The purpose of the Guide for Newborn Physical Assessment, Anticipatory Guidance and Health Teaching is to describe in detail the competency demonstrates newborn physical assessment and compares data with norms as stated in Maternal and Child Health Home Visiting Nursing Standards and Competencies, Postpartum Maternal and Newborn Nursing Care Competency, Vermont Department of Health, January 1997.

It is important to note that only when physical assessment of the newborn is combined with the psychosocial and environmental assessment of the newborn as well as the physical, psychosocial and environmental assessment of the postpartum woman and her family will effective nursing interventions and positive client outcomes take place. The competencies related to the psychosocial and environmental assessment of the newborn and postpartum woman are described in the Postpartum Maternal and the Newborn Nursing Care Competency, Maternal and Child Health Home Visiting Nursing Standards and Competencies, January 1997. A Guide for Postpartum Maternal Physical Assessment, Anticipatory Guidance and Health Teaching is under development.

Because important changes (e.g. jaundice) occur during the second and third days after birth, the following components of the physical assessment must be completed upon the first visit of all newborns less than 48 hours of age:

¨ parent(s) - infant interaction
¨ general health
        sleep
        feeding
        elimination
        cry
        alertness
        respiration
        temperature
        apical pulse
¨ newborn screening
¨ movement
        muscle tone
        symmetry
¨ jaundice
¨ hydration
¨ umbilicus
¨ circumcision

It is expected that communication between the MCH Home Visiting nurse and the postpartum woman's and newborn's medical care provider and other Healthy Babies providers (e.g. nutritionist or lactation consultant) takes place on an ongoing basis and includes normal and abnormal findings, assessment items not addressed, nursing interventions and client outcomes.

The physical assessment of the newborn may be adapted to meet the needs of the postpartum woman and newborn. For example, if the newborn had a physical assessment by their medical care provider on the day of the home visit, then the complete physical assessment as outlined in this guide may not be necessary. Discussing the findings of the physical assessment by the medical care provider and its impact on nursing interventions is more appropriate.

There may be variations in local medical practice regarding anticipatory guidance and health teaching. For example, some medical providers request parents to take a rectal rather than axillary temperature. It is important that MCH Home Visiting nurses know these local variations and incorporate, as appropriate, this information in their anticipatory guidance and health teaching so that parents receive consistent health teaching. Methods of communication between MCH Home Visiting nurses, medical care providers and other Healthy Babies providers will also vary at the local level. The key component of any method of communication is that it is timely, ongoing and meets the needs of the client.

The acquisition and maintenance of physical assessment skills of the newborn, as outlined in this guide, are best accomplished in a setting which includes theory and practice under the guidance of a skilled preceptor(s). It is the personal responsibility of the MCH Home Visiting nurse to maintain competency in newborn physical assessment as described in this guide.

This guide is based upon the work of Barbara Cardenas, author of Community Health Nursing in Canada, Essential Skills: Physical and Developmental Assessment, Many thanks for her work and providing a model of nursing care that: 1. includes a health oriented approach, 2. intertwines physical assessment with anticipatory guidance and health teaching and 3. includes the client - postpartum woman, newborn and family as a partner in assessing and planning care.

This guide articulates physical assessment of the newborn by MCH Home Visiting nurses within the context of maternal and child health nursing; community health nursing; home visiting of newborns less than 48 hours of age as well as newborns over 48 hours of age; and nursing care that complements, rather than substitutes for the newborn's primary medical care.

The contributors to this guide are listed below; many thanks for your expertise and time.

Nancy Kennedy, RN - VNA of Vermont and New Hampshire
Lynn Metheny-Leib, RN, BSN, MPA - VNA of Chittenden, Grand Isle
Dell McDonough, RN BSN, IBCLC - Barre District Office, Dept of Health
Helen Woodard, RNC - Bennington Area Home Health

Betty Allen, RN, BSN - VNA Chittenden & Grand Isle
Martha Grady, RN, MSN - Vermont Regional Perinatal Program
Ellen Leff, RN, MS - Franklin County Home Health
Margaret Luce, RN, MSN - Central VT Home Health & Hospice
Kathleen Paterson, RN, MPH - Division of Community Public Health, Dept of Health

Sally Bellew, RN, BSN - Burlington District Office, Dept of Health
Paula Duncan, MD - Division of Health Improvement, Dept of Health
Toni Harbison, RN, BSN - Burlington District Office, Dept of Health
Cindy Ingham, RN, BSN - Division of Community Public Health, Dept of Health
Jane Jackson, RN, MS - Division of Community Public Health, Dept of Health
Christine McKenzie, RN, BSN - Division of Community Public Health, Dept of Health
Mary Woodruff, MPH, RD - Division of Community Public Health, Dept of Health

George Brown, MD - Chittenden County Child Protection Network
Wendy Davis, MD - University Pediatrics
Joseph F. Hagan, Jr., MD - VT Chapter of American Academy of Pediatrics
Sally Forgues, RN, IBCLC - Dr. J. F. Hagan's Medical Practice
Carol Walters, PhD - Vermont Newborn Screening Program

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ANA. (1985). Code for nurses with interpretive statements. Kansas City: author.

ANA, Council of Community Health Nurses. (1986). Standards of community health nursing practice. Kansas City: author.

Cardenas, B.D.B. (1989). Essential skills: Physical and developmental assessment. In

Stewart, M., J. Innes, S. Searl and C. Smillie. (Eds.), Community health nursing in Canada (pp. 496-530). Toronto: Gage Educational Publishing Company.

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Contemporary Pediatrics. April 1996: 29-46.

Vermont Newborn Screening Program. (1993). Newborn screening for your baby's health. (2nd ed.) Burlington, Vermont: Vermont Department of Health and Vermont Regional Genetics Center.