pregnancy policy packet
TRANSCRIPT
Early Head Start
Prenatal and postnatal health, nutrition, mental
health and safety services for Early Head Start sites
Pregnancy Policy Packet
Developed by the Early Head Start Maternal Group, Summer of 2013
Edited by Ella Trepashko – Early Head Start
Dietitian, Dominican University
Early Head Start Pregnancy Packet
Sections
DFSS Services to Pregnant Women in Early Head Start
Prenatal Log and Policy
Pregnancy Pathway
Appendix to the Pregnancy Pathway
Prenatal and Postnatal+Infant Nurse Assessment
Pregnancy Risk and Authorization Form
Chicago Department of Family & Support Services
Prenatal Visit Log Policy and Procedure
Performance Standard: 45CFR 1304.40(a) (1) (ii)
Purpose: To ensure clients attend prenatal visits as recommended by their prenatal provider.
1. At the first visit with the pregnant mother, document the date of the first prenatal healthcare visit on the prenatal visit log form.
2. Explain to the pregnant mother that it is very important for all prenatal appointments required by the pregnancy primary care provider be kept.
3. The prenatal visit log is a document for the Family Support Worker to use to document all appointments recommended by the prenatal provider and kept by pregnant mothers.
4. If a pregnant mother states that she has missed a scheduled prenatal provider appointment, assist the pregnant mother with calling the prenatal provider to schedule another appointment immediately, and document the reason for the missed visit in your case notes. Try to identify the reason for the missed visit and any barriers to health care (transportation, childcare etc...), and assist the pregnant mother with resources and ideas to overcome the barrier to prenatal health care.
5. If a pregnant mother has missed two or more prenatal appointments, discuss the situation with your supervisor to address ways to assist the pregnant mother to become compliant with prenatal care appointments.
6. A pregnant mother’s risk status may change at any time during the pregnancy. Appointment frequencies may change at any time during the pregnancy based on the pregnant mother’s individual health needs.
Monica Dillon RN, November 8, 2010
(1) Early Head Start grantee and delegate agencies must assist pregnant women to access comprehensive prenatal and postpartum care, through referrals, immediately after enrollment in the program. This care must include:
(ii) Health promotion and treatment, including medical and dental examinations on a schedule deemed appropriate by the attending health care providers as early in the pregnancy as possible;
Chicago Department of Family & Support Services
Prenatal Care Visit Log Clients Name: _________________________ FSW: _________________________ Due Date: _____________________________ Provider’s Name: _______________ Week of Pregnancy Appointment Date
(Medical or Dental Visits) Notes: What happened at the visit? (Sonogram, Non-Stress Tests, etc…)
4 *Every 4 Weeks
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
Chicago Department of Family & Support Services 23
24
25
26
27
28 *Every 2 to 3 Weeks
29
30
31
32
33
34
35
36 *One Visit/Week
37
38
39
40
41
42
Visit schedules may vary. * Denotes recommendation for a low risk pregnancy
Chicago Department of Family & Support Services Pregnancy Pathway
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Date Pathway Initiated: Baby’s due Date: Client’s Name FSW’s Name: Trimester when entered the program: 1. *Prenatal Care
A. *Health Care Provider: Name _____________________________________________________ Address ____________________________________________________ Phone Number ______________________________________________ If client does not have a provider, refer to: [Insert Community Prenatal Provider, address and phone number listed on your Medical Provider Cooperative Agreement]
B. *Pregnancy High Risk Assessment: (Use “High Risk” Assessment Form).
A client may become “High Risk” at any time during the pregnancy, labor or delivery. High Risk at Enrollment: Yes _________ No __________ If the client becomes “high risk” anytime during the pregnancy, labor or delivery, enter the date she became “high risk” here _____________________________ And change her risk status in COPA:
C. *Date of first Prenatal Visit:_____________________________________ Start “Prenatal Visit Log” Form
D. Name of Hospital _______________________________________________ E. Hospital Tour done? Yes __________ No ___________ F. Birth Plan done? Yes __________ No ___________
G. What to Expect When Your Expecting Date given to client: _______________
(To be given during 1st trimester when possible)
H. Other Prenatal Written Resources Given to Client: Illinois DHS Feeding your Baby (Ap. 1) Tips on Pregnancy: How much should I gain? (Ap. 2) Weight loss while breastfeeding (Ap. 3) Why prenatal care is important (†BB 18) Expect at first prenatal visit (†BB 19) My Birth Plan (†BB 88) Mother’s Bottle Guide (Ap. 4) Other materials:
Chicago Department of Family & Support Services Pregnancy Pathway
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* Denotes required data for COPA
2. Nutritional Support
A. WIC Referral Date: ______________
Indicated for all pregnant women, especially those who: -have any medical diagnosis (gestational diabetes, hyper emesis Anemia etc…) -want nutritional counseling -want to breastfeed their baby and would like to be connected to a lactation
counselor, and/or may need a breast pump. Date of first visit to WIC:
B. *Has the “Nutrition Assessment for Pregnant Client” been done?
Prenatal Nutrition Assessment (Ap. 5) Date: Postnatal Nutrition Assessment (Ap. 7) Date:
C. Food Safety and Fish precautions during pregnancy information: (Given during 1st – 2nd Trimester) Food safety during pregnancy (Ap. 9) Fish Facts: Print and Go Guide (Ap. 10) Date:
D. * Breastfeeding information given to client:
Breastfeeding: best for me & my baby (†F6 4) Date: Myths about Breastfeeding (†F6 5) Date:
E. Lactation Counselor Home Visit done six weeks prior to due date?
Yes _________ No _________ Contact Peer Lactation Counselor: [Insert Contact Information] □ Lactation Support Resources for Chicago (Ap. 12) Date:
Does client need assistance with obtaining a breast pump?
Yes _________ No _________
* Denotes required data for COPA
Breast Pumps for WIC clients: may be available for rental at mother’s local WIC center. Each site has varying availability so contact your WIC site for more information on their pump program.
Breast Pumps for Medicaid Eligible Clients: Illinois public aid will reimburse for a double electric pump from Medela. Client will need a prescription from the MD. The script must say: “Electric breast pump for lactating mother,” and have complete MD info on the script. A copy of the public aid card needs to be faxed too. Family Home Care (will ship anywhere): (773)-486-3998 phone or (773)-486-5848 fax Ballin Pharmacy (3330 N. Lincoln): (773)-348-0027 phone
Chicago Department of Family & Support Services Pregnancy Pathway
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3. Infant Nutrition Information (To be given during 2nd - 3rd Trimesters) _______________________________________
A. How to feed your baby step by step (Ap. 13) Date: B. Is my baby ready for solid foods (†F6 63) Date: C. Suggestions for starting solid foods (†F6 83) Date: D. How does food nourish my baby (†BB 62) Date: E. Healthy things to do for you and your baby (†BB 21) Date:
4. *Health Insurance
________________________________ Make a copy of Medicaid, All Kids or Private Health Insurance Card for the Client File.
A. Medicaid Moms and Babies Program __________ B. All Kids C. Private Health Insurance: ________________________________________ D. Medically Uninsured: __________ If client is uninsured, refer to
Insert Local DHS – Medicaid Office Contact Information
5. *Pregnancy Education/Information
_____________________________________________________________________ Client’s Literacy Level/ Last Grade Completed _________________________
A. Pregnancy/Fetal screening tests and information (1st – 2nd Trimesters)
Date: ____________
B. *Preterm Labor information (1st – 2nd Trimesters) What are the signs of preterm labor (†BB 66) Preterm labor: What to do (†BB 67) Date: ____________
C. Postpartum health information (2nd - 3rd trimesters) Postpartum Concerns (†BB 108) Following a C-Section (†BB 109) Date: ____________
D. Birth Control information and resources (2nd - 3rd Trimesters) Family Planning Choices (†BB 41 1-6) Date: ____________
E. Doula information (1st Trimester) Pregnancy, delivery & after birth professionals (Ap. 15) Date: ____________
F. *The Effects of Alcohol and Drugs during Pregnancy(1st Trimester) How alcohol and drugs can hurt (†BB 13) Date: ____________
Chicago Department of Family & Support Services Pregnancy Pathway
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G. Exercise and Pregnancy information (1st -3rd Trimesters) Exercising safely during pregnancy (†BB 38) Date: ____________
H. Prenatal Class information(1st – 3rd Trimester Date: ____________
I. *Fetal Development(1st- 3rd Trimesters) First trimester (†BB 28) Second trimester (†BB 53) Third trimester (†BB 93) Date: ____________
J. *Labor and Delivery(2nd – 3rd Trimesters) Labor and Delivery (Ap. 16) Date: ____________
K. *The Effects of Smoking during Pregnancy (1st-3rd Trimesters) How smoking can hurt (†BB 12) Date: ____________
L. Prenatal Home Visit assessment with Community Health Nurse (upon enrollment) Date: ____________
6. *Dental/Oral Health _____________________________ A dental visit during pregnancy is required. If the client does not have an oral health provider, refer to: [Insert dental providers in which you have a cooperative agreement].
A. Date referral made ( documentation received): _______________
B. Written information about oral health during pregnancy: Date: __________
C. Date of Visit: __________________
D. Completed Dental Documentation Received: Yes _____ No _____
E. Name of Dental Provider: ______________________________________ Address: ____________________________________________________ Phone Number: ______________________________________________
F. Infant oral health information given to pregnant mom. Date: _______
Chicago Department of Family & Support Services Pregnancy Pathway
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7. Environmental Health ____________________________________________
A. Prior history of lead poisoning exposure? Yes_________ No________
B. Client has had lead level test done during pregnancy (if applicable): Yes_________ No________
C. Information about lead poisoning during pregnancy: Date Given: ________
D. Home Environmental Assessment done by the Department of Public Health, Child Lead Division (if lead risk suspected)? Yes_________ No____
E. Information about Childhood Lead Poisoning Prevention (upon enrollment): Date Given: __________
* Denotes Required Data for COPA
8. *Mental Health
Prior History of Mental Health Problems? Yes_________ No________ *Refer to Mental Health Coordinator if yes.
A. Signs/Symptoms of Depression? Yes_________ No________ *Refer to Mental Health Coordinator if yes.
B. Mental Health Referral made? Yes_________ No________
Where? ________________________________________
Date of Referral: _______________________________
C. *Information about Postpartum Depression: Date:____________
D. Postpartum Depression 24 –Hour Crisis Hotline Information given to client:
Date:__________
Signs and Symptoms of depression include: change in sleeping, eating, and/or activity patterns, expressions of hopelessness and helplessness, and other signs described in depression handout. If you are not sure if a client is expressing signs and symptoms of depression, consult with the Mental Health Coordinator.
Chicago Department of Family & Support Services Pregnancy Pathway
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E. Domestic Violence questionnaire done? Date Completed: _____________________
• Have you been hit, kicked, punched or otherwise hurt by someone in the past? Yes_________ No____
• Do you feel safe in your current relationship? Yes_________ No________
• Is there a partner from a previous relationship who is making you feel unsafe? Yes_________ No____
• In the past month, have you had little interest or pleasure in doing things? Yes_________ No____
• In the past month, have you often been bothered by feeling down, depressed or hopeless? Yes_________ No___
F. Referral to Domestic Violence counselor? Yes_________ No____
G. *Use of Alcohol or Drugs? Yes_________ No____
*Referral to Mental Health Coordinator if “yes”
Depression Screening Documentation During and After Pregnancy Each pregnant mother should have a depression screening done at least once (usually twice) during pregnancy and once after delivery of the baby. Document the following information here and in your case notes: Depression Screening done during pregnancy:
• Date completed: Score: ___ • Referral initiated: Yes____ No____ • If yes, referred to: _____________________________________________________ • Who completed the screening with the client? ____________________________
Depression Screening done after pregnancy: • Date completed: Score: ___ • Referral initiated: Yes____ No____ • If yes, referred to: _____________________________________________________ • Who completed the screening with the client? ____________________________
Notify the Mental Health Consultant for scores > 8 and/or if a referral was initiated
Chicago Department of Family & Support Services Pregnancy Pathway
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9. Infant Health ______________________________________________________
A. *Name of Pediatrician ________________________ Address: ___________________________ Phone Number: _____________________
B. If client does not have a pediatrician, refer to: [Insert pediatric health care provided listed on medial cooperative agreement.] Date: ____________
C. Meet the Pediatrician visit prior to delivery: Date: ____________
D. “How to Select a Pediatrician” Information Questions to ask when choosing a pediatrician (Ap. 17) Date: ____________
E. Immunization Schedule and parent information. CDC immunization schedule (Ap. 18) Immunizations and well-baby visit (†F6 32) When is your baby sick? (†F6 33) Date: ____________
F. “Soft Bedding Alert”/Safe Sleep Information Crib safety and Back to Sleep (Ap. 20) Date: ____________
G. “SIDS” Prevention Information A safe sleep environment for my baby (†BB 52) Date: ____________
H. “When to Go to the Doctor” Information When to call the doctor (Ap. 21) Date: ____________
10. Infant Safety ____________________________________________ Car:
A. Does client have a car seat? Yes_________ No____ B. Referral to a Certified Car Seat Technician: Yes_________ No____ C. Car seat safety information
Basic car seat safety (Ap. 22) Car seat safety (†F6 7) Date: ____________
Other: D. Crib Safety Information
Soft Bedding (Ap. 24) Date: ____________ E. Infant safety handout
Keeping baby safe (†F6 64) Date: _________ F. Pets Date: ____________ G. _____________________________ Date: _________
Chicago Department of Family & Support Services Pregnancy Pathway
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Home Safety: H. Smoke Detector Date:____________ I. Carbon Monoxide Detector Date:____________ J. Outlet Covers Date:____________ K. Cabinet Locks Date:____________ L. Sharp Objects out of reach Date:____________ M. Locked Doors Date:____________ N. Floor Check Date:____________ O. Childproofing your home (Ap. 25)
* Denotes required data for COPA 11. Post Partum Care
A. Delivery Method Vaginal _____ Cesarean_____ a. If Cesarean- two week incision check done: Date______________
B. OB/Midwife/PCP 6 week check up appointment date: _______________
Did Mom keep appointment? Yes: _____ No: ____
If no, why not: _______________________________________________
C. Newborn/ Post-Partum Home Visit with Community Health Nurse Date: ____________ Newborn Assessment by Program Community/Public Health Nurse should be done within two weeks of the baby’s birth.
D. Did Client Receive a Post-Partum Depression Screening at 6 Week Post-Partum Visit with Pregnancy Provider? Yes _____ No:__
E. If answer is “no” to receiving a post-partum depression screening by the pregnancy by 7 weeks post-partum, refer to Mental Health Coordinator to do a post-partum depression screening. Date Referral Made: ________________
F. Written information about post-partum depression given to mother: (at 2-week visit) Edinburg Scale completed (Ap. 27) Date: ___________
Taking care of your body (†F6 10) Date: ___________
Postpartum Concerns (†BB 108) Date: ___________
G. Postnatal Nutrition Assessment: See Section 2: Nutrition Support
Chicago Department of Family & Support Services Pregnancy Pathway
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Comments and Response to Teaching: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Additional Written Resources/Information given to client: ________________________________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________________________________ Date the Pregnancy Pathway Completed: _____________ All pregnancy information entered into COPA: Yes _____ No: ______
Signatures FSW: ________________________ Date _________________ Supervisor: _____________________ Date _________________ Revised by Ella Trepashko for the MCH Work Group August 2013 Please note: All written documents marked with a “” are indicated in the corresponding appendix. Materials from the curriculum from Florida State’s “Partners For a Healthy Baby” are to be obtained from your site. Each Early Head Start should be equipped with the curriculum. Ap. Appendix †BB Partners for a Healthy Baby: Before Baby Arrives †F6 Partners for a Healthy Baby: First 6 Months
Chicago Department of Family & Support Services
Appendix Pregnancy Pathway
Appendix Page No. Section *PFHB ver. and No. (prev. No.)
PFHB = Partners for a Healthy Baby BB = Before Baby Arrives F6 = First 6 Months Page i
1. Prenatal Care
H. Illinois Department of Human Services: Feeding your baby 1 Tips on Pregnancy: How much should I gain? (University Tennessee Extension) 2 Weight loss while breastfeeding 3 Why prenatal care is important BB 18(8) What should I expect at my first prenatal visit BB 19(9) My birth plan BB 88(70) Mother’s bottle guide 4
2. Nutritional Support B. Prenatal Nutrition Assessment 5-6 Postnatal Nutritional Assessment 7-8 C. Food safety during pregnancy 9 Fish Facts: Print and go guide (CDC) 10-11 D. Breastfeeding: best for me and my baby BB 51(56) Myths about breastfeeding BB 50 (55) E. Lactation support resources for Chicago Head Start 12
3. Infant Nutrition Information A. How to feed your baby step by step (Oregon Dairy Council) 13-14 B. Is my baby ready for solid foods? F6 63 C. Suggestions for starting solid foods F6 83 D. How does food nourish my baby? BB 62 (44) E. Healthy things to do for you and your baby BB 21 (15)
5. Pregnancy Education/Information
B. What are the signs of preterm labor? BB 66 (46) What to do if you think you are having preterm labor BB 67 (47) C. Postpartum concerns BB 108 Following a C-Section BB 109 D. Family planning choices (6 pages) BB 41 (88) E. Pregnancy, delivery and after-birth professionals 15 F. How using alcohol and drugs can hurt your baby BB 13 (14) G. Exercising safely during pregnancy BB 38 (31) I. How is my baby developing in the first trimester? BB 28 How is my baby developing in the second trimester? BB 53 How is my baby developing in the third trimester? BB 93 J. Labor and Delivery 16 K. How smoking can hurt your baby BB 12
Chicago Department of Family & Support Services
Appendix Pregnancy Pathway
Appendix Page No. Section *PFHB ver. and No. (prev. No.)
PFHB = Partners for a Healthy Baby BB = Before Baby Arrives F6 = First 6 Months Page ii
9. Infant Health D. Questions to ask when choosing a pediatrician 17 E. Immunization schedule (CDC) 18-19 Immunizations and well-baby visit F6 32 When is your baby sick? F6 33 F. Crib safety and Back to sleep (Safe Kids) 20 G. A safe sleep environment for my baby BB 52 H. When to call the doctor 21
10. Infant Safety C. Basic car seat safety (Safe Kids) 22-23 Car seat safety F6 7 D. Soft bedding (CPSC) 24 E. Keeping baby safe F6 64 O. Childproofing your home (USCPSC) 25-26
11. Post Partum Care F. Edinburg Scale 27-28 Taking care of your body F6 10 Postpartum Concerns BB 108
Smart Choices...
Janie BurneyAssociate Professor
Family and Consumer Sciences
Tips on Pregnancy: HowTips on Pregnancy: HowTips on Pregnancy: HowTips on Pregnancy: HowTips on Pregnancy: HowMuch Should I Gain?Much Should I Gain?Much Should I Gain?Much Should I Gain?Much Should I Gain?
SP441-E
The Expanded Food andNutrition Education Program
Women who do not gain enough weight may havebabies who are too small. These babies could haveproblems with:
breathing.feeding.behavior.learning.
Babies who are too small may have more illnessesand sometimes die in the first year.
The amount of weight you should gain depends onyour weight before pregnancy. You should gain:
25 to 35 pounds - if you were a healthy weightbefore pregnancy.
28 to 40 pounds - if you were underweightbefore pregnancy.
15 to 25 pounds - if you were overweightbefore pregnancy.
Why is weight gain important?Why is weight gain important?Why is weight gain important?Why is weight gain important?Why is weight gain important?
How much total weight should I gain?How much total weight should I gain?How much total weight should I gain?How much total weight should I gain?How much total weight should I gain?
Uterus (womb)2 - 2 1/2 lbs.
Amniotic Fluid1 1/2 - 2 lbs.
Placenta1 - 2 lbs.
Breasts1 1/2 - 2 lbs.
Blood2 1/2 - 3 1/2 lbs.
Baby7 - 8 1/2 lbs.
Fluid3 - 6 lbs.
The weight you gain during pregnancyThe weight you gain during pregnancyThe weight you gain during pregnancyThe weight you gain during pregnancyThe weight you gain during pregnancyhelps your baby grow. The weight goeshelps your baby grow. The weight goeshelps your baby grow. The weight goeshelps your baby grow. The weight goeshelps your baby grow. The weight goesnot only to the baby, but to othernot only to the baby, but to othernot only to the baby, but to othernot only to the baby, but to othernot only to the baby, but to otherparts of your body.parts of your body.parts of your body.parts of your body.parts of your body.
Where does the weight go?Where does the weight go?Where does the weight go?Where does the weight go?Where does the weight go?
Maternal Fat6 1/2 - 9 lbs.
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Weight Loss While Breastfeeding
B r e a s t f e e d i n g i s b e s t f o r m o m s a n d t h e i r b a b i e s f o r s e v e r a l
r e a s o n s . B e s i d e s p r o v i d i n g n o u r i s h m e n t a n d h e l p i n g t o p r o t e c t
y o u r b a b y a g a i n s t b e c o m i n g s i c k , b r e a s t f e e d i n g m a y h e l p y o u
l o s e t h e w e i g h t g a i n e d i n p r e g n a n c y . M o d e r a t e e x e r c i s e a n d
e a t i n g l e s s c a n h e l p b r e a s t f e e d i n g m o t h e r s l o s e w e i g h t .
A great time to lose weight after pregnancy is while breastfeeding. Breastfeeding may make it easier to lose weight because you are using extra calories to
feed your infant. Women who breastfeed exclusively for more than 3 months tend to lose more weight
than those who do not. Those who continue breastfeeding beyond 4-6 months may continue to lose weight.
Continue to visit your doctor or health care provider while you are breastfeeding. He or she can keep track of your weight and tell you if you are losing weight as you should.
If you are not losing weight or losing too slowly, cut back on the calories you are
currently eating. The best way to eat fewer calories is by decreasing the amount of "empty calories" you
are eating. "Empty calories" are the calories from added sugars and solid fats, in foods like soft drinks, desserts, fried foods, cheese, whole milk, and fatty meats. Look for choices that are low-fat, fat-free, unsweetened, or with no-added-sugars. They have fewer "empty calories."
If you are losing weight too fast, you need to eat more calories. You can do this by eating a little more from each food group. Try adding a healthy snack each day, or increasing portion sizes at meals. If you keep losing weight faster than you want to, check with your doctor.
"Weight Loss While Breastfeeding." ChooseMyPlate.gov. May 2013.
http://www.choosemyplate.gov/pregnancy-breastfeeding/weight-loss.html
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Mother’s Bottle Guide
Cleanliness is key!
• Discard Any content remaining 2 hours after feeding
• Discard Prepared formula after 24 hours
• Breastmilk can be refrigerated or frozen
• Discard Refrigerated breastmilk after 48 hours
• Discard Frozen breastmilk after 2 weeks
• Washing bottles with soap/water then sanitizing chemically (in dishwasher) or by boiling before reuse
• Setting all bottles to air-dry upside-down
Helpful Tips:
• Always washing hands prior to feeding
• Thaw frozen breastmilk in refrigerator or under warm running water
• DO NOT thaw breastmilk by allowing it to sit on the counter for a few
hours/overnight. This stimulates the growth of unhealthy bacteria.
• Use FIFO method: First In, First Out; When using refrigerated/frozen
breastmilk, always use the oldest first
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Mother’s information: Last: First: M.I. Age:
Home Address: Telephone:
Medical Provider’s Name/ Address/Phone: Name:_ Address: Phone:_ _ When is the due date of your baby? ___/___/___ What is the date of your next scheduled prenatal care visit? ___/___/___ What was the date of your most recent past prenatal care visit? ___/___/___ When mother did first see a physician or attend a clinic for prenatal care? ___/___/___ How much weight have you gained during your pregnancy so far? ______ Do you have any concerns about your current weight or weight gain? ____ How many times have you been pregnant? ___ _ How many children have you given birth to?_ ___ How long has it been since you last delivery? First time: ____ Less than 18 months: ____ More than 18 months: ____ Have you given birth to a child that was under 5lbs? Yes: _____ No: _____ Have you given birth to a child that was over 10lbs? Yes: _____ No: _____ Have you ever been diagnosed with diabetes? Yes: _____ No: _____ If yes what type? Gestational:___ Type I:___ Type II:___ Are you currently taking any medications such as prescriptions, insulin, OTC medications like aspirin? If yes please specify:
Yes: _____ No: _____
Do you currently take a prenatal vitamin, multivitamin or individual vitamin supplement such as iron, folic acid, vitamin C, vitamin B12, or calcium? If yes please specify:
Yes: _____ No: _____
Do you take an iron supplement? Yes: _____ No: _____ Are you currently taking any herbal supplements? Yes: _____ No: _____ If yes please specify: Are you currently consuming or have an appetite for any non-food substances (i.e. clay, chalk, ice chips, cornstarch)?
Yes: _____ No: ____
Have you used any of the following substances during your pregnancy? ___Street Drugs ___Cigarettes/Tobacco ___Caffeine* ___Alcohol ___Prescription Drugs ___Non Rx Drugs ___Iron Supplements ___Exposure to second hand smoke? *Caffeine examples: Red Bull, Soda Products, Tea, Coffee, 5 Hour Energy, Monster
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Have you participated in any of the following educational groups?
_ Prenatal Exercise _ Preparing for Baby Care _ Personal Development
_ Prenatal General Discussion _ Parenting Education _ Birth Education(i.e. Lamaze)
_ Breast Feeding Preparation _ Doula Other: _
Do you have any interest in pursuing any of the above education? Yes: _____ No: _____ Have you received any breastfeeding resource information? Yes: _____ No: _____ How do you plan on feeding your baby? ___Unsure ___Breastfeed ___Formula Have you received any prenatal care or counseling from someone other than your Primary Care provider? Yes: _____ No: _____ Please specify if yes: _ _ How many times per day do you eat the following foods?
Fruit 0 1 2 3 4 ≥5 Vegetables 0 1 2 3 4 ≥5
Meat/Poultry/Beans/Fish 0 1 2 3 4 ≥5 Grains (Bread, Pasta, Rice) 0 1 2 3 4 ≥5
Dairy (Yogurt, Cheese, Milk) 0 1 2 3 4 ≥5 Sweets/Dessert/Soda 0 1 2 3 4 ≥5
Water (8 ounces) 0 1 2 3 4 ≥5 Do you follow a diet such as vegetarian, cultural or prescribed by doctor? Yes: _____ No: _____ Please specify if yes: _ _ How many times per week to you engage in physical activity? __ _ List type of activity Amount of time (in minutes) spent
Do you participate in the WIC Program, food stamps, or local pantry? _ _ Is there enough safe food for you and the family in the house?__ Do you have any questions about your pregnancy or nutrition during your pregnancy?
_
Mother’s Signature:_ Date: _ Home Visitor Signature:_ Date:_ RN or RD Signature:_ Date:__
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Mother’s information: Last: First: M.I. Age:
Home Address: Telephone:
Medical Provider’s Name/ Address/Phone: Name:_
Address: Phone:_ _ How much did your baby weigh when it was born? Have you ever been diagnosed with diabetes? Yes: _____ No: _____ If yes what type? Gestational:___ Type I:___ Type II:___
Do you currently take a prenatal vitamin, multivitamin or individual vitamin supplement such as iron, folic acid, vitamin C, vitamin B12, or calcium?
Yes: _____ No: _____ If yes please specify
Do you take an iron supplement? Yes: _____ No: _____ Do you take a vitamin D supplement? Yes: _____ No: _____ Are you currently taking any medications such as prescriptions, insulin, OTC medications like aspirin? If yes please specify:
Yes: _____ No: _____
Are you currently taking any herbal supplements? Yes: _____ No: _____ If yes please specify: Are you currently consuming or have an appetite for any non-food substances (i.e. clay, chalk, ice chips, cornstarch)?
Yes: _____ No: ____
Have you used any of the following substances during your pregnancy? ___Street Drugs ___Cigarettes/Tobacco ___Caffeine* ___Alcohol ___Prescription Drugs ___Non Rx Drugs ___Iron Supplements ___Exposure to second hand smoke?
*Caffeine examples: Red Bull, Soda Products, Tea, Coffee, 5 Hour Energy, Monster
Have you participated in any of the following educational groups?
_ Prenatal Exercise _ Preparing for Baby Care _ Personal Development
_ Prenatal General Discussion _ Parenting Education _ Birth Education(i.e. Lamaze)
_ Breast Feeding Preparation _ Doula Other: _ Have you received any prenatal care or counseling from someone other than your Primary Care provider? Yes: _____ No: _____ Please specify if yes: _ _
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How are you feeding your baby? ___Breastfeeding ___Formula Other/Details: _ _ How many times per day does your baby feed? _ _ How much formula or breastmilk (if known) does your baby consume? _ __ Do you have any concerns if breastfeeding? Yes: _____ No: _____ If yes, please describe: _ Has mother sought / been given information on lactation resources? Yes: _____ No: _____ How many times per day do you eat the following foods?
Fruit 0 1 2 3 4 ≥5 Vegetables 0 1 2 3 4 ≥5
Meat/Poultry/Beans/Fish 0 1 2 3 4 ≥5 Grains (Bread, Pasta, Rice) 0 1 2 3 4 ≥5
Dairy (Yogurt, Cheese, Milk) 0 1 2 3 4 ≥5 Sweets/Dessert/Soda 0 1 2 3 4 ≥5
Water (8 ounces) 0 1 2 3 4 ≥5 Do you follow a diet such as vegetarian, cultural or prescribed by doctor? Yes: _____ No: _____ Please specify if yes: _ _
How many times per week do you engage in physical activity? __ _ List type of activity Amount of time (in minutes) spent
Do you participate in the WIC Program, food stamps, or local pantry? _ _ Is there enough safe food for you and the family in the house?__ Do you have any additional nutrition questions at this time? _ _
Mother’s Signature:_ Date: _ Home Visitor Signature:_ Date:_ RN or RD Signature:_ Date:__
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Food Safety During Pregnancy
Pregnant women and their growing babies are at an increased risk to develop a food born illness. It
is important to make sure that you are always practicing good food safety practices.
It is recommended that pregnant women avoid certain foods during their pregnancy:
Alcohol
consumption is harmful to the developing baby.
Deli meats – unless steamed, cooked, or heated before eating
deli meats (like turkey, ham, beef for example) may harbor bacteria that is harmful to a pregnant
mother. Heating the meats before putting them in a sandwich is acceptable. Restaurants may
heat these up for you upon request.
Deli salads made in store
salads (such as potato, tuna, egg) may harbor bacteria that is harmful to a pregnant mother. If
you make a salad, ensure it is stored correctly to prevent against bacterial growth.
Soft cheeses
may harbor bacteria that is harmful to a pregnant mother.
Raw shellfish
may have bacteria that is harmful to a pregnant mother. Cooking shellfish appropriately is
acceptable.
Unpasteurized juice or milk
may harbor bacteria that is harmful to a pregnant mother.
Raw sprouts such as alflafa
may harbor bacteria that is harmful to a pregnant mother.
Uncooked cookie dough or batter
has raw eggs that may harbor bacteria that is harmful to a pregnant mother.
Practice good food safety habits every day:
Make sure all meats, eggs, and fish are cooked thoroughly.
Rinse all produce (fruits and vegetables) before eating.
Avoid cross contamination by keeping raw and cooked foods separate from each other,
especially when preparing foods and using cutting boards.
Wash your hands before cooking, eating, when changing diapers, using the washroom or
covering your mouth when coughing or sneezing.
To learn about food safety, ask your Head Start site about education sessions offered
or visit the website www.FDA.gov. Head Start Nutrition Services
Dominican University: August 2013
Page 9
page 1
H e a lt H y P r e g n a n c y
U.S. Department of Health and Human Services, Office on Women’s Health
http://www.womenshealth.gov
800-994-9662
TDD: 888-220-5446
Fish FactsPrint-and-Go Guide
Fish Facts for Women Who Are Pregnant or Breastfeeding Fish and shellfish are an important part of a healthy diet. They are a great source of protein and heart-healthy omega-3 fatty acids for people of all ages. The nutrients in seafood are important for unborn babies, as well as for infants and young children. Research shows that omega-3 fatty acids eaten by pregnant women may aid in babies’ brain and eye development. Also, some researchers believe depression in women during and after pregnancy may be related to not eating enough fish.
Women who are pregnant or breastfeeding should eat at least 8 ounces and up to 12 ounces of a variety of seafood per week to get the health benefits. Unfortunately, some pregnant and nursing women do not eat any fish because they worry about mercury in seafood. Mercury is a metal that, at high levels, can harm the brain of your unborn baby even before he or she is conceived. Yet many types of seafood have little or no mercury at all. So your risk of mercury exposure depends on the amount and type of seafood you eat.
Women who are pregnant or breastfeeding can safely eat a large variety of cooked seafood, but should not eat a few kinds of fish that contain high levels of mercury. Keep in mind that removing all fish from your diet will rob both you and your baby of all the nutritional benefits that seafood provides, including important omega-3 fatty acids. To reach the recommended amount of 8 to12 ounces per week while limiting exposure to mercury, follow these tips:
• Eatavarietyofcooked*seafoodthatcontainslittleornomercury,suchasthesetypesthatarehigherinomega-3fattyacids:
• Salmon
• Anchovies
• Herring
• Sardines
• Pacificoysters
• Trout
• AtlanticandPacificmackerel(notKingmackerel)
* Don’t eat uncooked fish or shellfish (such as clams, oysters, scallops), which includes refrigerated uncooked seafood labeled nova-style, lox, kippered, smoked, or jerky. Uncooked seafood may contain bacteria that are harmful during pregnancy.
Page 10
page 2
H e a lt H y P r e g n a n c y
• Limitwhite(albacore)tunato6ounces(about1serving)perweek.
• Donoteatthesefish,whicharehighinmercury:
• Swordfish
• Tilefish
• Kingmackerel
• Shark
• Checkbeforeeatingfishcaughtinlocalwaters.State health departments have guidelines on fish from local waters. Or get local fish advisories from the U.S. EnvironmentalProtectionAgency.Donoteatfishfromlocalwatersunlessyourstatehealth department says that doing so is safe. If you are unsure about the safety of a fish that you have already eaten, don’t eat any other fish that week.
• Eatavarietyofcookedseafoodratherthanjustafewtypes.
FoodssupplementedwithDHA/EPA(suchas“omega-3eggs”)andprenatalvitaminssupplementedwithDHAareothersourcesofthetypeofomega-3fattyacidsfoundinseafood.
Fish Facts was reviewed by:
RafaelPerez-Escamilla,Ph.D.ProfessorofEpidemiology&PublicHealthDirector,OfficeofCommunityHealthYaleSchoolofPublicHealth
ContentlastupdatedAugust22,2011.
U.S. Department of Health and Human Services, Office on Women’s Health
http://www.womenshealth.gov
800-994-9662
TDD: 888-220-5446
Page 11
Breastfeeding Lactation Support Resources for Chicago
Listed are lactation support groups that can be contacted for breastfeeding and lactation support for new
or expecting mothers. Please call ahead for times and meeting locations.
La información de contacto para el grupo de apoyo a la lactancia. Por favor llame para más información.
Abiyamo Omo Society at UIC Medical Center
1740 West Taylor St, Chicago, IL
773-600-8046
Breastfeeding Support Group at Norwegian American Hospital
1044 North Francisco Ave, Chicago, IL
773-292-8228
Bosom Buddy Breastfeeding Mom's Support Group at St. Bernard Hospital
326 West 64th St, Chicago, IL
773-962-4017 (RSVP Required)
Chicago Family Health Center Breastfeeding Program
C.F.H.C. location: 9119 South Exchange, Chicago, IL
773-768-5000 x1029
Roseland Area: 556 E 115th St
773-768-5000 x1512
South Side La Leche Group
Quaker House
5615 South Woodlawn Ave, Chicago, IL
773-783-9905
La Leche Espanol Group
Erie Family Health Center
2750 West North Ave, Chicago, IL
773-790-0419
La Leche Beverly Group
East Meeting Room of St. Barnabas' Convent
10161 South Longwood Dr, Chicago, IL
773-454-1318
Mercy Hospital Breastfeeding Basics
2525 South Michigan Ave, Chicago, IL
312-567-2441
Roseland Community Hospital WIC Program
11255 South Michigan Ave, Chicago, IL
773-785-1173 x17
Page 12
Fo
r th
e f
ull s
ized
do
cu
men
t to
use
fo
r p
are
nt
ed
ucati
on
ple
ase
do
wn
load
fro
m t
he
follo
win
g s
ite f
rom
th
e O
reg
on
Dair
y C
ou
ncil
. h
ttp
://w
ww
.ore
go
nd
air
yco
un
cil.o
rg/r
eso
urc
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ow
nlo
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ow
nlo
ad
s/h
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_en
glish
_201
2.p
df
For the full-sized document, please see the Oregon Diary Council Website
Page 13
Fo
r th
e f
ull s
ized
do
cu
men
t to
use
fo
r p
are
nt
ed
ucati
on
ple
ase
do
wn
load
fro
m t
he
follo
win
g s
ite f
rom
th
e O
reg
on
Dair
y C
ou
ncil
. h
ttp
://w
ww
.ore
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nd
air
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cil.o
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For the full-sized document, please see the Oregon Diary Council Website
Page 14
Professionals that work with pregnant mothers during
pregnancy, delivery and after birth
Doula – A doula is professionally trained and experienced in giving social support to birthing
families during pregnancy, labor, and birth and at home during the first few days or weeks
after birth. Those who are trained in breastfeeding can help you be more successful with
breastfeeding after birth.
Doulas can be hired privately by the mother to work with her throughout the pregnancy. They
may also be employed by hospitals or clinics to work with the pregnant/new mothers while at
the facility.
Birth Doula – A birth doula is a person trained and experienced in childbirth who provides
continuous physical, emotional and informational support to the mother before, during and
just after childbirth.1
Postpartum Doula – What a postpartum doula does changes from day to day, as the needs of
the family change. Postpartum doulas do whatever a mother needs to best enjoy and care for
her new baby. Postpartum doulas also make sure the mother is fed, well hydrated and
comfortable. They may assist with breastfeeding education.1
International Board Certified Lactation Consultant (IBCLC)
Lactation consultants are credentialed breastfeeding professionals. IBCLCs
are experienced in helping mothers to breastfeed comfortably by helping
with positioning, latch, and a wide range of breastfeeding concerns. Many
IBCLCs are also nurses, doctors, speech therapists, dietitians, or other kinds
of health professionals.2
Breastfeeding Peer Counselor or Educator
A breastfeeding counselor or educator can teach others about the
benefits of breastfeeding and help women with basic breastfeeding
challenges and questions. A "peer" means a person has breastfed
her own baby and is available to help other mothers.2
1Definitions adapted from the Doulas of North America (DONA) website definitions of Doulas. Found at http://www.dona.org
2Adapted from Office on Women's Health in the Office of the Assistant Secretary for Health at http://womenshealth.gov
Dominican University Head Start Nutrition Services 2013
Page 15
Stages of Labor
The First Stage of Labor
The first stage is the start of labor and lasts until the cervix is fully open at 10 centimeters. This is
the longest stage of labor and can last 12 to 17 hours.
This stage is divided into early labor, active labor and transition.
1. During early labor, the cervix dilates from 0 to 3 centimeters.
Contractions may last 30 to 60 seconds and occur every 5 to 20 minutes. There may be a
pink, slightly bloody or mucous discharge from the vagina. Backache, nausea and diarrhea
may also occur.
2. During active labor, the cervix dilates to about 7 centimeters.
Contractions become stronger and longer, lasting about 1 minute and repeating every 2 to
4 minutes. Pain medicine may be given at this time.
3. During transition, the cervix dilates to 10 centimeters. Contractions are stronger and occur
more often. Intense pressure in the lower back and rectum may be felt.
What you can do:
Relax between contractions. Use the breathing or relaxation techniques you learned in
childbirth classes or ask your nurse for help. Do not push until you are told to do so.
The Second Stage of Labor
The second stage begins when the cervix is fully open and lasts until the baby is delivered,
about 2 to 4 hours based on whether or not this is the first baby and whether an epidural
is in place. During this time, staff will tell you when you can push and help support your
body as you deliver your baby.
What you can do:
You will be encouraged to push with each contraction. You may be told to push more gently
or to stop pushing at times.
The Third Stage of Labor
The third stage is the delivery of the afterbirth called the placenta. This is the shortest stage
of labor, lasting 30 minutes.
What you and your partner can do:
Relax and enjoy this time with your baby.
Talk to the staff if you have any questions or concerns at any time during labor and delivery.
2007 – 1/2012 Health Information Translations
Unless otherwise stated, user may print or download information from www.healthinfotranslations.org for personal, non-commercial use only. The medical information found
on this website should not be used in place of a consultation with your doctor or other health care provider. You should always seek the advice of your doctor or other
qualified health care provider before you start or stop any treatment or with any questions you may have about a medical condition. Wexner Medical Center at The Ohio State
University, Mount Carmel Health System, OhioHealth and Nationwide Children’s Hospital are not responsible for injuries or damages you may incur as a result of your stopping
medical treatment or your failure to obtain medical treatment.
Updated stages of labor from the Nov 2012, Am. College of Obstetrics and Gynecologists, Vol 120, #5.
Page 16
Questions to Ask When Choosing a Pediatrician or Family Practice Doctor
When having a baby there are many decisions to be made. One decision is to select the best pediatrician for your newborn. Take the time to research a couple of pediatricians to make sure you are comfortable with your choice.
It is a good idea to interview potential doctors before the baby is born. Providers usually welcome these appointments and do not charge for prenatal interviews but occasionally some do. Check in advance that the provider accepts your health insurance.
• Come prepared by writing down things you do not want to forget. • Ask questions. If you do not understand, have the doctor explain it again to you.
Repeat back what the doctor says to ensure that the topic is understood clearly. • Make sure you have understood all the information the doctor has given you
by repeating it back from your notes.
Questions you may want to ask:
1. What are your qualifications? 2. Are you a member of the American Academy of Pediatrics or any other specialty
organization? 3. How long have you been in practice? 4. What hospitals do you have privileges? 5. What is your philosophy about child rearing? Do your homework and read up on
your issues of interest before this conversation. For example, our may want to know the doctors views on breastfeeding, co-sleeping, vaccinations or circumcision.
6. Do you return patient calls yourself? 7. Do you have a “sick-child” waiting room? 8. If you share a practice, will my child always see you? 9. Do you have evening or weekend appointments? 10. Is there a 24-hour answering service that can connect me to a doctor or a nurse
call line? 11. Who covers for you when you are on vacation? 12. How much time do you schedule for well-baby visits?
Page 17
At 1
mon
th o
f age
, Hep
B (1
-2
mon
ths)
, At
2 m
onth
s of a
ge, H
epB
(1-2
m
onth
s), D
TaP,
PCV,
Hib
, Pol
io,
and
RVAt
4 m
onth
s of a
ge, D
TaP,
PCV,
H
ib, P
olio
, and
RV
At 6
mon
ths o
f age
, Hep
B (6
-18
mon
ths)
, DTa
P, PC
V, H
ib, P
olio
(6
-18
mon
ths)
, RV,
and
Influ
enza
(y
early
, 6 m
onth
s thr
ough
18
year
s)*
At 1
2 m
onth
s of a
ge, M
MR
(12-
15
mon
ths)
, PCV
(12-
15 m
onth
s)† ,
Hib
(12-
15 m
onth
s), V
aric
ella
(1
2-15
mon
ths)
, Hep
A (1
2-23
m
onth
s)§ , a
nd In
fluen
za (y
early
, 6
mon
ths t
hrou
gh 1
8 ye
ars)
*At
4-6
yea
rs, D
TaP,
IPV,
MM
R,
Varic
ella
, and
Influ
enza
(yea
rly, 6
mon
ths t
hrou
gh 1
8 ye
ars)
*
2013
Rec
om
men
ded
Imm
un
izat
ion
s fo
r C
hil
dre
n fr
om
Bir
th T
hro
ug
h 6
Yea
rs O
ld
Bir
th1
mon
th2
mon
ths
4
mon
ths
6
mon
ths
12mon
ths
15mon
ths
18mon
ths
19–2
3mon
ths
2–3
years
4–6
years
Hep
B
RV
RV
RV
DTa
P D
TaP
DTa
P D
TaP
Hib
H
ib
Hib
PCV
PC
V
PCV
IP
V
IP
V
IP
V
MM
R
Va
rice
lla
Hep
BH
epB
DTa
P
Hep
A§
MM
RVa
rice
lla
PCV
Hib
IPV
Influ
enza
(Yea
rly)
*
Shad
ed b
oxes
indi
cate
the
vacc
ine
can
be g
iven
dur
ing
show
n ag
e ra
nge.
Is y
our f
amily
gr
owin
g? To
pro
tect
yo
ur n
ew b
aby
and
yo
urse
lf ag
ains
t who
opin
g co
ugh,
get
a T
dap
vacc
ine
tow
ards
the
end
of e
ach
preg
nanc
y. T
alk
to y
our
doct
or fo
r mor
e de
tails
.
NO
TE:
If yo
ur c
hild
mis
ses a
shot
, yo
u do
n’t n
eed
to st
art o
ver,
just
go
back
to y
our c
hild
’s
doct
or fo
r the
nex
t sho
t.
Talk
with
you
r chi
ld’s
doct
or
if yo
u ha
ve q
uest
ions
ab
out v
acci
nes.
FOO
TNO
TES:
*
T wo
dose
s giv
en a
t lea
st fo
ur w
eeks
apa
rt a
re re
com
men
ded
for c
hild
ren
aged
6 m
onth
s thr
ough
8 y
ears
of
age
who
are
get
ting
a flu
vac
cine
for t
he fi
rst t
ime
and
for s
ome
othe
r chi
ldre
n in
this
age
gro
up.
§ Tw
o do
ses o
f Hep
A va
ccin
e ar
e ne
eded
for l
astin
g pr
otec
tion.
The
firs
t dos
e of
Hep
A va
ccin
e sh
ould
be
give
n be
twee
n 12
mon
ths a
nd 2
3 m
onth
s of a
ge. T
he se
cond
dos
e sh
ould
be
give
n 6
to 1
8 m
onth
s lat
er.
Hep
A va
ccin
atio
n m
ay b
e gi
ven
to a
ny c
hild
12
mon
ths a
nd o
lder
to p
rote
ct a
gain
st H
epA.
Chi
ldre
n an
d ad
oles
cent
s who
did
not
rece
ive
the
Hep
A va
ccin
e an
d ar
e at
hig
h-ris
k, sh
ould
be
vacc
inat
ed a
gain
st H
epA.
If yo
ur c
hild
has
any
med
ical
cond
ition
s tha
t put
him
at r
isk
for i
nfec
tion
or is
trav
elin
g ou
tsid
e th
e
Uni
ted
Stat
es, t
alk
to y
our c
hild
’s do
ctor
abo
ut a
dditi
onal
vac
cine
s tha
t he
may
nee
d.
See
bac
k p
age
fo
r m
or
e
info
rm
atio
n o
n
vac
cin
e-
p
rev
ent
abl
e
dis
ease
s an
d t
he
v
acci
nes
th
at
pr
even
t t
hem
.
For m
ore
info
rmat
ion,
cal
l tol
l fre
e
1-80
0-CD
C-IN
FO (1
-800
-232
-463
6)
or v
isit
http
://w
ww
.cd
c.go
v/va
ccin
es
Page 18
Vac
cin
e-P
reve
nta
ble
Dis
ease
s an
d t
he
Vac
cin
es t
hat
Pre
ven
t Th
em
Dise
ase
Vacc
ine
Dise
ase s
prea
d by
Dise
ase s
ympt
oms
Dise
ase c
ompl
icatio
ns
Chick
enpo
xVa
ricell
a vac
cine p
rote
cts ag
ainst
chick
enpo
x.Ai
r, dire
ct co
ntac
tRa
sh, t
iredn
ess,
head
ache
, feve
rIn
fecte
d blis
ters,
blee
ding d
isord
ers,
ence
phali
tis (b
rain
swell
ing),
pneu
mon
ia (in
fectio
n in t
he lu
ngs)
Diph
ther
iaDT
aP* v
accin
e pro
tects
again
st dip
hthe
ria.
Air, d
irect
cont
act
Sore
thro
at, m
ild fe
ver, w
eakn
ess,
swoll
en
gland
s in n
eck
Swell
ing of
the h
eart
mus
cle, h
eart
failur
e, co
ma,
para
lysis,
deat
h
Hib
Hib v
accin
e pro
tects
again
st Ha
emop
hilus
infl
uenz
ae ty
pe b.
Air, d
irect
cont
act
May
be no
sym
ptom
s unl
ess b
acte
ria
ente
r the
bloo
d
Men
ingiti
s (inf
ectio
n of
the c
over
ing ar
ound
the b
rain
and s
pinal
cord
), int
ellec
tual
disab
ility,
epigl
ottit
is (li
fe-
thre
aten
ing in
fectio
n tha
t can
bloc
k the
wind
pipe a
nd
lead t
o ser
ious b
reat
hing p
roble
ms),
pneu
mon
ia (in
fec-
tion i
n the
lung
s), de
ath
Hepa
titis
AHe
pA va
ccine
prot
ects
again
st he
patit
is A.
Dire
ct co
ntac
t, co
ntam
inate
d fo
od or
wat
er
May
be no
sym
ptom
s, fev
er, st
omac
h pain
, los
s of a
ppet
ite, fa
tigue
, vom
iting
, jaun
dice
(yello
wing
of sk
in an
d eye
s), da
rk ur
ine
Liver
failu
re, ar
thra
lgia (
joint
pain)
, kidn
ey, p
ancre
atic,
an
d bloo
d diso
rder
s
Hepa
titis
BHe
pB va
ccine
prot
ects
again
st he
patit
is B.
Cont
act w
ith bl
ood o
r bo
dy flu
ids
May
be no
sym
ptom
s, fev
er, he
adac
he,
weak
ness,
vom
iting
, jaun
dice (
yello
wing
of
skin
and e
yes),
joint
pain
Chro
nic liv
er in
fectio
n, liv
er fa
ilure,
liver
canc
er
Flu
Flu va
ccine
prot
ects
again
st infl
uenz
a.Ai
r, dire
ct co
ntac
tFe
ver, m
uscle
pain,
sore
thro
at, c
ough
, ex
trem
e fat
igue
Pneu
mon
ia (in
fectio
n in t
he lu
ngs)
Mea
sles
MM
R** v
accin
e pro
tects
again
st m
easle
s.Ai
r, dire
ct co
ntac
tRa
sh, fe
ver, c
ough
, run
ny no
se, p
inkey
eEn
ceph
alitis
(bra
in sw
elling
), pn
eum
onia
(infec
tion i
n th
e lun
gs),
deat
h
Mum
psM
MR*
*vac
cine p
rote
cts ag
ainst
mum
ps.
Air, d
irect
cont
act
Swoll
en sa
livar
y glan
ds (u
nder
the j
aw),
fever,
he
adac
he, t
iredn
ess,
mus
cle pa
in
Men
ingiti
s (inf
ectio
n of t
he co
verin
g aro
und t
he br
ain
and s
pinal
cord
) , en
ceph
alitis
(bra
in sw
elling
), infl
am-
mat
ion of
testi
cles o
r ova
ries,
deafn
ess
Pert
ussis
DTaP
* vac
cine p
rote
cts ag
ainst
pertu
ssis
(who
oping
coug
h).
Air, d
irect
cont
act
Seve
re co
ugh,
runn
y nos
e, ap
nea (
a pau
se in
br
eath
ing in
infan
ts)Pn
eum
onia
(infec
tion i
n the
lung
s), de
ath
Polio
IPV v
accin
e pro
tects
again
st po
lio.
Air, d
irect
cont
act,
thro
ugh
the m
outh
May
be no
sym
ptom
s, so
re th
roat
, feve
r, na
usea
, hea
dach
ePa
ralys
is, de
ath
Pneu
moc
occa
lPC
V vac
cine p
rote
cts ag
ainst
pneu
moc
occu
s.Ai
r, dire
ct co
ntac
tM
ay be
no sy
mpt
oms,
pneu
mon
ia (in
fectio
n in
the l
ungs
)Ba
ctere
mia
(bloo
d inf
ectio
n), m
ening
itis (
infec
tion o
f th
e cov
ering
arou
nd th
e bra
in an
d spin
al co
rd),
deat
h
Rota
viru
sRV
vacc
ine pr
otec
ts ag
ainst
rota
virus
.Th
roug
h the
mou
thDi
arrh
ea, fe
ver, v
omiti
ngSe
vere
diar
rhea
, deh
ydra
tion
Rube
llaM
MR*
* vac
cine p
rote
cts ag
ainst
rube
lla.
Air, d
irect
cont
act
Child
ren i
nfec
ted w
ith ru
bella
viru
s som
etim
es
have
a ra
sh, fe
ver, s
wolle
n lym
ph no
des
Very
serio
us in
preg
nant
wom
en —
can l
ead t
o misc
ar-
riage
, stil
lbirth
, pre
mat
ure d
elive
ry, bi
rth de
fects
Teta
nus
DTaP
* vac
cine p
rote
cts ag
ainst
teta
nus.
Expo
sure
thro
ugh c
uts i
n skin
Stiff
ness
in ne
ck an
d abd
omina
l mus
cles,
diffi
culty
swall
owing
, mus
cle sp
asm
s, fev
erBr
oken
bone
s, br
eath
ing di
fficu
lty, d
eath
* DTa
P com
bines
prot
ectio
n aga
inst d
iphth
eria,
teta
nus,
and p
ertu
ssis.
** M
MR c
ombin
es pr
otec
tion a
gains
t mea
sles,
mum
ps, a
nd ru
bella
.La
st u
pdat
ed o
n 03
/20/
2013
• CS
239274-A
Page 19
Safe Kids Worldwide ❉ Baby Safety Basics ❉ 2
Remember that the Cribs for Kids Graco Pack n’ Play was made for
babies who are less than 35 inches tall and weigh less than 30 lbs.
Crib SafetyMore babies die each year in incidents involving cribs, than from any other nursery product. Your baby spends a lot of time unsupervised in the crib, so learn to make it a safer place.
BUYING A SAFE CRIB
All new cribs on the market today meet the safety standards of the Consumer Product Safety Commission (CPSC) and the Juvenile Products Manufacturers Association (JPMA).
Before getting a used crib, check to see if it has been recalled at www.recalls.gov. Also, look for the following suffocation and strangulation hazards:
• Sharp or jagged edges
• Missing, broken or loose parts
• Loose hardware
• Cut out designs in the headboard or footboard
• Crib slats more than 2 3/8 inches apart (width of a soda can)
• Corner post extension over 1/16 of an inch high
• Gaps larger than 2 fingers width between the sides of the crib and the mattress
• Drop side latches that could be easily released by your baby
When using any crib:
• Follow the directions for assembly.
• Don’t try to fix any part of it with tape, wire, a rope, or by putting a broken side up against the wall.
Back to Sleep Soft bedding can suffocate a baby, blocking the baby’s airway during sleep. Babies can suffocate when their faces become wedged against or buried in a mattress, pillow or other soft object. This can also happen when someone in the same bed rolls over onto them.
Room-sharing is a safer option than having your baby sleep in bed with you. Place your baby’s crib, play yard or bassinet in your room during the first 6 months for more convenient feeding and close contact. Remember to always return your baby to his or her own crib when you’re ready to go back to sleep.
DOS AND DON’TS OF SAFE SLEEP DO:
• Lay your baby on his or her back to sleep to reduce the risk of SIDS (Sudden Infant Death Syndrome.)
• Use a safe crib with a firm, tight-fitting mattress covered with a crib sheet and nothing else in it.
• To keep your baby warm, use a sleep sack (wearable blanket).
DON’T:
Do not put your baby to sleep on beds, sofas, recliners, chairs, soft surfaces, bouncy chairs, baby swings, or car seats. • Do not use pillows, loose sheets or blankets, stuffed
toys, crib bumpers, sleep positioners, and other soft bedding products.
Page 20
When to call the doctor
When you are pregnant don't wait to call your doctor or midwife if something is bothering or worrying you. Sometimes physical changes can be signs of a problem.
Call your doctor or midwife as soon as you can if you:
• Are bleeding or leaking fluid from the vagina
• Have sudden or severe swelling in the face, hands, or fingers
• Get severe or long-lasting headaches
• Have discomfort, pain, or cramping in the lower abdomen
• Have a fever or chills (temperature greater than 100.4)
• Are vomiting or have persistent nausea
• Feel discomfort, pain, or burning with urination
• Have problems seeing or blurred vision
• Feel dizzy
• Suspect your baby is moving less than normal after 28 weeks of pregnancy
• Have thoughts of harming yourself or your baby
Page 21
All children must use a car seat, booster seat or seat belt.
My child always rides in a back seat and never in front of an airbag.
Everyone in my car buckles up on every ride using the right car seat, booster seat or seat belt for each person’s age and size.
My child’s car seat has all of its parts, labels and instructions and has never been in a crash.
I follow the instructions for my car and my car seat so that my child is buckled in right.
I never leave my child alone in a car.
If I have any car seat questions, I know I can contact Safe Kids USA.
1
Program Sponsor
Proud Program SupporterSafe Kids USA202-662-0600
1301 Pennsylvania Avenue, NWSuite 1000
Washington, DC 20004
www.safekids.org
Basic Car Seat SafetyDon’t put your child at risk—buckle up the right way on every ride!
Page 22
2©2011 Safe Kids Worldwide
She always rides in a back seat and never in front of an air bag.
She always rides in a car seat made for her size and age.
She sits facing the back of the car in her car seat.
The straps are snug on her, and I can’t pinch the buckled strap.
Her car seat is buckled tightly in the car and doesn’t move more than one inch when I pull it.
She uses a bigger seat rear-facing until she outgrows the harness. Many harnesses go to 35, 40 or 45 pounds.
He always rides in a back seat and never in front of an air bag
He always rides in a car seat made for his size and age.
The straps are snug on him, and I can’t pinch the buckled strap.
His car seat is buckled tightly in the car and doesn’t move more than one inch when I pull it. I use the top tethers designed for the seat.
He uses this car seat until he outgrows the harness. Many harnesses go to 50, 60 or even 80 pounds.
She always rides in a back seat and never in front of an air bag.
She always rides on a booster seat using a seat belt with lap and shoulder straps.
The lap belt sits low on her hips, not her stomach.
The shoulder belt is on her shoulder – not on her neck, under her arm or behind her back.
The seat belt is snug, flat and comfortable on her.
She may be between 8-12 years of age before the seat belt fits.
She always rides in a back seat and never in front of an air bag.
She always uses a seat belt with lap and shoulder straps.
The lap belt sits low on her hips, not her stomach.
The shoulder belt is on her shoulder – not on her neck, under her arm or behind her back.
Her back is firmly against the seat back, her knees bend at the front edge of the seat, and she can sit this way for the whole ride.
The seat belt is snug, flat and comfortable on her. If the seat belt does not fit right, she must use a booster seat.
Babies under 2 use rear-facing car seats
Toddlers and big kids use forward-facing car seatsIf my child is over age 2 AND has outgrown the weight and height limits for the rear-facing seat:
Older, bigger kids use booster seatsIf my child is under 4 feet, 9 inches tall AND has outgrown the weight and height limit of the forward-facing car seat:
Kids ready for seat beltsIf my child is over 4 feet, 9 inches tall and has outgrown the booster seat:
Page 23
U.S. CONSUMER PRODUCT SAFETY COMMISSION • (800) 638-2772 • www.cpsc.gov • www.SaferProducts.gov
Soft Bedding Can Be Hazardous to Babies “Bare is Best”
To prevent infant deaths due to soft bedding, the U.S. Consumer Product Safety Commission (CPSC) recommends the following safe bedding practices when putting infants under 12 months down to sleep.
Placing babies to sleep on their backs instead of their stomachs has been associated with a dramatic decrease in deaths from Sudden Infant Death Syndrome (SIDS). Babies have been found dead on their stomachs with their faces, noses, and mouths covered by soft bedding, such as pillows, quilts, comforters and sheepskins. However, some babies have been found dead with their heads covered by soft bedding even while sleeping on their backs.
Publication 5049 042013
A Safe Sleeping Environment for Your Baby
Safe Bedding Practices for Infants
Place baby on his/her back on a firm tight-fitting mattress in a crib that meets current safety standards.
Remove pillows, quilts, comforters, sheepskins, pillow-like stuffed toys, and other soft products from the crib.
For warmth, dress baby in footed pajamas.
Positioning devices are unnecessary and can be deadly.
Do not place baby on a waterbed, sofa, soft mattress, pillow, or other soft surface to sleep.
Page 24
Each
yea
r, ch
ildre
n ar
e in
jure
d by
haz
ards
in a
nd a
roun
d th
e ho
me.
Th
e go
od n
ews
is th
at th
e ris
k of
inju
ry c
an b
e re
duce
d or
pre
vent
ed
by u
sing
child
-safe
ty d
evic
es a
nd re
min
ding
old
er c
hild
ren
in th
e ho
use
to re
-secu
re s
afet
y de
vice
s af
ter d
isabl
ing
them
. M
ost o
f the
se s
afet
y de
vice
s ar
e ea
sy to
find
and
are
rela
tivel
y in
ex-
pens
ive.
You
can
buy
them
at h
ardw
are
store
s, b
aby
equi
pmen
t sho
ps,
supe
rmar
kets,
dru
g sto
res,
hom
e im
prov
emen
t sto
res,
on
the
Inte
rnet
and
th
roug
h m
ail o
rder
cat
alog
s. S
afet
y de
vice
s sh
ould
be
sturd
y en
ough
to
hind
er a
cces
s an
d ye
t eas
y fo
r you
to u
se.
To b
e ef
fect
ive,
they
mus
t be
prop
erly
insta
lled.
Fol
low
insta
llatio
n in
struc
tions
car
eful
ly. R
emem
ber,
too,
that
no
devi
ce is
com
plet
ely
child
proo
f; de
term
ined
you
ngste
rs h
ave
been
kno
wn
to o
verc
ome
or
disa
ble
them
. H
ere
are
som
e ch
ild s
afet
y de
vice
s th
at c
an h
elp
redu
ce in
jurie
s to
you
ng c
hild
ren.
The
red
num
bers
cor
resp
ond
to th
ose
on th
e im
age
follo
win
g th
e te
xt.
Use
Safe
ty L
atch
es a
nd L
ocks
1 fo
r cab
inet
s an
d dr
awer
s in
kitc
hens
, bat
hroo
ms,
and
oth
er a
reas
to h
elp
prev
ent p
oiso
ning
s an
d ot
her i
njur
ies.
Saf
ety
latc
hes
and
lock
s on
cab
inet
s an
d dr
awer
s ca
n he
lp p
reve
nt c
hild
ren
from
gai
ning
ac
cess
to m
edic
ines
, hou
seho
ld c
lean
ers,
m
atch
es, o
r cig
aret
te li
ghte
rs, a
s w
ell a
s kn
ives
and
oth
er s
harp
obj
ects.
Even
pro
duct
s w
ith c
hild
-resis
tant
pa
ckag
ing
shou
ld b
e lo
cked
aw
ay a
nd
kept
out
of r
each
. Thi
s pa
ckag
ing
is no
t ch
ildpr
oof.
Look
for s
afet
y la
tche
s an
d lo
cks
that
adu
lts c
an e
asily
insta
ll an
d us
e,
but a
re s
turd
y en
ough
to w
ithsta
nd p
ulls
and
tugs
from
chi
ldre
n.
Use
Safe
ty G
ates
2 to
hel
p pr
even
t fal
ls do
wn
stairs
and
to
kee
p ch
ildre
n fro
m e
nter
ing
room
s an
d ot
her a
reas
with
pos
sible
da
nger
s.Lo
ok fo
r saf
ety
gate
s th
at c
hild
ren
cann
ot d
islod
ge e
asily
, but
that
ad
ults
can
open
and
clo
se w
ithou
t diffi
culty
. For
the
top
of s
tairs
, onl
y us
e ga
tes
that
scr
ew to
the
wal
l.Us
e sa
fety
gat
es th
at m
eet c
urre
nt s
afet
y sta
ndar
ds. R
epla
ce o
lder
sa
fety
gat
es th
at h
ave
“V”
shap
es th
at a
re la
rge
enou
gh to
ent
rap
a ch
ild’s
head
and
nec
k.
Use
Doo
r K
nob
Cove
rs a
nd D
oor
Lock
s 3
to h
elp
prev
ent
child
ren
from
ent
erin
g ro
oms
and
othe
r are
as w
ith p
ossib
le d
ange
rs.
Door
kno
b co
vers
and
doo
r loc
ks c
an h
elp
keep
chi
ldre
n aw
ay fr
om
plac
es w
ith h
azar
ds.
Be s
ure
the
door
kno
b co
ver i
s stu
rdy,
and
allo
ws
a do
or to
be
open
ed q
uick
ly b
y an
adu
lt in
cas
e of
em
erge
ncy.
Use
Ant
i-Sca
ld D
evic
es 4
for f
auce
ts an
d sh
ower
hea
ds a
nd s
et y
our w
ater
hea
ter t
em-
pera
ture
to 1
20 d
egre
es F
ahre
nhei
t to
help
pr
even
t bur
ns fr
om h
ot w
ater
. Ant
i-sca
ld
devi
ces
for r
egul
atin
g w
ater
tem
pera
ture
ca
n he
lp re
duce
the
likel
ihoo
d of
bur
ns.
Use
Smok
e A
larm
s 5
on
ever
y le
vel o
f you
r hom
e, in
side
each
be
droo
m, a
nd o
utsid
e sle
epin
g ar
eas
to a
lert
you
to fi
res.
Sm
oke
alar
ms
are
esse
ntia
l saf
ety
devi
ces
for p
rote
ctio
n ag
ains
t fire
dea
ths
and
inju
ries.
Che
ck s
mok
e al
arm
s on
ce a
mon
th to
mak
e su
re th
ey’re
wor
king
. C
hang
e ba
tterie
s at
leas
t onc
e a
year
or c
onsid
er u
sing
10-y
ear
batte
ries
for a
larm
s.
Use
Win
dow
Gua
rds
and
Safe
ty N
ettin
g 6
to h
elp
prev
ent
falls
from
win
dow
s, b
alco
nies
, dec
ks, a
nd la
ndin
gs.
Che
ck th
ese
safe
ty d
evic
es fr
eque
ntly
to m
ake
sure
they
are
sec
ure
and
prop
erly
insta
lled
and
mai
ntai
ned.
Lim
it w
indo
w o
peni
ngs
to fo
ur
inch
es o
r les
s, in
cludi
ng th
e sp
ace
betw
een
the
win
dow
gua
rd b
ars.
If y
ou h
ave
win
dow
gu
ards
, be
sure
at l
east
one
win
dow
in e
ach
room
can
be
easil
y us
ed fo
r esc
ape
in a
fire
. W
indo
w s
cree
ns a
re n
ot e
ffect
ive
for p
reve
nt-
ing
child
ren
from
falli
ng o
ut o
f win
dow
s.
Use
Corn
er a
nd E
dge
Bum
pers
7 to
he
lp p
reve
nt in
jurie
s fro
m fa
lls a
gain
st sh
arp
edge
s of
fu
rnitu
re a
nd fi
repl
aces
. Be
sure
to lo
ok fo
r bum
pers
that
sta
y se
cure
ly
on fu
rnitu
re o
r hea
rth e
dges
.
Use
Out
let C
over
s an
d O
utle
t Pla
tes 8
to h
elp
prev
ent
elec
trocu
tion.
Out
let c
over
s an
d ou
tlet p
late
s ca
n he
lp p
rote
ct c
hild
ren
from
ele
ctric
al s
hock
and
pos
sible
ele
ctro
cutio
n.
Be s
ure
outle
t pro
tect
ors
cann
ot b
e ea
sily
rem
oved
by
child
ren
and
are
larg
e en
ough
so
that
chi
ldre
n ca
nnot
cho
ke o
n th
em. I
f you
are
re
plac
ing
rece
ptac
les,
use
a ta
mpe
r-res
istan
t typ
e.
Use
a Ca
rbon
Mon
oxid
e (C
O) A
larm
9 to
hel
p pr
even
t CO
po
isoni
ng. A
ll co
nsum
ers
shou
ld in
stall
CO
ala
rms
near
sle
epin
g ar
eas
in th
eir h
omes
. Cha
nge
batte
ries
at le
ast o
nce
a ye
ar.
CPS
C re
com
men
ds u
sing
Cord
less
Win
dow
Cov
erin
gs 1
0
in h
omes
with
you
ng c
hild
ren,
in o
rder
to h
elp
prev
ent s
trang
ulat
ion.
C
hild
ren
can
wra
p w
indo
w c
over
ing
cord
s aro
und
thei
r nec
ks o
r ca
n pu
ll co
rds t
hat a
re n
ot c
lear
ly v
isibl
e bu
t are
acc
essib
le a
nd
beco
me
enta
ngle
d in
the
loop
s. If
you
have
win
dow
blin
ds fr
om 2
000
or e
arlie
r and
you
can
not a
fford
new
, cor
dles
s win
dow
cov
erin
gs,
call
the
Win
dow
Cov
erin
g Sa
fety
Cou
ncil
at 8
00-5
06-4
636
or v
isit
WindowCoverings.org
for a
free
repa
ir ki
t. W
indo
w b
linds
that
hav
e
an in
ner c
ord
(for r
aisin
g th
e sla
ts of
the
blin
ds) c
an b
e pu
lled
by a
ch
ild a
nd fo
rm a
pot
entia
lly d
eadl
y lo
op. C
onsu
mer
s sho
uld
imm
edia
tely
re
pair
thes
e ty
pes o
f blin
ds. C
onsu
mer
s sho
uld
know
that
WC
SC’s
retro
fit k
its d
o no
t add
ress
the
dang
ling
pull
cord
haz
ard
asso
ciat
ed
with
man
y co
mm
on w
indo
w b
linds
.
Use
Anc
hors
to A
void
Fur
nitu
re a
nd A
pplia
nce
Tip-
Ove
rs
11. F
urni
ture
, TVs
and
rang
es c
an ti
p ov
er a
nd c
rush
you
ng c
hild
ren.
De
aths
and
inju
ries
occu
r whe
n ch
ildre
n cli
mb
onto
, fal
l aga
inst
or p
ull
them
selve
s up
on
tele
visio
n sta
nds,
she
lves,
boo
kcas
es, d
ress
ers,
des
ks,
ches
ts an
d ra
nges
. For
add
ed s
ecur
ity, a
ncho
r the
se p
rodu
cts
to th
e flo
or
or a
ttach
them
to a
wal
l. Fr
ee s
tand
ing
rang
es a
nd s
tove
s sh
ould
be
insta
lled
with
ant
i-tip
bra
cket
s.
Use
Laye
rs o
f Pr
otec
tion
with
Poo
ls a
nd S
pas 12
. A b
arrie
r co
mpl
etel
y su
rroun
ding
the
pool
or s
pa in
cludi
ng a
4-fo
ot ta
ll fe
nce
with
se
lf-clo
sing,
sel
f-lat
chin
g ga
tes
is es
sent
ial.
If th
e ho
use
serv
es a
s a
side
of th
e ba
rrier
, doo
rs h
eadi
ng to
the
pool
sho
uld
have
an
alar
m o
r the
po
ol s
houl
d ha
ve a
pow
er s
afet
y co
ver.
Pool
ala
rms
can
serv
e as
an
addi
tiona
l lay
er o
f pro
tect
ion.
Sl
idin
g gl
ass
door
s, w
ith lo
cks
that
mus
t be
re-se
cure
d af
ter e
ach
use,
ar
e no
t an
effe
ctiv
e ba
rrier
to p
ools.
THIS
BRO
CHU
RE B
ROU
GH
T TO
YO
U B
Y:
U.S
. CO
NSU
MER
PRO
DU
CT S
AFE
TY C
OM
MIS
SIO
N43
30 E
ast W
est H
ighw
ay, B
ethe
sda,
MD
2081
4W
eb s
ite: w
ww.
cpsc
.gov
Toll-f
ree
hotli
ne: 1
-800
-638
-277
2
The
U.S.
Con
sum
er P
rodu
ct S
afet
y C
omm
issio
n (C
PSC
) is
a fe
dera
l age
ncy
that
hel
ps k
eep
fam
ilies
and
chi
ldre
n sa
fe in
and
aro
und
thei
r hom
es.
Go
to www.cpsc.gov
to c
heck
for r
ecal
led
prod
ucts
and
sign
up fo
r aut
omat
ic e
-mai
l rec
all n
otifi
catio
ns.
Publ
icat
ion
252
1120
08
0409
13
Page 25
Child
proo
fing
Your
Hom
e1
2 S
AF
ET
Y D
EV
ICE
S T
O
PR
OT
EC
T Y
OU
R C
HIL
DR
EN
Child
safe
ty d
evic
es a
re a
n im
porta
nt a
id
to p
aren
tal s
uper
visio
n. H
ere
are
12 c
hild
sa
fety
dev
ices
that
will
hel
p ke
ep y
our h
ome—
and
child
ren—
safe
r.
Use
SAFE
TY L
ATC
HES
and
LO
CKS 1
for
cabi
nets
and
draw
ers i
n ki
tchen
s, ba
thro
oms,
and
othe
r are
as to
hel
p pr
even
t poi
soni
ngs a
nd o
ther
in
jurie
s.
Use
SAFE
TY G
ATE
S 2
to h
elp
prev
ent f
alls
dow
n sta
irs a
nd to
kee
p ch
ildre
n fro
m e
nter
ing
room
s and
oth
er a
reas
with
pos
sible
dan
gers
.
Use
DO
OR
KN
OB
COV
ERS
and
DO
ORS
LO
CKS 3
to h
elp
prev
ent c
hild
ren
from
ent
erin
g ro
oms a
nd o
ther
are
as w
ith p
ossib
le d
ange
rs.
Use
AN
TI-S
CALD
DEV
ICES
FO
R FA
UCE
TS a
nd
SHO
WER
HEA
DS 4
and
set y
our w
ater
hea
ter
tem
pera
ture
to 1
20 d
egre
es F
ahre
nhei
t to
help
pr
even
t bur
ns fr
om h
ot w
ater
.
Use
SMO
KE
ALA
RMS 5
on
ever
y le
vel o
f you
r ho
me,
insid
e ea
ch b
edro
om a
nd o
utsid
e sle
epin
g ar
eas t
o al
ert y
ou to
fire
s.
Use
WIN
DO
W G
UA
RDS
and
SAFE
TY
NET
TIN
G 6
to h
elp
prev
ent f
alls
from
win
dow
s, ba
lconi
es, d
ecks
, and
land
ings
.
Use
CORN
ER a
nd E
DG
E BU
MPE
RS 7
to h
elp
prev
ent i
njur
ies f
rom
falls
aga
inst
shar
p ed
ges o
f fu
rnitu
re a
nd fi
repl
aces
.
Use
OU
TLET
CO
VER
S an
d O
UTL
ET P
LATE
S 8
to
hel
p pr
even
t ele
ctroc
utio
n.
Use
a CA
RBO
N M
ON
OX
IDE
(CO
) ALA
RM 9
ne
ar sl
eepi
ng a
reas
to h
elp
prev
ent C
O p
oiso
ning
.
Use
CORD
LESS
WIN
DO
W C
OV
ERIN
GS 10
in
hom
es w
ith y
oung
chi
ldre
n to
hel
p pr
even
t str
angu
latio
n.
Use
AN
CHO
RS T
O A
VO
ID F
URN
ITU
RE A
ND
A
PPLI
AN
CE T
IP-O
VER
S 11
.
Use
LAY
ERS
OF
PRO
TECT
ION
WIT
H P
OO
LS
AN
D S
PAS 12
.
1
4
12
49 2
3
5
5
6
5
7
118
10
Page 26
Edinburgh Postnatal Depression Scale 1 (EPDS) Name: ______________________________ Address: ___________________________
Your Date of Birth: ____________________ ___________________________
Baby’s Date of Birth: ___________________ Phone: _________________________
As you are pregnant or have recently had a baby, we would like to know how you are feeling. Please check the answer that comes closest to how you have felt IN THE PAST 7 DAYS, not just how you feel today.
Here is an example, already completed.
I have felt happy: Yes, all the time Yes, most of the time This would mean: “I have felt happy most of the time” during the past week. No, not very often Please complete the other questions in the same way. No, not at all
In the past 7 days:
1. I have been able to laugh and see the funny side of things *6. Things have been getting on top of me As much as I always could Yes, most of the time I haven’t been able Not quite so much now to cope at all Definitely not so much now Yes, sometimes I haven’t been coping as well Not at all as usual
2. I have looked forward with enjoyment to things No, I have been coping as well as ever As much as I ever did Rather less than I used to *7 I have been so unhappy that I have had difficulty sleeping Definitely less than I used to Yes, most of the time Hardly at all Yes, sometimes
Not very often *3. I have blamed myself unnecessarily when things No, not at all
went wrong Yes, most of the time *8 I have felt sad or miserable Yes, some of the time Yes, most of the time Not very often Yes, quite often No, never Not very often
No, not at all 4. I have been anxious or worried for no good reason
No, not at all *9 I have been so unhappy that I have been crying Hardly ever Yes, most of the time Yes, sometimes Yes, quite often Yes, very often Only occasionally
No, never *5 I have felt scared or panicky for no very good reason
Yes, quite a lot *10 The thought of harming myself has occurred to me Yes, sometimes Yes, quite often No, not much Sometimes No, not at all Hardly ever
Never
Administered/Reviewed by ________________________________ Date ______________________________
1 Source: Cox, J.L., Holden, J.M., and Sagovsky, R. 1987. Detection of postnatal depression: Development of the 10-item Edinburgh Postnatal Depression Scale. British Journal of Psychiatry 150:782-786 .
2 Source: K. L. Wisner, B. L. Parry, C. M. Piontek, Postpartum Depression N Engl J Med vol. 347, No 3, July 18, 2002, 194-199
Users may reproduce the scale without further permission providing they respect copyright by quoting the names of the authors, the title and the source of the paper in all reproduced copies.
No, most of the time I have coped quite well
Page 27
Edinburgh Postnatal Depression Scale 1 (EPDS) Postpartum depression is the most common complication of childbearing. 2 The 10-question Edinburgh Postnatal Depression Scale (EPDS) is a valuable and efficient way of identifying patients at risk for “perinatal” depression. The EPDS is easy to administer and has proven to be an effective screening tool.
Mothers who score above 13 are likely to be suffering from a depressive illness of varying severity. The EPDS score should not override clinical judgment. A careful clinical assessment should be carried out to confirm the diagnosis. The scale indicates how the mother has felt during the previous week. In doubtful cases it may be useful to repeat the tool after 2 weeks. The scale will not detect mothers with anxiety neuroses, phobias or personality disorders.
Women with postpartum depression need not feel alone. They may find useful information on the web sites of the National Women’s Health Information Center <www.4women.gov> and from groups such as Postpartum Support International <www.chss.iup.edu/postpartum> and Depression after Delivery <www.depressionafterdelivery.com>.
SCORING QUESTIONS 1, 2, & 4 (without an *) Are scored 0, 1, 2 or 3 with top box scored as 0 and the bottom box scored as 3.
QUESTIONS 3, 510 (marked with an *) Are reverse scored, with the top box scored as a 3 and the bottom box scored as 0.
Maximum score: 30 Possible Depression: 10 or greater Always look at item 10 (suicidal thoughts)
Users may reproduce the scale without further permission, providing they respect copyright by quoting the names of the authors, the title, and the source of the paper in all reproduced copies.
Instructions for using the Edinburgh Postnatal Depression Scale:
1. The mother is asked to check the response that comes closest to how she has been feeling in the previous 7 days.
2. All the items must be completed.
3. Care should be taken to avoid the possibility of the mother discussing her answers with others. (Answers come from the mother or pregnant woman.)
4. The mother should complete the scale herself, unless she has limited English or has difficulty with reading.
1 Source: Cox, J.L., Holden, J.M., and Sagovsky, R. 1987. Detection of postnatal depression: Development of the 10-item Edinburgh Postnatal Depression Scale. British Journal of Psychiatry 150:782-786.
2 Source: K. L. Wisner, B. L. Parry, C. M. Piontek, Postpartum Depression N Engl J Med vol. 347, No 3, July 18, 2002, 194-199
Page 28
Prenatal Nurse Assessment
Page 1 of 2
Prenatal Record:
Brief narrative:
Mom’s name, age:
Expected due date:
Weeks pregnant:
Social factors-
Who is present during interview?
Any history of drinking?
Any history of smoking?
Any history of drug use?
Type of apartment/house:
Father of baby present or involved:
Has your partner ever hit or threatened you?
1. First Prenatal Care (at how many weeks)
2. Course of Pregnancy: Any complications during this pregnancy such as HTN, DM, pre-eclampsia?
3. How many other children does client have? Ages? Do you have childcare?
Prenatal Nurse Assessment
Page 2 of 2
4. Emotional health during the pregnancy (depression, any history of mental health problems.) Who do you have for support during this pregnancy? (family, friends, husband)
5. Birth plan: Where will you deliver? Plan to get medications/epidural?
Do you plan to circumcise if you have a boy?
Topics to Discuss • Pregnancy complications (s/s pre-term labor, preeclampsia, etc.)
• Importance of prenatal care
• Healthy nutrition during pregnancy
• Breastfeeding
• Birth control/family planning
After visit assessment/recommendations:
• How did the client accept the information?
• Does the client need reinforcement of information? If so which information do you feel
the client needs reinforcement on by home visitor or nurse @ 2 week visit?
• Any recommendations or follow up?
• Client’s questions or concerns? Were they all addressed?
• Home visitor’s questions or concerns? Were they all addressed?
Assessment completed by: Date:
Infant and Postnatal Assessment Template
Page 1 of 6
Prenatal Record: Name of Mother of baby: Brief narrative: Mother of baby’s name, age, social factors, name of hospital where mother delivered, etc. (see example newborn & new mother assessment)
1. Length of Pregnancy
2. First Prenatal Care
3. Course of Pregnancy
4. Position of the babies in the family constellation
5. Emotional health during the pregnancy Labor Record Type of Delivery: Complications:
Infant and Postnatal Assessment Template
Page 2 of 6
Infant Age of Newborn: Infant Health Problems identified prior to birth: Infant health problems identified at birth: Infant health problems identified after birth: Type of feeding: Immunizations: Results of Newborn Hearing Screening:
Physical Assessment General Appearance: Skin:
Infant and Postnatal Assessment Template
Page 3 of 6
General Body Proportions: Weight at Birth: Weight today:
Length at Birth: HC at Birth:
Behavior: Sleep pattern: Head, Ears and Fontanels: Face, Eyes and Mouth:
Cry:
Neck: Chest: Extremities: Abdomen: GU:
Infant and Postnatal Assessment Template
Page 4 of 6
Newborn Needs: Oxygenation: Nutrition: Mother/Baby Bonding: Warmth/Protection from weather extremes: Protection from Infection:
Infant and Postnatal Assessment Template
Page 5 of 6
Mother’s Post-Partum Health Physical Health/Complications: Emotional Health: Family Planning: Post-Partum Nutrition: Post-Partum Visit:
Infant and Postnatal Assessment Template
Page 6 of 6
Written Information Given to MOB: Follow Up Needs: Signature: ________________________________ Date: ______________________
PREGNANCY VERIFICATION
Dear Health Care Provider,
_________________________________________________ is a mother participating in our Early Head Start program. Federal Performance Standards require us to verify that she is receiving regular prenatal care.
Is this mother receiving prenatal care from you? Yes No
Date of first prenatal visit_________________ at __________ week’s gestation.
How many prenatal visits has she received up to this date? _______
Is her pregnancy considered high risk? Yes No
1. Initial Assessment Weeks Gestation: _________
High Risk Factors
High Risk Factors Very High Risk Factors
� Age: <18 or >35 � Substance Use � Drug Addiction
� Currently involved in a violent relationship.
� Diabetes � 2 or more prior low birth weight infants.
� BMI <18 or >30 � Prior Infant with a Major Health Problem
� 2 or more HIGH RISK FACTORS
� Anemia � Cardiac Problems � Multiple Pregnancy
� Smoking � Rh Sensitization � Other
� Poor Socioeconomic Condition
� Uterine abnormality or an Incompetent Cervix
� Suspected Poor Nutrition � 1 Prior Infant with a Birth weight < 5 ½ lbs.
� Prior Cesarean Section � Hypertension
� Seizures � Kidney Disease
� Chronic Mental Illness � History of a Miscarriage
� Sought Prenatal Care > 20 weeks
� History of a Stillborn Baby
� Other (specify): � Prior baby in the Neonatal Intensive Care Unit
Date of next scheduled prenatal visit________________
AUTHORIZATION FOR MUTUAL EXCHANGE OF INFORMATION
I (name) _______________________________________________________authorize the mutual exchange of information concerning my prenatal care between __________________________________ [Insert delegate program name] and ______________________________________________________________ (health care provider or agency).
Participant's
Signature_________________________________________________________Date______________
Doctor Signature___________________________________________________Date____________
Please fax this form back to [Insert delegate program name] Early Head Start, Home Visiting Program at
[Insert program fax number]. Thank you.
[Insert Program Name, Address and Phone Number]