What should I expect and do during the 6 week newborn follow-up appointment with the healthcare provider?

6-Week Newborn Follow-Up Visit

At the 6-week newborn follow-up, perform a comprehensive physical examination including weight measurement, feeding assessment, developmental screening, review of newborn screening results, jaundice evaluation if indicated, and provide anticipatory guidance on safety, feeding, and developmental milestones. 1, 2

Physical Assessment

Growth Parameters

• Measure and document weight, length, and head circumference, plotting on appropriate growth charts to ensure adequate growth trajectory 2
• Calculate weight gain from birth and previous visits to confirm appropriate growth velocity 1

Complete Physical Examination

• Perform head-to-toe examination assessing general appearance, vital signs, and hydration status 1, 2
• Examine the umbilical cord site for complete healing, checking for signs of infection, granuloma, or hernia 1, 2
• Assess skin condition for rashes, birthmarks, or jaundice (though less common at 6 weeks) 2
• Evaluate genitalia for appropriate healing if circumcision was performed 1
• Check for developmental hip dysplasia with Barlow and Ortolani maneuvers 3

Feeding Assessment

Breastfeeding Evaluation

• Directly observe breastfeeding technique, assessing position, latch quality, and effective swallowing 1, 2
• Verify infant is nursing 8-12 times per day with adequate intake 2
• Document stool and urine output patterns to confirm sufficient feeding (should have multiple wet diapers and stools daily) 1, 2

Formula Feeding Assessment

• Evaluate bottle-feeding coordination and volume intake 2
• Assess for feeding difficulties, excessive spitting up, or signs of gastroesophageal reflux 3

Laboratory and Screening Review

• Verify completion and review results of newborn metabolic screening per state regulations 1, 2
• Confirm hearing screening was completed and results are normal 1, 2
• Review maternal laboratory results including hepatitis B, HIV, and syphilis status 2
• If initial metabolic screening was performed before 24 hours of milk feeding, ensure repeat screening was completed 2

Developmental Assessment

• Evaluate achievement of age-appropriate developmental milestones including visual tracking, social responsiveness, and motor development 2
• Assess mother-infant attachment and infant behavioral patterns 2
• Screen for signs of developmental delay or neurological concerns 3

Maternal and Family Assessment

• Screen for maternal postpartum depression using validated screening tools 2
• Evaluate family support systems and identify barriers to adequate care 2
• Screen for social risk factors including housing instability, domestic violence, parental substance use, or mental illness 2

Immunizations

• Administer hepatitis B vaccine (second dose) if not already given 3
• Verify maternal Tdap vaccination status and encourage if not received during pregnancy 2
• Provide education about upcoming 2-month immunizations 3

Safety Education and Anticipatory Guidance

Sleep Safety

• Reinforce safe sleep practices including supine positioning, firm sleep surface, room-sharing without bed-sharing, and avoidance of soft bedding 2
• Educate about risks of sudden infant death syndrome (SIDS) 3

Car Seat Safety

• Verify proper car seat installation and use, ensuring rear-facing positioning 1, 2

Recognition of Illness

• Teach parents to recognize warning signs requiring immediate medical attention: fever (rectal temperature ≥100.4°F/38°C), poor feeding, lethargy, increased irritability, respiratory distress, or persistent vomiting 2
• Provide guidance on temperature assessment and thermometer use 2

Developmental Expectations

• Discuss expected developmental milestones for the coming weeks 3
• Encourage tummy time when infant is awake and supervised 3

Follow-Up Planning

• Schedule next well-child visit at 2 months of age 3
• Ensure establishment of medical home for ongoing primary care 2
• Provide emergency contact information and after-hours care instructions 2

Special Considerations for High-Risk Infants

Earlier or more frequent follow-up is warranted for infants with:

• Gestational age 35-38 weeks 1
• History of significant jaundice or phototherapy 1
• Feeding difficulties or inadequate weight gain 1, 4
• Maternal depression or limited social support 4
• Preterm birth requiring NICU care 4, 5

For these higher-risk populations, consider additional developmental surveillance and coordination with subspecialty services as needed 4, 5.