Section 2 - Child health checks

1. Procedure

• If both parents are present, engage each separately in confidence
• Ask parents the questions and explore further if required. See Table 1.
• Provide the parent with brief intervention
• Determine if the answers require a referral and place parent(s) and child on a follow-up and recall register

1. Asking the questions

• While asking the questions look for signs of attachment including:
  • holding, cuddling, being physically close and protective of baby
  • smiling, talking and eye contact with baby
• Poor attachment signs include:
  • physically distant from baby
  • holding baby turned facing away
  • leaving baby for long periods by themselves
  • talking negatively about baby
  • not responding to baby’s cues i.e. crying
  • poor infant hygiene
  • not smiling, talking or eye contact with baby

2. Results

1. Questions for both parents ^1–3
   • Asking these questions can help the clinician determine:
     • a parents preparedness for parenting
     • the level of stress they might be experiencing
     • the effect on a parents mental health
     • whether children are exposed to an unsafe and harmful environment e.g. violence, harmful toxins, intoxicated adults
   • If concerns are identified perform the:
     • Edinburgh Postnatal Depression Scale (EPDS) or
     • Kimberley Mum’s Mood Scale (KMMS). See Resource 1.
   • If ‘yes’ to the violence question perform the Safe Start psychosocial questionnaire. See Resource 2.
2. Mother specific questions
   • Identifying if a mother had antenatal care, including screening for diabetes and STIs, allows clinicians to identify if the mother or child is at risk of chronic conditions

3. Brief intervention

1. Unplanned pregnancy ^1–3
   • Be alert to a stressed or anxious first-time parent who will require extra reassurance
   • Poor paternal Social-emotional wellbeing (adult) can impact on infant attachment
   • Exhausted parents +/- support, should still show signs of attachment
   • Childhood trauma is often a cause of poor parental attachment to their own children

Lacking signs of attachment indicates the parent requires urgent psychosocial support, not that they are a “bad parent”

2. Paternal or household smokers ⁴
   • Smoking during pregnancy is associated with increased risk of:
     • pre-term and low birth weight and small for gestational age
     • birth defects e.g. cleft lip, cleft palate
     • diabetes and other chronic conditions
   • Smoking while breastfeeding or around baby is associated with:
     • ear and chest infections
     • slow lung growth
     • asthma
     • SIDS. See Environment
     • wheezing and coughing
   • Do not expose a baby or child to cigarette smoke. All smokers should smoke outside
   • Smoke particles persist on hands and clothes. Wash hands and change shirt after smoking before handling a baby
   • See Smoking cessation for support resources to quit
3. Alcohol, prescription medicines or other substance use ⁴
   • Intake during the perinatal period increases childhood risk of:
     • Developmental delay or disability (child)
     • breathing difficulties and muscle weakness
     • fetal alcohol spectrum disorder (FASD) and neonatal withdrawals
     • impaired brain, heart and kidney development
     • death
     • poor feeding and sleep patterns
     • behavioural, learning and communication problems
   • Can impair parental care associated with poor supervision and judgement e.g. dropping baby, rolling on baby when sleeping
   • How much alcohol or other substances passes through breastmilk depends on:
     • strength and amount consumed
     • what food and amount consumed
     • mothers weight
     • how quick the substance is taken
   • Reduce risk if planning to drink alcohol by arranging a dedicated carer for children and pre-expressing breastmilk to feed baby
   • Alcohol is not ‘stored’ in breastmilk, just as it isn’t ‘stored’ in blood
   • Expressing and disposing of breastmilk maintains supply. It does not reduce the amount of alcohol in breastmilk
   • Provide the Feed safe app (Resource 3.) to assess when adequate time has passed to resume breastfeeding after alcohol intake
   • See Alcohol reduction
4. Multiple children in parent’s care ^1–3
   • Can alert clinicians to issues impacting the family including:
     • Social-emotional wellbeing (adult)
     • financial stress
     • maternal mood
     • domestic violence
     • child neglect or abuse
     • overcrowding

5. Domestic violence
   • See Domestic and family violence
6. Diabetes during pregnancy ⁵
   • Gestational diabetes mellitus (GDM) or diabetes during pregnancy is associated with babies that:
     • are large for gestational age
     • have low blood glucose levels
     • are jaundiced
     • are at higher risk of chronic conditions in adulthood
   • Closely manage, monitor and follow-up women with Diabetes or who developed GDM
   • Support parents with Lifestyle modifications postnatally
7. Antenatal sexually transmitted infection screen
   • Sexually transmitted infections (STIs) can be passed from mother to baby
   • If the mother did not have an antenatal STI screen:
     • perform a full STI screen according to the Primary Clinical Care Manual and treat any positive results
     • treat babies symptomatically and follow-up any positive maternal result
8. Parental confidence
   • Although mum is usually identified as the primary caregiver of children, her primary caregiver is usually her partner
   • Some fathers distance themselves from parenting young children and babies due to not knowing what to do, believing it is a mothers responsibility or from own trauma during childhood
   • This can place stress on mothers, other family members and the relationship
   • Provide and model simple skills with fathers e.g. holding or carrying baby, changing nappy
   • Provide all fathers with SMS4dads details; a national SMS support service to help fathers connect with their baby and partner. See Resource 4.
9. Sex after pregnancy
   • If comfortable and culturally appropriate, discuss safe Sexual and reproductive health including:
     • communicating openly and frankly
     • due to hormonal changes, mothers might experience fatigue, vaginal dryness, pain and low sexual desire after the birth of a baby
     • It is safe to return to sexual practice after 4–6 weeks if both parents are ready, longer if mother had surgical interventions e.g. perineal repair, caesarian
     • take it slow, use lubricant for vaginal dryness, experiment, discuss alternatives to vaginal intercourse, such as massage, oral sex or mutual masturbation

4. Referral ^1–8

• For any Social-emotional wellbeing (adult) concerns (an EPDS score ≥ 13 for women or  ≥ 10 for men, unplanned pregnancy, poor attachment) refer to:
  • child health nurse, MO/NP or
  • Early Intervention Specialist (psychologist or social worker) or
  • perinatal mental health services and
  • a home visiting child health program and
  • parenting program or group e.g. Circle Of Security©, Together in Mind and
  • local family support services
• For parents who smoke tobacco, consume alcohol or take prescription medicines or other substances of dependence refer to MHAODs. See Resource 5.
• For a mother who had GDM ensure:
  • postnatal oral glucose tolerance test (OGTT) at 6–8 weeks or HbA1c at 12 weeks, to screen for persistent Diabetes
  • lifelong screening every 3 years
  • patient is engaged with diabetes services

5. Follow-up

• Place the parent on a recall register if required
• Ensure all referrals are actioned
• Provide the parent with details for the next scheduled follow-up appointment

6. References

• All Chronic Conditions Manual references are available via the downloadable References PDF

7. Resources

1. The Edinburgh Postnatal Depression Scale (EPDS) or Kimberley Mum’s Mood Scale (KMMS)
2. Safe Start psychosocial questionnaire
3. The Feed Safe app informs parents who drink alcohol of safe levels or Australian Breastfeeding Association: Alcohol and breastfeeding
4. SMS4dads
5. Alcohol, tobacco and other drugs resources