about that but just
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kind of like getting a sense and trying
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to be
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at ease yourself when talking about it
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helps to kind of ease their mind
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and after talking about that um you want
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to kind of again
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going back to your making sure that you
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have that full history what were their
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vaccines
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um when they were born did they get
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hepatitis b did they get vitamin k
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um all of that kind of general history
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stuff and i don't want to get too much
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into that because i don't want this to
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be like a million years long
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but um looking at all of those kind of
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checkpoints and usually your electronic
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health
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record can be really helpful because it
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will prompt you for all of those
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questions and then you'll say oh okay
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i'm gonna go find all of those things
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you know the maternal blood test the
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baby's blood tests like et cetera et
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cetera
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a couple of other screening things to
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keep in mind all babies will
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born in a hospital setting will have a
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hearing screen
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they will have their newborn screening
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labs and then they will also
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have um screening for heart disease like
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a congenital heart disease using the
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oxygen monitoring and if they pass
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there's like pre-ductal and post ductal
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it just has to do with like where they
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measured on the body i think it's like
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hand and foot
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and then the other thing is jaundice so
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there is some sort of jaundice
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bilirubin screening for jaundice and i'm
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actually going to make a separate video
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about that because i see this all the
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time and
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the newborn visit by itself is stressful
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but then you add jaundice on top of it
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can be a little bit intense
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so i'll make a separate video about that
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but they'll be talking i'll be talking
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about jaundice there
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but there's definitely a bilirubin
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screening
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um so yeah and aside from that it's your
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general kind of physical exam and
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and this is very basic right this is the
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basic orientation because
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whenever there's an abnormality you just
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have to go down that path right
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is there like um is there a hematoma in
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the back of their head
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right is there some sort of congenital
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abnormality that they've come out with
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right and typically the nice thing when
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you get that is that usually they've
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already assessed it
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and they've kind of come up with the
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recommendation so for example um i had a
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baby with
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hydronephrosis
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detected on the in utero um
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uh ultrasound and so they already knew
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at the time of birth that this was an
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issue and they already had a scheduled
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appointment
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with the nephrologist to follow up and
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they kind of told me exactly what to do
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right
10:12
and a baby who was born breech and they
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said you know what needs a follow-up
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ultrasound in four to six weeks
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so a lot of the times if you can get
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those hospital records they're really
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helpful
10:20
but like i said every single time
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there's an abnormality outside of the
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window of expected
10:24
is really just taking that that path and
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researching it down and just making sure
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that you're doing your due diligence
10:30
working that up and asking and asking
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all the questions
10:34
of your supporting providers because um
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you know it's normal to feel a little
10:39
uncomfortable with the newborn babies
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even pediatric mps do
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pediatricians do it's just you know you
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don't want to you don't want to miss
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anything so there's no
10:47
no harm in asking questions um the next
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those are that's
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again those are the general kind of
10:52
things to think about
10:54
um when you're doing your assessment and
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then you want to think about their birth
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weight
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their discharge weight and what's their
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current weight and as you remember
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it's going they're going to lose about
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10 percent of their body weight which
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they will regain it at two weeks in
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but you want to kind of see like how
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much have they lost so far
11:12
um and kind of just looking at that
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doing their physical assessment like how
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do they look do they have any
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abnormalities
11:17
do they have any signs of like
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dehydration do they have any jaundice
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um can you get a red reflex that's
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really hard to see but you gotta give it
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your
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you know your best shot and just keep
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trying and trying and you'll find it i
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promise
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um so after you've done your history
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taking
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and assessing where they're at in terms
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of the elimination the intake all of
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that stuff how they're sleeping
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how the feeding is going um and
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uh the next kind of piece and aside from
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the physical exam again going branching
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off depending on the abnormalities that
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you find because
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i can't talk about every single one that
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you could possibly find because again
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this would be like years of conversation
11:55
but just like kind of like reading into
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those cues of like okay if this then
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this you know
11:59
um and the next thing is about
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anticipatory guidance
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um and there's a lot to know here
12:04
especially again if you haven't had your
12:06
own children like there's a lot to
12:08
to think about but like i kind of start
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with just like what are the most
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important things keeping in mind that
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they are likely very sleep-deprived
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overwhelmed and um yeah just like
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exhausted
12:21
so i usually keep it to like the most
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important things like do not miss
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these things between now and your next
12:27
visit
12:28
so always saying arms distance away so i
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see a lot of new families
12:33
where they will be away from the baby
12:35
and they'll be the baby will be on the
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exam table and it's a newborn baby it's
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probably not gonna go anywhere right
12:39
but like some of them are very strong
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and so i always say you know arms
12:43
distance away
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always within reach of the newborn um
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whenever your back is turned always have
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a hands
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on them or near them the other one is
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about um
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body temperature right because they have
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born with the brown fat and so they need
12:56
to make sure that they are
12:58
warm enough and so one of the rules of
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thumb
13:01
is kind of like if you think about your
13:03
own body temperature
13:04
the clothing that you would wear at this
13:06
temperature in the room like add like
13:08
one more layer
13:09
just being mindful that you can over
13:11
heat them and you can't over bundle them
13:13
um and they might not necessarily be
13:16
able to
13:17
kind of communicate that right because
13:18
they're they're new babies and they
13:19
might not necessarily be able to
13:21
modulate that either
13:22
so um the other thing is like people ask
13:24
about the ideal room temperature
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and like there isn't really one but like
13:28
68 to 72
13:29
maybe some baby books say um the other
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thing is about fever monitoring for
13:34
fever right so anything
13:36
that is um greater than 100.4 needs to
13:39
be
13:39
urgently emergently dealt with um and so
13:42
making sure that they have the on-call
13:43
number for the
13:44
clinic or um knowing where to go to the
13:46
nearest er if they need to
13:48
and then just again being aware that if
13:50
you over bundle them in the summer time
13:52
and they feel warm unbundle them for a
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little bit like for like a little while
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not making them cold but
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making sure that it's not falsely high
13:59
because they're super bundled up
14:02
um yeah and then the next stuff is is
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just reinforcement of all of the feeding
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like what are the what are the things
14:07
they need right now they need
14:09
safety they need to eat and they need
14:11
caring for
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right so i'm making sure that they feel
14:14
comfortable without a with
14:16
whichever feeding option they've chosen
14:18
whether it's breastfeeding formula
14:19
feeding or both
14:20
um and breastfeeding we could get that's
14:22
like again a whole other topic and if
14:23
you're interested in
14:24
hearing about that i'm happy to talk
14:26
about that and actually i have a really
14:28
wonderful colleague who is it also a
14:30
she's a physician but she's also a
14:31
lactation consultant
14:33
and um she's pretty wonderful so i'm
14:35
happy to ask her if she's willing to
14:36
come on i don't know she will be she
14:38
might be too shy but
14:39
um i can always ask your questions if
14:41
you have them
14:43
uh but yeah and then in terms of the one
14:45
to follow up depends on what's happening
14:47
right depends if they have jaundice
14:49
depends how well they're eating um
14:51
depends if they have any things you've
14:52
detected or any concerns or how
14:54
concerned the parents are
14:55
but i'll definitely do a check in about
14:57
a week um to see how their weight is
14:59
right
15:00
depending on how they've gained since
15:02
since birth and depending on how it's
15:04
going with the wet diapers and all that
15:05
stuff
15:06
it's it's that's not a very like
15:08
straightforward answer and i know that
15:09
you appreciate straightforward answers
15:10
but if you want one check in one week
15:12
right keep checking babies in a week
15:14
later or sooner
15:16
if you have concerns right unfortunately
15:18
there's no real blanket statements here
15:19
but it's just kind of
15:21
using caution using your clinical
15:23
judgment and
15:24
um yeah so hopefully hopefully that is
15:26
helpful
15:27
if you are interested in the kind of
15:29
like cheat sheet that i have that goes
15:31
along with the newborn visit
15:32
it's actually in the digital mp binder
15:35
which is all of the cheat sheets i've
15:36
ever made plus additional bonus ones
15:38
including the one from today and you can
15:40
purchase that down below this video
15:42
and it's pretty wonderful and it's also
15:44
updated every three months
15:45
so um with brand new stuff so yeah so
15:48
thank you so very much for watching um
15:50
stay tuned for next week's video which
15:51
is all about newborn jaundice and
15:54
hopefully that one is also very helpful
15:56
please let me know what questions you
15:57
have thank you so much for watching
15:58
hang in there and i'll see you soon
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