What is the recommended checklist for a newborn's first-week well-child visit?

Newborn First-Week Well-Child Visit Checklist

For a newborn's first-week well-child visit, you must systematically address immunization status, feeding adequacy, jaundice assessment, screening confirmations, safety counseling, and maternal mental health—following a structured protocol that prioritizes early disease detection and preventive care.

Timing and Scheduling

The visit should occur within 48 hours of discharge for infants discharged before 48 hours of age, or by 72-120 hours depending on discharge timing 1, 2. If discharged before 24 hours, see by 72 hours; between 24-48 hours, see by 96 hours; between 48-72 hours, see by 120 hours 2.

Essential Assessment Components

1. Weight and Feeding Evaluation

• Weigh the infant and calculate percent change from birth weight 1
• Assess adequacy of intake through:
  • Feeding frequency and duration
  • Observation of breastfeeding technique (position, latch, swallowing) 1
  • Stool and urine patterns (historical evidence of adequate output) 1, 2
• Red flag: Weight loss >7-10% or inadequate regain requires immediate intervention

2. Jaundice Assessment

• Visual inspection is insufficient—obtain objective measurement if any jaundice present 2
• Measure transcutaneous bilirubin (TcB) or total serum bilirubin (TSB) if:
  • Jaundice appears excessive for age 2
  • Any jaundice in first 24 hours 2
  • Jaundice extends beyond face to trunk/extremities
• Plot TSB on hour-specific nomogram to determine risk zone 2
• Critical: Jaundice at or beyond 3 weeks requires total and direct bilirubin measurement to rule out cholestasis 2

3. Immunization Verification

• Confirm hepatitis B vaccine was given within 24 hours of birth 3
• If mother is HBsAg-positive: verify infant received both HepB vaccine AND HBIG within 12 hours 4
• If mother's HBsAg status unknown at birth: confirm testing was completed and HBIG given if positive (within 7 days) 4
• Document vaccine lot numbers and administration site

4. Screening Confirmations

• Verify completion of newborn metabolic screening (PKU, hypothyroidism, others per state requirements) 1
• Confirm hearing screening was performed and passed 5
  • If failed or not done: arrange diagnostic audiology assessment by 3 months 5
• Critical congenital heart disease screening with pulse oximetry should be documented 6
• Review any pending laboratory results 1

5. Physical Examination Focus

Perform targeted assessment for conditions with delayed presentation:

• Umbilical cord: Check for infection, bleeding, or delayed separation 7
• Genitalia: Assess circumcision healing if performed; check for testicular descent 7
• Hips: Barlow and Ortolani maneuvers for developmental dysplasia
• Eyes: Red reflex bilaterally to detect cataracts or retinoblastoma
• Skin: Assess hydration status and any rashes
• Cardiovascular: Auscultate for murmurs; palpate femoral pulses

6. Safety Counseling (Non-Negotiable)

• Sleep position: Back to sleep, every sleep 1, 7
• Sleep environment: Firm surface, no co-sleeping, no soft objects in crib 1
• Car seat: Rear-facing only, never use for positioning at home 1, 7
• Never give honey before 12 months (botulism risk) 7
• No water bottles before 12 months 7
• Discuss shaken baby syndrome prevention

7. Maternal Mental Health Screening

Screen the mother for postpartum depression using validated tool (Edinburgh Postnatal Depression Scale or PHQ-9) 1, 6. This is required through infant's first 6 months 8.

8. Establish Medical Home

• Verify plan for ongoing health maintenance 1
• Confirm method for obtaining emergency services 1
• Schedule next well-child visit (typically 2 weeks, then 1 month) 1
• Provide written and verbal information about warning signs requiring immediate attention 2

High-Risk Situations Requiring Extended Assessment

Delay discharge or arrange intensive follow-up if:

• Maternal substance use (positive toxicology) 1
• History of child abuse/neglect by any caregiver 1
• Lack of social support, especially single first-time mothers 1
• No fixed home or barriers to follow-up care 1
• Adolescent mother with other risk factors 1

Documentation Requirements

Ensure results are transmitted to:

• The infant's primary care provider 5
• State EHDI (Early Hearing Detection and Intervention) coordinator 5
• Parents in culturally sensitive, understandable format 5

Common Pitfall: Do not rely on visual estimation of jaundice severity, particularly in darkly pigmented infants—always obtain objective measurement when in doubt 2.