What is included in the 6‑week post‑natal visit for a term or near‑term neonate?

6-Week Postnatal Check-Up for a Neonate

The 6-week postnatal visit should include a comprehensive physical examination with vital signs and growth assessment, feeding evaluation with direct observation of breastfeeding technique, developmental screening, review of newborn screening results, assessment of jaundice and umbilical cord healing, maternal mental health screening, and anticipatory guidance on safe sleep and illness recognition. 1

Physical Assessment

The physical examination must include:

• Complete vital signs assessment including temperature (36.5°C to 37.4°C axillary), respiratory rate (below 60/minute), and heart rate (100-190 beats/minute when awake, as low as 70/minute during quiet sleep) 2, 1
• Weight measurement and growth trajectory evaluation to ensure adequate weight gain since discharge 1
• Hydration status assessment including evaluation of skin turgor, mucous membranes, and fontanelle 1
• Jaundice assessment with clinical evaluation and bilirubin measurement if clinically indicated, particularly in infants with risk factors such as blood group incompatibility, gestational age 35-36 weeks, previous sibling requiring phototherapy, exclusive breastfeeding with poor intake, or East Asian race 1
• Umbilical cord healing and skin condition evaluation 1
• Genital examination to assess for any abnormalities 1

Feeding Assessment and Support

This is a critical component requiring direct observation:

• Direct observation of breastfeeding technique assessing position, latch, swallowing, and infant satiety 2, 1
• Verification that breastfeeding infants are nursing 8-12 times per 24 hours 1
• For bottle-feeding infants, confirmation of coordination between sucking, swallowing, and breathing 2
• Referral for lactation support if feeding evaluation is not reassuring 1
• Documentation of adequate stool and urine patterns to confirm sufficient intake 1

Laboratory and Screening Review

The visit must include verification of:

• Newborn metabolic screening completion per state regulations, with repeat screening if initial test was performed before 24 hours of milk feeding 1
• Hearing screening completion 1
• Pulse oximetry screening for congenital heart disease 1
• Review of maternal laboratory results including syphilis, hepatitis B surface antigen, and HIV status 2, 1
• Newborn blood type and direct Coombs test results if clinically indicated 2, 1

Maternal and Family Assessment

This often-overlooked component is essential:

• Screening for maternal postpartum depression using validated tools 1
• Evaluation of mother-infant attachment and bonding 1
• Assessment of family, environmental, and social risk factors including untreated parental substance use, history of child abuse or neglect, parental mental illness, lack of social support, housing instability, and domestic violence history 1
• Identification of barriers to adequate follow-up care 1

Preventive Interventions and Safety Education

Critical safety education includes:

• Safe sleep practices education emphasizing supine positioning and avoidance of co-sleeping 1
• Guidance on proper skin-to-skin care with monitoring to prevent sudden unexpected postnatal collapse 2, 1
• Verification of appropriate car safety seat use 1
• Assessment of maternal Tdap vaccination status with administration if not previously received 2, 1

Anticipatory Guidance

Parents must receive specific instruction on:

• Recognition of illness signs, particularly progressive jaundice, lethargy, poor feeding, fever, or respiratory distress 1
• Temperature assessment technique and thermometer use 1
• Expected urination patterns (at least 6 wet diapers per day by day 5-7) and stooling patterns 1
• Umbilical cord care and general skin care 1
• Benefits of continued breastfeeding for both mother and infant 1

Follow-Up Planning

The visit should conclude with:

• Confirmation of established medical home for ongoing care 1
• Scheduling of subsequent well-child visits according to recommended intervals 1
• Provision of emergency contact information with clear instructions on when to seek urgent care 1

Common Pitfalls to Avoid

A critical pitfall is failing to directly observe feeding rather than relying solely on parental report, as feeding difficulties may not be apparent without direct observation 2, 1. Another common error is inadequate maternal mental health screening, which can miss postpartum depression that affects both maternal and infant outcomes 1. Additionally, dismissing parental concerns about jaundice without objective assessment can lead to missed cases of severe hyperbilirubinemia, particularly in high-risk infants 1.

The timing of this visit is particularly important for infants discharged early from the hospital. For infants discharged before 48 hours after delivery, follow-up should occur within 48 hours of discharge; for those discharged between 24-47.9 hours, by 96 hours of age; and for those discharged between 48-72 hours, by 120 hours of age 1. This early follow-up is essential as many neonatal problems, including jaundice and feeding difficulties, may not become apparent until after hospital discharge 2, 3.