Maternal and Child Health Procedures in the ACT



Canberra Hospital and Health ServicesClinical ProcedureMaternal and Child Health Procedures in the ACTContents TOC \o "1-4" \h \z \u Contents PAGEREF _Toc508968061 \h 1Purpose PAGEREF _Toc508968062 \h 3Alerts PAGEREF _Toc508968063 \h 3Scope PAGEREF _Toc508968064 \h 3Section 1: Process for Assessment of Infants and Young Children up to 6 years PAGEREF _Toc508968065 \h 3MACH Child Health Checks Schedule, Intervention and Health Promotion PAGEREF _Toc508968066 \h 6Physical assessment PAGEREF _Toc508968067 \h 7Procedure to measure weight PAGEREF _Toc508968068 \h 11Procedure to measure length PAGEREF _Toc508968069 \h 12Procedure to measure Head Circumference (HC) PAGEREF _Toc508968070 \h 13Body Mass index (BMI) >3 years PAGEREF _Toc508968071 \h 14Ages and Stages Questionnaire (ASQ) (Attachment 1: Assessment Tools): PAGEREF _Toc508968072 \h 15Vision check procedure: Birth to 5 years PAGEREF _Toc508968073 \h 16Self-Weigh Station PAGEREF _Toc508968074 \h 19Section 2 – Maternal and Child Health Groups PAGEREF _Toc508968075 \h 20New Parent Group (NPG) PAGEREF _Toc508968076 \h 20Early Days Group (EDG) PAGEREF _Toc508968077 \h 22SLEEP GROUP PAGEREF _Toc508968078 \h 25Section 3 –Guide to Managing Challenging Behaviours in Children under 5 Years PAGEREF _Toc508968079 \h 28Identification of Challenging Behaviours in Children under 5 Years PAGEREF _Toc508968080 \h 28Section 4 Family Health and Social Wellbeing PAGEREF _Toc508968081 \h 29Maternal Wellbeing PAGEREF _Toc508968082 \h 29Implementation PAGEREF _Toc508968083 \h 30Related Policies, Procedures, Guidelines and Legislation PAGEREF _Toc508968084 \h 30Framework PAGEREF _Toc508968085 \h 30Policies & Guidelines PAGEREF _Toc508968086 \h 30Procedures PAGEREF _Toc508968087 \h 31Legislation PAGEREF _Toc508968088 \h 31References PAGEREF _Toc508968089 \h 31Definition of Terms PAGEREF _Toc508968090 \h 33Search Terms PAGEREF _Toc508968091 \h 33Attachments PAGEREF _Toc508968092 \h 33Appendix 1: Assessment Tools PAGEREF _Toc508968093 \h 35Appendix 2: Child Health and Wellbeing Assessment (3-5 years) PAGEREF _Toc508968094 \h 36Appendix 3: New Parent Group: Facilitator Challenges PAGEREF _Toc508968095 \h 37Appendix 4: New Parent Group- Play/ Development/ Attachment Session PAGEREF _Toc508968096 \h 38Appendix 5: New Parent Group - Family Wellbeing PAGEREF _Toc508968097 \h 41Appendix 6: New Parent Group - Common Childhood Illnesses Session PAGEREF _Toc508968098 \h 43Appendix 7: Circle of Security, Building a Secure Attachment for Your Baby, Travelling Around the Circle of Security PAGEREF _Toc508968099 \h 44Appendix 8: New Parent Group Useful Websites PAGEREF _Toc508968100 \h 45Appendix 9: Sleep Group: 3-8 Months PAGEREF _Toc508968101 \h 46Appendix 10: Sleep Group 9-18 Months PAGEREF _Toc508968102 \h 47Appendix 11: Sleep Group 19 Months – 3 years PAGEREF _Toc508968103 \h 48Appendix 12: MACH Early Days Flow Chart PAGEREF _Toc508968104 \h 49Appendix 13: List of Resources required for Early Days Program PAGEREF _Toc508968105 \h 50Appendix 14: Early Days Attendance Record PAGEREF _Toc508968106 \h 52Appendix 15: Circle of Security PAGEREF _Toc508968107 \h 53Appendix 16: Circle of Repair PAGEREF _Toc508968108 \h 54Appendix 17: Parent Evaluation of Developmental status (PEDS) PAGEREF _Toc508968109 \h 55PurposeThe purpose of these procedures is to provide a standard approach for Maternal and Child Health (MACH) nurses using best practice information for routine screening, assessment and support of families and children under 6 years of age in the community setting. Back to Table of ContentsAlertsIt is mandatory for MACH nurses to make a report to Care and Protection Services when they believe on reasonable grounds that a child or young person has experienced or is experiencing sexual abuse or non- accidental physical injury. This includes neglect and emotional abuse. (Section 356 of the Children and Young People Act 2008)Back to Table of ContentsScopeThis document applies to all nurses and midwives who are working within their scope of practice within the Women Youth and Children’s Community Health Programs (WYCCHP). A Primary Healthcare approach as per the Competency Standards for the Maternal and Child Health (MACH) Nurse in Victoria (2010) is adhered to. This document is for use in conjunction with Canberra Hospital and Health Services Clinical Guideline: Maternal and Child Health Services in the ACT. Back to Table of ContentsSection 1: Process for Assessment of Infants and Young Children up to 6 years Maternal and Child Health (MACH) nurses are required to assess infants and young children as per the Personal Health Record (PHR) key developmental visits. Assessment may also be attended opportunistically in clinic or home visiting. The MACH nurse; Communicates with parents/ carers utilising the Family Partnership Model, aiming to identify and reduce risk factors for their child and to promote strengths and protective factors.Identifies parental concerns through history taking, parent questions in PHR and Parent Evaluation of Developmental status (PEDS) toolUtilises knowledge of attachment theory and Circle of Security Model to observe, assess, model and encourage positive child/parent interactions Adopts current evidence based tools and trigger questions to aid assessment Carries out a physical assessment of an infant or young childRefers to other health professionals as appropriate At each consultation:Review the infant/child’s general health, previous history and interventions in partnership with the family/carerUtilise observation skills to assess social, emotional and physical wellbeing Utilising her/his understanding of different developmental stages to assess the infant/child’s emotional, social and cognitive development during the physical assessment and documents findingsUtilise the Family Partnership Model to promote family, parent and carer wellbeing At key developmental stages:Complete developmental checks according to the Personal Health Record (PHR) utilising a range of holistic assessment guides –PHR parent questions to identify any concernsComplete the Parents’ Evaluation of Developmental Status (PEDS) questionnaire for development check from 6 months to interpret the significance of parental concerns (Attachment 1) and the Ages and Stages Questionnaire (ASQ) if further assessment is required ASQ Adopt a comprehensive, consistent, systematic head-to-toe approach explaining processes and findings to parents or carer during the examination.Documentation: Access Clinical Record Forms Register for ACT Health MACH Consultation e-form or Patient progress e-form. Record information according to ISOAP (Introduction, Subjective information, Objective information, Analysis-Action-Advice, and Plan)Record parental concerns or any growth or development deviations on the checklist for key developmental stages in clinical notes and PHR Document the plan of care in PHR and clinical recordComplete documentation and upload to ACT Health Clinical Record Information System(CRIS) according to MACH Business Rules (2017)Complete the Child Health Check documentation as per PHR scheduleProvide approved resources noting them on the appropriate forms for uploadingRecord appointment or contact on ACTPAS inserting MACH Intervention code/sRefer to: Canberra Hospital and Health Services Standard Operating Procedure: Clinical Record Documentation Canberra Hospital and Health Services Clinical Procedure: Clinical HandoverHome Visit Requirements for Health Assessments:Procedure:Check car allocation and that mobile phone and portable devices are chargedReview e-Referral on CRISReview Pre-Assessment HV form and client alerts on ACTPAS for any risksPrepare HP Revolve lap top computer/modem/mouse and MACH documents Notify MACH Liaison of departure and contact number, leaving a phone message if necessaryNotify MACH Liaison on return to base Work Health Safety (WHS) risks:Ensure clean large firm surface available such as a table or bench for infant examination and documentationEnsure table waist height to minimise body stressingEnsure antimicrobial hand gel available Adequate warmth/cooling & ventilationAdequate lightRefer to: Canberra Hospital and Health Services Operational Procedure: Home Visiting Referrals:Refer according to appropriate internal and external processes outlined in WYCCHP Service Guideline and Referral Criteria April 2017Discuss any urgent, complex or ongoing concerns with Clinical Nurse Manager (CNM)Personal Health Record (PHR) Schedule Health Check0 - 4 weeks6 - 8 weeks4 months6 months12 months18 months2 yrs3 yrs4yrsFamily HistoryRisk FactorsQuestionsOther toolsYesGeneralRisk FactorsYesGeneralYesGeneralYesGeneral Parents’ Evaluation of Developmental Status (PEDS)Ages and Stages Questionnaire (ASQ)YesGeneral PEDSASQ if neededYesGeneral PEDSASQ if neededYesGeneral PEDSASQ if neededYesGeneral PEDSASQ if neededYesGeneral PEDSASQ if neededDevelopmentalAssessmentYesYesYesYesYesYesYesYesYesGrowth YesYesYesYesYesYesYesYesBMIYesBMIReflexes / BehaviourYesYesYesYesYesYesYesYesYesMotor SkillsYesYesYesYesYesYesYesYesYesVision CheckAge specificAge specificAge specificAge specificAge specificAge specificAge specificAge specificAge specificDevelopmental dysplasia of the hip (DDH)YesYesYesYesYes(gait)(gait)ImmunisationBirthCheckCheckCheckCheckCheckCheckCheckCheckAnticipatory InformationYesYesYesYesYesYesYesYesYes MACH Child Health Checks Schedule, Intervention and Health Promotion Child Health CheckHealth and Developmental MonitoringInterventionPromoting Health and Wellbeing1-4 WeeksInitial clinic or home visitDevelopment Family wellbeingFull physical assessmentPregnancy, birth and family history and risk factorsSmoking assessment/ cessation supportHearing questions (PHR)1-4 week development checkMaternal Perinatal Psychosocial Assessment (PPSA)Breastfeeding/ feeding support, Immunisation,Red Nose / Safe SleepingObserve sleep environmentAppropriate car seat / safetyDose 2 -The Period of PURPLE Crying Normal Infant Behaviour-anticipatory guidanceIntroduction to MACH services6-8 weeksDevelopmentFamily wellbeingFull physical AssessmentRespond to assessments Smoking assessment/ cessation support6-8 week development checkMaternal Edinburgh Postnatal Depression Scale (EPDS)Feeding, ImmunisationNormal Infant Behaviour- anticipatory guidanceRed Nose / Safe SleepingSun Smart / KidsafeParents Emotional HealthContraception, Health, Wellbeing, Nutrition Community Supports / Groups/New Parent Groups4 monthsDevelopmentFamily WellbeingFull physical AssessmentRespond to AssessmentsSmoking assessment/ cessation support4 month development checkFeeding, ImmunisationCommunication, language and playTeething and dental care Normal infant behaviour- anticipatory guidanceRed Nose / Safe SleepingSun Smart / KidsafeCommunity Supports / groups6 monthsDevelopmentFamily WellbeingFull physical Assessment6/12 Parents Evaluation of Development Status (PEDS) Respond to Assessments6 month development checkSmoking assessment/ cessation supportStarting Solids, Immunisation,Health, Sleeping, Dental careNormal infant behaviour- anticipatory guidanceRed Nose / Safe SleepingSun Smart / KidsafeSafe Siblings / Positive ParentingCommunication, language and play12 monthsDevelopmentFamily wellbeingFull physical Assessment12/12 Parents Evaluation of Development Status (PEDS)Respond to Assessments12 month development checkSmoking assessment/ cessation supportHealthy Eating, Family mealsDental care / Dental checkChild Behaviour, Speech, Sun Smart, Immunisation, Childcare, Health / Safety18 monthsDevelopmentFamily WellbeingFull physical Assessment18/12 Parents Evaluation of Development Status (PEDS) Respond to Assessments18 month development checkSmoking assessment/ cessation supportHealthy families eating, ImmunisationChild Behaviour, SleepDental care / Dental Check, Speech,Sun Smart / SafetyToilet training 2 yearsDevelopmentFamily WellbeingFull physical Assessment2 year Parents Evaluation of Development Status (PEDS)Respond to Assessments2 year development checkSmoking assessment/ cessation supportCommunication, language and playHealthy Eating for families, HealthDental care / Dental Check, Speech, Sun Smart / Safety Health, Childcare, Sleep, Child’s Independent BehaviourPositive parenting, Toilet training3 years DevelopmentFamily WellbeingFull physical Assessment3 year Parents Evaluation of Development Status (PEDS)Respond to Assessments3 year development checkSmoking assessment/ cessation supportBMIHealthy Family EatingImmunisationCommunication relating to othersSpeech, Literacy – story reading SleepChild Behaviour / SiblingsHealth Dental care / Dental CheckSun Smart / Safety, Toilet training4 yearsDevelopmentFamily WellbeingFull physical Assessment4 year Parents Evaluation of Development Status (PEDS)Respond to Assessments4 year development checkSmoking assessment/ cessation supportCommunication and relating to othersHealthy Eating for familiesChild feelings and behavioursSleep Sun Smart / SafetyGoing to preschool or schoolPositive parenting, Health Physical assessment:Nurses will adhere to ‘Hand Hygiene and Infection Control’ measures as per the Healthcare Associated Infections Clinical GuidelineEnsure parental / guardian consent before proceeding to physically examine an infant or young childInclude the parent in the examination process; describing what and why it’s being done and encourage an exchange of information concerning the infant’s well-beingAdopt a comprehensive, consistent, systematic head-to-toe approach utilising a gentle approach and engaging with the infant/child.When performing a complete physical assessment, a child under 2 years of age should be fully undressed. Equipment: Clinic or modified for Home setting:Annually calibrated and fully charged infant digital scales or standing digital scalesExamination table adjusted to correct height for individual nurseClean infant measurement board (clinic only)Stadiometer(or height rule)Disposable paper tape measurePencil torchAssessment resources –PEDS, trigger questions, ASQChild’s Personal Health Record (PHR)Endorsed resources (Appendix 13)The physical examination should include but may not be limited to assessment of:General appearance: face, posture, symmetry, nutritional status, activity type and movements.GrowthBare weight (<2 years)Length / heightHead circumference SkinSkin turgor, texture, moisture (e.g. dryness), temperatureBirthmarks, rashes, lesionsCondition/symmetry of creasesSkin colour/pigmentation (e.g. jaundice, pallor, cyanosis)Evidence of trauma (e.g. scratches, bruising) or infection (e.g. thrush, pustules)Head Size, shape, symmetryPlagiocephaly/ Cephalhaematoma/CaputHead lagRange of motion Anterior fontanelle - size & tensionPosterior fontanelle - closed or openSuture lines for degree of overlap or separationEyes Position/placementPupils Shape Symmetry Reaction to light White or greyish spotsSclera - colourDucts – discharge, rednessEyelids - epicanthic foldsEars Position, symmetry, structureskin tags/mobile glandsSkin condition behind the pinnae Face, nose, mouth Facial features - symmetryInfection - oral thrushGums, hard & soft palates Tongue for size, position and tongue tie Neck Position & alignment to head/torso - torticollisThickening/mass in the sternomastoid areaChest Shape (contour), size, symmetrySymmetrical chest movement Respiratory effortBreast shape, size, engorgementAccessory nipples Cardiovascular – colour/effort/nailbed anomaliesAbdomen Shape, size, symmetryHernias (umbilical, inguinal/femoral). Umbilicus (colour, discharge, odour, inflammation, herniation, granuloma)Feet/hands Position of feet in relation to ankles (e.g. talipes)Digits - number, webbing, overlappingCreasesBackDimples/tufts of hairSpine curvature/structural symmetryReflexes Walk reflex (Disappears age 2-3 months) Grasp reflex (fades at 2-3 months)Moro reflexStartle reflexHips and buttocksRefer toCanberra Hospital and Health Services Clinical Guidelines for Developmental Dysplasia of the Hip (2017)DDHUp to 3 months of age – check Ortolani, Barlow, Galeazzi tests and thigh creasesFrom 3months to-walking- check Galeazzi and thigh creases and gaitAbnormalities: Refer to GP: include handwritten referral stating concerns, risk factors and findings on physical assessment Femoral pulses Presence, quality & symmetry Male genitalia Scrotum: assess for testes or swelling (e.g. hydrocele)Penis: size, colour, shape, position of urethral meatus. Foreskin (circumcision - discharge, bleeding)Female genitalia Labia for size, colour, skin integrity, abnormalitiesClitoral size, plus urethral & vaginal openings (e.g. for oedema or redness)Anus Malformations (fissures, skin tags) RashesGeneralTake time to become acquainted with parents, infant /childObserve general appearance of child:Does the child appear well? Is there any overt clinical distress (e.g. respiratory)Behaviour, alertness and responsivenessGeneral nutritional statusStature (short, tall, overweight, underweight)Symmetry of head, body proportions and body movements (eg. arms and legs, facial features or grimace)Cleanliness, hygieneMovement including involuntary tremor, jerkinessMuscle tone - gaitObserve parent /infant/child interaction Ask parents how infant/child copes with new or stressful situations if appropriateObserve responses to parental comforting measuresExamination:Quietly and confidently engage the infant / child with eye contact, appropriate language and pace the examination to their cues and tolerance level.Explain the assessment process in terms consistent with the child’s developmental levelMake expectations known clearlyParent /carer will undress the infant/child or allow the child to undress gradually.Present small amounts of information at a relevant time When examining more than one child, usually begin with the oldest or most cooperativeSummarise the assessment for parents and provide opportunity to ask questions about the assessmentIdentify & acknowledge their strengths as care giversRefer to: Canberra Hospital and Health Services Clinical Guideline: Assessment of the NewbornAnthropometric MeasurementsWeight, Height and Body Mass index (BMI)Procedure to measure weight:Birth-2 years: Infants under two years should be bare weighedDigital scales are to be annually calibrated and for use on hard level surface Wipe clean between useProvide some barrier material on the scales – a sheet of paper towel or parent supplied clothEnsure digital scales are reading zeroPlace undressed baby supine onto the scales (older babies may sit if more comfortable)Ensure safety of child whilst on scalesRead scales when digital indicator determines final weight reading2-3 YearsParent to undress child to underclothesAsk child to stand on scales- if child declines to stand on scale- weigh parent and child together, then parent alone and calculate the differenceRead, record, as per Birth to 2 years. 3- 5 yearsParent to remove shoes and extra layers of clothing Ask child to stand on scales- if child declines to stand on scale- weigh parent and child together, then parent alone and calculate the differenceRead, record, as per Birth to 2 years Accuracy in plotting is important:All MACH staff to complete the Royal Children’s Hospital , Melbourne “Child growth learning resource” Messages:Plot weight the gender appropriate weight percentile chart in the Personal Health Record (PHR) using dots to plot - do not join the dots into a lineRecord weight on child health clinical record including all recorded measurementsAge errors are the most common plotting mistakesSmall changes in percentile measures may occur at 'crossover' of charts.?For example from the 0 - 2 year old WHO growth charts to the 2 - 18 year old CDC Growth Charts or from length to height charts. ?Compare with expected normal growth or with measurements recorded for the same child at an earlier ageExplain the relevance of the measurement to the parent taking into consideration such factors as ethnic variances, genetic disposition and type of feedingMedical referral required if: Infant’s/child’s weight has crossed 2 percentiles despite feeding advice (refer to WYC Nutrition and GP assessment)If measurements are accompanied by any signs or symptoms suspicious of a disorderInterpretation of growth measurementsPercentile charts serve as a general guide for screening and monitoring purposes, and not as an absolute diagnostic toolSpecialised percentile charts will be used when there is a specific issue in conjunction with paediatricians e.g. Growth Chart for Downs Syndrome; Fenton Pre term Growth chart less than 37 weeks gestation and after the 32nd completed weeks gestation should have their age corrected until one year– corrected gestational age (CGA) recorded in red pen Infants less than 32 completed weeks gestation should have their age corrected up until two yearsInitial weight loss for newborns (up to 10% of the birth weight) may occur, followed by the infant gaining weight by four to six days of age and returning to birth weight by two to three weeks of age weight gains: (based on a 4 week average, general trend and clinical presentation)Gains of 150-200 g/per week up to 3 months Gains of 100-150 g/per week from 3-6 months Gains of 70-90 g/per week from 6-12 months (NHMRC Eat for Health Infant Feeding Guidelines - Information for health workers 2012, page 36)Procedure to measure lengthBirth- 2 yearsEnsure measuring board is on a flat and stable surfacePlace undressed baby supine onto the measuring boardHead at the fixed angled endTwo people are required for accurate measurementParent/ carer is asked to hold baby’s head so it is touching the headboard with baby looking up at ceilingEnsure baby is lying straight and in the middle of the boardPlace hand on baby’s knees and gently press legs down against the boardMeasurement is taken at the position of the baby’s heels with toes pointing upwards, both legs togetherRead measurement and document in Child Health Record and PHRPlot measurement on growth chart – re-measure if concerned about accuracyExplain measurement to parent2-5 yearsUse a stadiometer (or height rule) with attached headboardAsk child to remove shoes and the child facing forwards in bare feetHeels touchingFeet together and facing frontwardsButtocks, shoulder blades and back of head touching stadiometerArms by sidesLower headboard to top of child’s head- thick hair, ribbons may affect accuracyRead measurement and document in Child Health Record and PHRPlot measurement on growth chartExplain measurement to parentProcedure to measure Head Circumference (HC)Observe and palpate the head noting any abnormal shape and the size of the anterior fontanelleMeasure HC or occipital frontal circumference (OFC) with child lying down or with child sitting well supportedApply tape firmly around the most prominent part on the back of the head (occiput) and just above the eyebrows (supraorbital ridges), and above the ears to obtain the largest circumference of the head. The tape should be sufficiently tight to compress hairRead measurement and document in Child Health Record and PHRPlot measurement on growth chartExplain measurement to parent Refer to physiotherapist if significant cranial asymmetry persistsReferral options: WYC Nutrition and/ or General Practitioner (GP):If the infant is under 12 months of age and if any deviation in expected weight gains, where the weight has crossed two percentiles, or drops below the 3rd percentile or greater than the 97th percentile over a 4 week period. Clinical history and assessment will inform referral to WYC Nutrition and GP.If length has crossed two percentile lines or if it is above 97th percentile or below 3rd percentile. Weight and length to be within 2 percentile lines of each other.If the head circumference growth line crosses the percentiles upwards and the child shows symptoms or signs of hydrocephalus or other abnormality. HC: above the 97th percentile or below the 3rd percentile at any stage is an indication for more detailed assessment. If there are no accompanying signs or symptoms, repeat the measurement in four weeks and reassess.Contact Clinical Nurse Manager (CNM) if concerns highlighted and reflection on practice as requiredUtilise WYCCHP Service Guideline and Referral Criteria April 2017 Body Mass index (BMI) >3 yearsDiscuss BMI with all parents / carers in context of healthy food, exercise, appropriate screen time and the importance of physical activityCalculate BMI using electronic deviceMeasure weight and heightCalculate BMI Measurement on scales or with electronic device using Centre for Disease Control (CDC) children’s BMI Calculator at Discuss growth and BMI results with parent/carer and provide relevant resources for management if parent is willingUse CDC BMI- for Age Percentile Charts to plot BMI result, according to age and genderBMI Referral pathway. Consider referral if parent is agreeable. At this stage the BMI calculation is to raise awareness of BMI measurements and growth concernsConsider parent or carer concernMeasurements cross two percentiles (upwards or downwards) BMI is above 85% or below 5%Indication of health or nutritional concernsFor BMI outside the healthy weight range it is recommended that parent or carer see GP and/ or WYC NutritionRefer to: Attachment 2: BMI Child Health and Wellbeing Assessment (3-5 years) MACH Nutrition Referral PathwayRefer to:Canberra Hospital and Health Services Clinical Guideline: Assessment of the NewbornCanberra Hospital and Health Services Clinical Guidelines: Developmental Dysplasia of the Hip (2017)Canberra Hospital and Health Services Clinical Guidelines: Jaundice in the Newborn (2017)Canberra Hospital and Health Services Clinical Guideline: Safe Sleeping Guidelines: Neonates and Infants up to 12 months of age 2017Canberra Hospital and Health Services Procedure: Paediatric Anthropometric MeasurementsTools:Parents’ Evaluation of Developmental Status (PEDS) Tool (Appendix 1: Assessment Tools)Ages and Stages Questionnaire if required (Appendix 1: Assessment Tools)ACT Health Nutritional resources @ health..au - Tuckatalk; Milk to More; Joining the Dots (Capital Health Network)Circle of Security and Circle of Repair (Appendix 14, 15)WYCCHP Referral booklet WYCCHP Service Guideline and Referral Criteria April 2017Useful Resources: Parentlink: .auAssessment Tools:Parents Evaluation of Developmental Status (PEDS) (Appendix 1: Assessment Tools)Nurses role and responsibilities: Undertake training in the use of the PEDS toolAdhere to the processes outlined in the Guide for Administration of PEDSGuide for administration of PEDSProcedure:Discuss use of the PEDS tool with parents or carer recognising parents are the ‘experts’ of their child.Allow time for questions to be completed and discussedAcknowledge parents/carers have a wider view of their child and their concerns are valued and respected.Categorise parents’ concerns using the Parental Response table (available in the PEDS Brief administration and scoring guide page 5. This document is available in all MACH Clinics and the MACH Resource folder in the Q DriveAdjust for prematurity = >3 weeks premature up to 2 years of ageSummarise concerns on the PEDS Score FormInterpret results, to determine the appropriate pathway after considering normal development and clinical judgementUtilise link to languages other than English available in the administration guideRefer to: Appendix 1 and Appendix 15Record Keeping:Document results on the MACH Consultation form for uploading onto the ACT Health clinical record information system (CRIS).Document referrals as appropriate for service required.A copy of referrals may be given to the parent.Ages and Stages Questionnaire (ASQ) (Attachment 1: Assessment Tools):The Ages and Stages Questionnaire? (ASQ) is a screening and monitoring system designed to accurately identify infants and young children in need of further assessment. Ideally, the tools are administered incrementally as part of a developmental surveillance program. The tools are valid and reliable, meeting Australian standards for sensitivity and specificity. Nurses role and responsibilities: Undertake training in the use of the ASQ tool and adhere to the processes outlined in the ASQ-3 User’s Guide and the ASQ Quick Start GuideProcedure: Explain use of ASQ tool to parents/carersCheck all required paperwork is available e.g.: A family information sheet, ASQ Questionnaires, ASQ Information Summary sheet Ensure use of the Correct Age Interval for the child for accurate use of the ASQ (see Quick Start Guide (adjust for prematurity = >3 weeks premature up to 2 years of age) Access appropriate ASQ questionnaire HERE: ASQ Provide questionnaire to parent/carer, subsequent to PEDS results indicating the requirement for further clarification of the parent or carer concerns. Request parent/carer to complete the questionnaire prior to follow-up appointment, with the support of the MACH nurse, at a clinic appointment or at a home visit. Encourage parents/carer to try each activity with the child before answering an itemOrganise follow up appointment to score questionnaire (see quick guide for adjusting scores when item responses are missing)Interpret and communicate results to parent/carerDetermine appropriate follow-up and/or referralRecord Keeping:Complete the ASQ summary and document on the appropriate form for uploading onto the ACT Health Electronic recordRecord any referrals required in the PHR and document as above. A copy of referrals may be given to the parentVision check procedure: Birth to 5 yearsProcedure:Check if parent has any concerns with infant/child’s vision- Check general questionnaires and parent questions for vision risk factors in the PHRObserve infant/child’s general appearance, head posture, evidence of eye infection Avoid glare in the infant/child’s eyes Observe behaviour during the screening procedure for inclusion as part of the assessment if appropriate. Equipment required for Vision screening Pen torch3 metre measureSheridan-Gardiner Child Acuity TestEye patchFixation stickVision screening procedures –Sequence of Events as per PHRHealth Check0 - 4 weeks6 - 8 weeks4 months6? months12 months18 months2 yrs3 ? yrs at least4 yrsVision Risk FactorsQuestionsYesYesYesYesYesYesYesYesYesObservationYesYesYesYesYesYesYesYesYesOcular MovementsYesYesYesYesYesTracking YesYesYesYesYesYesYesFixation yesYesYesYesYesYesYesYesCover / UncoverYesYesYesYesYesYesYesYesYesCorneal light reflexYesYesYesYesYesYesYesYesYesConvergenceYesYesVisual AcuityYesYesObservation:Observe the eyes for symmetry, location of the eyes in relation to the nose and structural abnormalityOcular Movements including:TrackingHold stick about 30cms from the infant / child’s faceObtain attention and move the fixation stick in the following pattern below, observe the infants / child’s movements at all times for any deviation Ensure the child’s head remains still and they are not turning their head towards the fixation stick. You may place your hand under the infants /child’s chin to stabilise the head. FixationHold stick about 30cms from infant / child’s faceWatch the child’s eyes to see if they have moved to fix on targetContinue to observe the infant / child’s eyes to see if fix is maintainedTo confirm fixation, the target can be moved slightly and the infant / child’s eyes observed for correctional fixation movementsNote : A noisy rattle can be used to gain and maintain fixation in infants from 4 months(note: either methods are acceptable) Cover/ Uncover TestsThe nurse will sit on a chair opposite the child. One eye is occluded with nurse’s hand taking care not to touch the infants / child’s faceThe nurse observes for any movement in the infant / child’s uncovered eye whilst fixing the child’s attention on a near objectAs the eye is uncovered the nurse observes for any movement of the covered eyeCorneal Light ReflexesObserve for reflexes in day light Hold torch level with child’s eyes, about 30cm from faceObserve position of the corneal light reflection in either eyeConvergenceHold fixation stick at forearm distance from the child, move the stick at a steady pace towards the child’s nose and observe for equal convergence of both eyesVisual AcuityMeasure 3 metres from the vision chart ensuring the distance is accurateSeat the child with the parent and key card Familiarise the child by showing the large letters from the Sheridan-Gardiner Child Acuity Test first and asking the child to point or name the lettersAlways test the right eye first to avoid errors in recordingCover the left eye with a patch or cardHold the vision book at the child’s eye level, standing at 3 metres distanceShow the child some letters from 3/60 down to and including the 3/9 level to achieve success. If matching is correct present all the letters from each subsequent level including 9, 6, 4 and 3. The child passes if all letters are correctly matched.Record the vision results for the right eye before repeating the process for the left eyeChildren who wear glasses should be tested with their glasses on, it is not necessary to test without glasses.Results recorded in the PHR and on the appropriate form for uploading to the ACT Health electronic record. Interpretation of Results: Results are recorded in the PHR and documented on the MACH Consultation form for uploading onto the ACT Health Electronic record. The vision results are recorded for each eye as:The testing distance (3m) / Level of accurate vision achieved, Record the level achieved: Testing distance (3m) / level of accurate vision achieved e.g. 3/6, 3/4, 3/3.Specify which eye R) 3/3 and L) 3/3 Refer if:3/ 4 recheck in 6-12 months 3/6 or higher in one or both eyes Unequal vision acuity results e.g R) 3/3 and L) 3/6Movement, tracking, convergence irregularities Parent concerns Referral Document in the PHR and on the appropriate MACH Consultation form.Upload to CRIS.Provide parent with a handwritten referralReferral options include Orthoptists, Optometrist or GP for further assessment and managementSelf-Weigh StationSelf-weigh stations are located at the following clinics:Belconnen:Belconnen Community Health CentreWest Belconnen Child and Family CentreWestonGungahlin: Gungahlin Community Health Centre and Gungahlin Child and Family CentreNgunnawal DicksonTuggeranong: LanyonTuggeranong Child and Family CentrePhillipNarrabundahNurses role and responsibilities:Ensure safe environment for parents/carers to weigh infants/childrenDigital scales are annually calibrated and poweredClear signage - ‘Self weigh station is available here when the clinic is open’ posterDisplay posters: Weigh your Baby Safely’ – outlines how to use the scales safely and accurately with information for contacting a MACH Nurse ‘Weight is Only One Piece of the Puzzle’ includes an explanation of growth charts and information to contact MACH for support and clarification to interpret child’s growth in the Personal Health Record.detergent wipes for cleaning scalesHand hygiene materials - alcohol based hand rub and/or wash basin, soap and paper towel out of the reach of childrenRefer to 2017 MACH Business Rules for Self Weigh ScalesBack to Table of ContentsSection 2 – Maternal and Child Health GroupsPurposeThe group environment provides the opportunity to disseminate evidence based information to a group of participants in an inclusive and welcoming environment.Groups may be open or closed and aim toProvide early parenting support and information around feeding, settling, behaviour and child developmentEnhance parental/carer confidence through the use of education and health promotion to achieve positive outcomes in parenting/caring for their infant or child.Normalise a baby’s behaviour to reduce parental anxiety and improve parent’s emotional well-beingEnable parents to create informal networks and social supportsEquipment all GroupsTelevisionDVD playerWhiteboard / White board markerTea/coffee facilitiesAttendee sheetName labelsArrange appropriate resources (ACT Health approved eg, New Parent Group (NPG) resource kit, Current Nutrition Resources, Sleep Group Folder, Early Days Flip Chart(under review), Strength Cards)Staff TrainingAll staff are initially supported to observe and facilitate groups, with feedback and competency assessment from CDNGroup facilitation training and education is provided by the CDN and/or mentor as part of the MACH orientation process.Staff are encouraged to complete cultural competence e-learning through Capabiliti and adopt cultural competence principles in the group environmentStaff are encouraged to complete Privacy and Confidentiality e-learning through Capabiliti and adopt the principles in the group environmentNew Parent Group (NPG)Procedure:Utilise facilitation skills and adult learning principles to foster a group environment which encourages, supports and values the ideas and opinions of the participating parents.Work collaboratively with the group to enable them to meet common goals and objectives.Check group booking on ACTPAS and print client list prior to the NPG commencing Provide paper sign in sheet Prior to arrival of attendees set up room, ensuring safety of staff and clients and as per manual handling policy/clinical guidelinesProvide signage as requiredDuring group:Welcome attendeesProvide name tag Housekeeping (privacy, confidentiality, group rules, evacuation procedures, facilities, safety with hot drinks)Triage complexity of clients and staffing requirements (Early Days)Group introduction, purpose and outline Timekeeping - Aim to finish on a positive note and on timeIntroduce visiting guest speakers (NPG)Tea break (as required) Around the room - to engage with attendeesDiscuss topics for discussion during the 4 week NPG Please note: Nutrition and Introduction of Solids should be an essential component of group discussion. Refer to: Canberra Hospital and Health Services Clinical Guideline: Feeding Guideline for infants and young children (in draft currently)NPG Ice Breaker:Allows group members to get to know one another and should be non-threatening and fun. Suggested ice breakers may include:Asking each parent to turn to the person next to them and introduce themselves and their baby.Once returning to the group the parent introduces the parent and baby they have met. Go around the room with each person introducing themselves and their baby.Appendix -3: NPG Facilitator ChallengesAppendix- 4: NPG Play Development Attachment SessionAppendix- 5: NPG Family Wellbeing/Adjustment to Parenting SessionAppendix- 6: NPG Common Childhood Illnesses SessionAppendix- 7: NPG Circle of Security, Building a Secure Attachment for Your Baby, Travelling Around the Circle of SecurityAppendix- 8: NPG Useful WebsitesGroup completion and documentation:Tidy venueReturn furniture to original layout as per manual handling policy/clinical guidelineComplete ACTPAS entry for each client (clients receiving group information and education do not require a written clinical record, unless assessment, intervention and/or referral is provided) Discuss concerns with CNM (if required)Early Days Group (EDG)The core themes of sleep, settling, feeding and maternal well-being underpin session content. The session will generally be divided into two parts:Part 1: Informal assessment and individual discussion of presenting issuesPart 2: Facilitated group discussion to address common identified issuesEarly Days Groups are co-facilitated by two MACH nurses, ideally one may be a midwife with International Board Certified Lactation Consultant (IBCLC) qualifications MACH staff who do not hold lactation qualifications are encouraged and supported to complete the The Government of SA Baby Friendly Online Education course ()Procedure Part 1: AssessmentWelcome, clients sign in and record relevant presenting details on Early Days documentation\Attendance RecordIdentify the presenting concerns and triage on the severity of the issue. If not appropriate for parent to join group session organise alternate service such as a home visit (HV) or for parent to return for individual session in the Early Days follow up afternoon (book on Early Days calendar). If a parent is distressed use a private room for brief assessment.Part 2: Facilitated discussionIntroduce parents to each other Discuss housekeeping issuesRefer to group rules on display regarding sharing of information and respecting each other’s confidentialityAscertain any expectations of the session by group participantsEncourage parents to share their experiences in “around the room” style Observe mothers’ readiness to feed in the group settingOffer practical support (e.g. infant positioning at breast, demonstrate using doll and model breast)Encourage participation in discussing and addressing common issues facilitating flow of discussion and inclusiveness of all clientsThe discussion will be appropriate to the identified needs of the participants with sensitivity to mother’s method of infant feedingAllow appropriate time to discuss needs with individual clients and implement appropriate management and follow up arrangements if requiredThemeResourcesSleep and SettlingDiscussion is to cover key pointsThis is relevant only to healthy infants- feeding issues must be addressed before providing sleep advice including:Safe sleep recommendationsIndividual infant characteristics and temperamentNormal infant behaviour and realistic expectationsSleep patterns and cyclesDay and night differenceRecognising and interpreting tired signs and appropriate responsesNormal cryingStrategies for settling e.g. wrappingDVD:Safe Sleep Space, “A Gentle loving Guide To Settling your Baby Birth to 12 months”The Period of PURPLE cryingNgala, “Conversations about Sleep”Early Days Flip Chart ( under review)Safe sleep poster/ Rednose informationRelevant endorsed handoutsFeedingPromotion and support of breastfeeding is a priority aim of Early Days. All clients are supported with respect to their chosen feeding method including:Normal infant feeding patterns and expectationsExpected growth and other signs of adequate feedingBreastfeeding specificDiscuss issues raised by group, or individually if more appropriate ( 2nd staff member)Discuss optimal attachment to breast – key issues of nipple pain, breast drainage, mastitisObserve milk transfer and suck patterns - offering second breast Signs of satietyBest practice indicates client education for preparation of formula is attended on an individual basis, not in a group situation when breastfeeding mothers are presentDVD:Mother and Baby by Sue Cox to breastfeed: getting a good attachment Breastfeeding and baby led attachment Demonstration clip of Baby led attachment (link page 26)Refer to Queensland Health: Baby feeding cues posterEarly Days Flip Chart (under review)Relevant endorsed handouts (Appendix 13) Breastfeeding assessment tool (MACH clinical forms)Maternal and Family Health & Well-beingDiscussion including:Emotional healthRealistic expectationsAdjustment to parenting Self-careDietInformation on MACH and community servicesRelevant endorsed resources (Appendix 13) to:Eat for Health: Infant feeding Guideline - information for workers, NHMRC (2012) to provide evidence based nutritional advice to familiesCanberra Hospital and Health Services Clinical Guideline: Breastfeeding 2016Follow up ConsultationsOffer individual time according to priority of issue for clients requiring further support or referral to manage complex or concerning issues Follow ups are planned according to client and staff availability (Appendix 12: MACH Early days referral flow sheet):By phone – staff may check client’s progress by follow up phone callBy home visit – arranged through MACH LiaisonClinic session after Early Days – following current session or by organising another sessionUse the early day’s electronic calendar for bookings. Note URN, Surname, home visit or clinic, Number of contact Use pod follow up on Wednesday afternoons( except 2nd wed of month)check pod electronic calendars for availability of staff By referral to Allied Health professional e.g. dietitian, physiotherapist, speech pathologist, feeding clinic, Early parenting counselling service By referral to GPBy referral to QE II- following existing referral criteriaClient activity recorded on ACTPASMorning session – using Early Days group codeAll other client contact use individual practitioner nameindicate type of contact e.g. face-to-face or indirectRecord “Early Days follow up” in comment boxIf seen at health facility, ensure location is recorded instead of client home addressAn ACTPAS referral to ‘early parenting’ is generated if one is not already createdDocumentation:Criteria for individual clinical record documentationAny formal breastfeeding assessmentClients who are assessed as requiring management advice and information from the morning sessionClients who receive follow up contact FormsThe Client Feeding Assessment Form found on clinical forms here: Client feeding Assessment (send to ASO for uploading by scanning to Clinical Record Unit (CRU) cruindexing@.au DOCPROPERTY Title \* MERGEFORMAT Patient Progress eForm when a non-breastfeeding issue and Note- documentation must clearly identify all client’s details including the URN and the service providing the intervention i.e. Early Days A clinical record is not required:Clients within groups receiving general information and education Group participants are entered as “walk-in” on ACTPASACTPAS entry needs to capture preparation time for the session WYCCHP Business rules for ACTPAS December 2017SLEEP GROUP Procedure:Educate and support parents to be responsive to their infant’s/child’s communication cuesConsider the family dynamics and maternal mental health when advising parents on sleep and settling management.Consider infant mental health issues in sleep management practices.Consider infant and maternal attachment. Persistent crying is linked to maternal depression, family stress, family breakdown and child abuse Group facilitation Staff training:Provides clinicians with best practice information for educating and supporting parents attending Sleep Group in the community setting Will be implemented and communicated to MACH Registered nurses and Scholarship nurses through orientation processes and specific communication strategies eg. upon roster allocation Sleep Group specific:‘Around the room’ – introduction, identify ages of participants’ infantIdentify common issues, may use white board as visual aidObtain a history of the infant’s/child’s crying, feeding, sleeping patterns Ascertain the current strategies used for settling Note: it is not appropriate to implement sleep strategies for children who are unwellAssess maternal wellbeing and encourage self-care, rest and supportExplain Sleep Group Phone call follow up (confirm attendee contact details)Aim to finish on a positive noteFollow up and Referral:Encourage parents to attend a MACH clinic after group to discuss progress and ongoing referral. Contact each client by phone, 2-4 weeks after the group to review progress and refer if appropriate Record contact on ACTPAS and eForm if information given to support clientRefer to QE II Family Centre as per QE II Family Centre guidelines after trying strategies from group and further support requiredGroup Discussion:Use Family Partnership principlesContinually bring discussion back to evidence-based practiceABC of Sleep mnemonic (Allen et al 2016)Age AppropriateBed times/wake timesConsistencySchedules (over 6 months & bed time routines)LocationExercise and restAvoid electronics at bedtimePositivity Independence when falling asleepNeeds of child met during the day=Great Sleep1. Infant Mental Health and the importance of developing secure attachmentsInfants are more likely to develop secure attachments when their distress is responded to promptly, consistently and appropriately. Secure attachment in infancy is the foundation for good adult mental health. Infants whose parents respond and attend to their crying promptly, learn to settle more quickly, as they become secure in the knowledge that their needs for emotional comfort will be met (AAIMH 2013).2. Circle of Security 3. Tired Signs – sleep needs are variable – explain, Karitane, Ngala, Tresillian resources4. Sleep Cycles / Circadian Rhythms5. Settling techniques discussed in the group are to help the parent reflect on the experience of the infant. For example, asking parents what they think their infant is saying/ telling them. This can encourage sensitivity to the infant’s experiences and can help clarify the parents’ perceptions of the meaning of the infant’s communication. parental support for future independent settling and resettling as young babies often need ongoing support to get there.Develop helpful sleep associations that lead to more independent settling Responsive: learning infant cues e.g. fussy cry versus distressed cry6. Infant Development, temperament Appropriate for age, normal growth and developmentTeethingObject permanence – awareness of carer/motherSeparation anxiety7. Parenting style (Sensitive and responsive care from parents is vital for the optimal growth and development of each child. (Hong & Park, 2012)8. Maternal and Family Health & Well-beingAsk – “about the parents coping mechanisms when their infant is unsettled and the parent is sleep deprived”Ask – “about the parent’s management strategies when they are feeling frustrated and discuss – prevention of ‘Shaken Baby Syndrome”. Include purple crying education Normalising behaviour expectationsFatigue Mental HealthSupportSelf-careDietIllness/ stressful events / traumaSpecific considerations for each Sleep Group age refer to:Appendix 9: Sleep Group 3 - 8 monthsAppendix 10: Sleep Group: 9 – 18 monthsAppendix 11: Sleep Group: 19m-3yrsBack to Table of Contents Section 3 –Guide to Managing Challenging Behaviours in Children under 5 Years Young children may exhibit a broad range of behaviours which can cause concern to their parents or caregivers. Identification of Challenging Behaviours in Children under 5 YearsProcedureThe MACH nurse willListen, explore and clarify parental concerns using the Family Partnership Modelnormalise expected developmental child behaviours for parent/ caregiver provide anticipatory guidance for likely developmental behaviours e.g. tantrumsexplore clients feelings, reactions to behaviouruse strengths-based approach and adult learning principles to inform/educate the client provide information with options for client to make informed choicesensure interventions and information are based on evidence and endorsed by WYCCHPcollaborate with the client to formulate a plan for strategies to be implementedEncourage warm parenting stylesRecognise parental characteristics and parenting styles influence child behaviourEducate parents regarding normal development, with the aim to enhance family relationships and child development. Children may externalise behaviour (oppositional defiance, aggressive), or internalise behaviour (anxiety, depression, withdrawal)Utilise the PEDS tool, particularly Questions 1, 6, 7 and 10, to identify child behaviour concerns at each developmental screen from 6 months of age (Appendix 17) Complete the pre-screening questions in the Personal Health Record at each developmental checkUse reflective listening skills to clarify parental perception of the behaviour issue at developmental screen and other occasions of serviceConsider common causes of behavioural issues ( hungry, tired, emotional needs not being met)Ascertain if other social or medical risk factors exist Be aware of early predictive signs and markers of Autism Spectrum Disorder including lack of eye contact, social interaction, smiling, imitation, verbal communication skills, gestures and joint attention skills, such as pointing and following a pointed finger. These markers may be evident from 12 months of ageFollow up with appropriate Ages and Stages Questionnaire (ASQ) if required ASQReferralsThe MACH nurse will provide information and offer referrals to appropriate health professionals and other agencies as requiredGeneral PractitionerChild Health Medical Officer / Community PaediatricianPrivate PaediatricianAudiometry, Orthoptist, Speech Therapy and Nutrition servicesChild and Family Centres for parenting programs Early Parenting Counselling Service (EPCS)(WYCCHP)Queen Elizabeth II Family Care Centre –up to 3 years of ageRegional community services for individual and group programsUniting Marymead advice and counselling services as per PHR Private practitioners e.g. psychologist, play therapistChild at Risk Health Unit (CARHU) - parent may request a concerns interviewChild Protection mandated report if indicated, which may also provide suitable support for familiesResourcesCircle of Security (Appendix 15)Circle of Repair (Appendix 16) Parentlink Handouts: Habits, Tantrums, Sleep, Sibling Rivalry, Bullying, Attention Deficit Disorder, Bedwetting, Biting, DisciplineRaising Children Network – Behaviour Toolkits - Tools for encouraging good behaviour, tools to help change behaviourBack to Table of Contents Section 4 Family Health and Social WellbeingMaternal WellbeingThe wellbeing of an infant is profoundly dependant on the wellbeing of their parent or carer.The MACH nurse collaborates with families to identify their individual needs and offers support by providing appropriate, accessible and acceptable MACH services in line with primary health care principles.Procedure Develop a rapport and engage Family Partnership Model (FPM) skills to build a relationship with the clientOffer the Perinatal Psychosocial Assessment (PPSA) to all postnatal women at the first contact either in the home or at clinicAssess maternal wellbeing and safety related to her birth experience, general health and psychological healthExplain and offer the questionnaire to assess and inform level of family support, domestic situation and family mental health historyExplain and offer Edinburgh Postnatal Depression Scale (EPDS) psychosocial assessment screening tool routinely at 6-8 week postnatal visit or when appropriate Staff Training:Completion of an eLearning package is required for all Registered Nurses and Midwives working within MACH to guide the use of EPDS and the PPSAPerinatal Emotional Wellbeing (el-2016) available on CapabilitiChildren of Parents with a Mental Illness- (COPMI)Tools: Edinburgh Postnatal Depression Scale (EPDS)Perinatal Psychosocial Assessment Tool (PPSA) (Access on clinical forms )Refer to: Canberra Hospital and Health Services Clinical Guideline: Perinatal Emotional WellbeingAssessment and Management of Perinatal Mental HealthEffective Mental Health Care in the Perinatal Period: Australian Clinical Practice GuidelineCentre of Perinatal Excellence COPE: Mental Health Care in the Perinatal period: Australia Clinical Practice Guidelines: October 2017. Here Back to Table of ContentsImplementation These procedures will be incorporated into training of new staff at orientation and for reference for all nurses and midwives working in the MACH Team.The document will be communicated in clinical team meetings and referred to as the framework for clinical discussion.Education of all CHHS staff to access the clinical Policy and Guidelines via the intranet Back to Table of ContentsRelated Policies, Procedures, Guidelines and LegislationFrameworkAustralian Health Ministers Advisory Council (2011) National Framework for Universal Child and Family Health Services – Vision, objectives and principles for universal child and family health services for all Australian children aged zero to eight years.Policies & GuidelinesACT Health Child ProtectionACT Health Staff working with Child & Youth Protection Services 2017Assessment of the NewbornBreastfeedingClinical Guidelines for Developmental Dysplasia of the Hip Home Visiting Jaundice in the NewbornPerinatal Emotional WellbeingSafe Sleeping Guidelines: Neonates and Infants up to 12 months of ageTongue Tie Assessment, Management and DivisionInitial Management, Assessment and Intervention for People Vulnerable to Suicide Keeping Children and Young People Safe – A shared community responsibility October 2017 keeping-children-and-young-people-safe Consent and TreatmentWork Health and Safety PolicyContinuing Competence Assessment and Management of Perinatal Mental HealthProceduresCHHS Healthcare Associated InfectionsCHHS Patient Identification and Procedure Matching PolicyPaediatric Anthropometric MeasurementsClinical Records, Records Management Manual LegislationHealth Records (Privacy and Access) Act 1997ACT Human Rights Act 2004Work Health and Safety Act 2011Child & Young People Act (2008) Freedom of Information Act (1989) Health Record (Privacy and Access Act (1997) accessed 29/11/2017Health Practitioner Regulation National Law (ACT) Act (2009)Back to Table of ContentsReferencesACT Government (2014) Parentlink Parenting Guides, retrieved 16 November 2017 from . L , Howlett, M. D, Coulombe, J. A, Corkum, P. V. (2016)ABCs of SLEEPING: A review of the evidence behind pediatric sleep practice recommendations, Sleep Medical Review, 29, 1-14. doi: 10.1016/j.smrv.2015.08.006Australian Association for Infant Mental Health (2013) Positions Paper 1: Controlled Crying viewed 17 June 2016, Barbaro, J. and Dissanayake, C. (2009) Autism spectrum disorders in infancy and toddlerhood: a review of the evidence on early signs, early identification tools and early diagnosis. Journal of Developmental Behavioural Pediatrics 30:447-459CDC Growth charts (2001) are accessed at and Youth Health Practice Manual, Statewide Child and Youth Clinical Network – Child Health Sub-Network. Children’s Health Queensland Hospital and Health service (2014)Circle of Security: Home (unknown) Circle of security resources retrieved on 17/11/2017 from: Commonwealth of Australia (2009), National Children’s Vision Screening Project Final Report, accessed 20 Dec 2017 , H., & Day, C. (2010). Working in Partnership with Parents: The Family Partnership Model. London, United Kingdom, Pearsons Education.Department of Education and Early Childhood Development (Victoria) (2011). Maternal and Child Health Service Guidelines. Maternal and Child Health, Office for children and portfolio coordination., P.S., & Hill, P.S. (2013) Behavioral Sleep Interventions in the First Six Months of Life Do not Improve Outcomes for Mothers or Infants: A Systematic Review, Journal of Developmental and Behavioral Pediatrics , 34:497–507.Fenton, T. R, & Kim, J. H.,?(2013). A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants, BMC Pediatrics, 13:59.National Health and Medical Research Council (2012): Infant feeding Guidelines. Canberra: , Y. R,?& Park, J. S (2012) Impact of attachment, temperament and parenting on human development, Korean Journal Pediatrics. Dec; 55(12):449-54. doi: 10.3345/kjp.2012.55.12.449. Epub 2012 Dec ernment of South Australia Sleep and Settling-A Reflective Workbook for Parents Health and Medical Research Council (2002), Child Health Screening and Surveillance: a critical review of the evidence. National Health and Medical Research Council: Canberra. Crying (2017). retrieved on 16/2/2018. Pillitteri, A., (2014). Maternal and child health nursing: Care of the childbearing and childrearing family, Philadelphia, Wolters Kluwer / Lippincott Williams and Wilkins.Raising Children Network (2006-2017) accessed 17/11/2017 Royal Children’s Hospital Melbourne, Centre for Community Child Health (2009) Parents’ Evaluation of Developmental Status (PEDS) Sheridan, M., Sharma, A. & Cockerill, H. (2014). Mary Sheridan’s From Birth to Five Years: Children’s Developmental Progress. (4th Ed) Routledge, Taylor & Francis Ltd. London, UK.The WHO Child Growth Standards (1999) accessed at Association of Maternal and Child Health Nurses (2010). Competency Standards for the Maternal and Child Health Nurse in Victoria.Zemel, B.S, Pipan M, Stallings, V. A, Hall, W, . Schadt, K, .Freedman, D. S, Thorpe, P. (2015). Growth Charts for Children with Down Syndrome in the U.S. Pediatrics. Back to Table of ContentsDefinition of Terms CNM: Clinical Nurse ManagerNPG: New Parent GroupBack to Table of ContentsSearch Terms MACH, Sleep, Early Days, Behaviour Back to Table of ContentsAttachmentsAppendix 1. Assessment Tools Appendix 2. Child Health and Wellbeing Assessment (3-5 years)Appendix 3. New Parent Group- Facilitator ChallengesAppendix 4. New Parent Group- Play/ Development/ Attachment SessionAppendix 5. New Parent Group-Family Wellbeing Appendix 6: New Parent Group- Common Childhood Illnesses SessionAppendix 7: Circle of Security, Building a Secure Attachment for Your Baby, Travelling Around the Circle of SecurityAppendix 8: New Parent Group Useful websitesAppendix 9: Sleep Group: 3-8 MonthsAppendix 10: Sleep Group 9-18 Months Appendix 11: Sleep Group 19 Months – 3 yearsAppendix 12: MACH Early Days Flow ChartAppendix 13: List of Resources required for Early Days ProgramAppendix 14: Early Days Attendance RecordAppendix 15: Circle of SecurityAppendix 16: Circle of RepairAppendix 17: Parent Evaluation of Developmental status (PEDS)Appendix 18: Weekly sleep feed chartAppendix 19: Myths of MotherhoodDisclaimer: This document has been developed by ACT Health, Canberra Hospital and Health Services specifically for its own use. Use of this document and any reliance on the information contained therein by any third party is at his or her own risk and ACT Health assumes no responsibility whatsoever.Policy Team ONLY to complete the following:Date AmendedSection AmendedDivisional ApprovalFinal Approval 16/03/2018New DocumentLiz Chatham, ED WY&CCHHS Policy CommitteeThis document supersedes the following: Document NumberDocument NameAppendix 1: Assessment ToolsInfant / Child Assessment Tool’s:General InformationThe MACH nurse uses two validated tools to elicit parental concerns about a child’s development and behaviour. The tools used are the Parents Evaluation of Developmental Status (PEDS) tool for initial screening and if further assessment is required an Ages and Stages Questionnaire (ASQ) (see Attachment 3). These tools require practitioners to undertake associated training in the use and scoring of the tool. Each tool used is interpreted or scored acting as a baseline for subsequent assessment and offers referral paths. Parents Evaluation of Developmental Status (PEDS)The PEDS tool is a primary assessment. It is a 10 item, parent completed questionnaire that has been demonstrated to be a reliable, valid and cost effective method for eliciting parents’ concerns about their child’s development and behaviour. The PEDS tools are utilised at key developmental age checks starting at 6 months then at 12 months, 18 months, 2 years, 3 years and 4 year old checks. Parents are advised to complete the questionnaire prior to their child’s clinic appointment or it can be completed with assistance in the clinic. The PEDS tool is printed in the Personal Health Record and spare forms are available in all clinics for use if required. The PEDS tools is to be utilized at key developmental ages checks commencing at the 6-9 months then at 12 months, 18 months and 3-4 year old checks.MACH nurses will inform parents of the PEDS tooladvising parents they are the ‘experts’ of their own childparents are able to have a wider view of their child as nurse only sees them for a short periodparent concerns are valued and respectedAges and Stages Questionnaire (ASQ)The ASQ questionnaire is a secondary assessment to a PEDS. It is a series of questionnaires for children aged 1 month to 5yrs 6 months. It is a brief assessment procedure designed to identify children who should receive more intensive early intervention.Each questionnaire has 3 parts: a family information sheetseveral pages of items/questions to be answered by parent or primary caregiverASQ Information Summary sheet.There are 21 questionnaires are available for use at different ages, referred to as “intervals”. Selecting the correct interval for the child is critical to accurate use of the ASQ (see Quick Start Guide).Each interval of the ASQ has 30 questions about a child’s abilities, organized into 5 areas: Communication, Gross Motor, Fine Motor, Problem Solving and Personal-SocialThe ASQ Questionnaire is given to a parent or caregiver to take home following use of the PEDS tool if further clarification of the parent’s concerns is required. Parents are advised to complete the questionnaire prior to their child’s clinic appointment or it can be completed with the nurse’s assistance in the clinic or at a home visit. The ASQ is scored and results are discussed with the parent at the next appointment or visit.Appendix 2: Child Health and Wellbeing Assessment (3-5 years)Appendix 3: New Parent Group: Facilitator ChallengesParticipantFacilitator StrategiesQuietEncourage working in pairs/small groupsOpen ended questions and ask for opinionsAllow the person to participate in an observatory capacityAggressiveSit next to the personBehaviour needs to be addressed appropriately after the group or on the phoneTalkerSit next to the personThank them for their contributionEncourage other members to share their experiencesDisrupterArrives lateLeaves earlyConstantly talkingLeave vacant seat near the entranceSpeak with the person outside of the group if disruptive behaviour continuesThe ‘Yes but’ PersonUse positive reinforcementSpeak individually to the person after the groupEncourage the person to reflect on their feelingsDefeatist (They’ve tried everything and nothing works)Consider brain storming the problem/issue with the groupUse resources, DVD, websitesAcknowledge their experienceFollow-up after group concludes Upset/CryingAcknowledge their feelings and offer supportAsk if they would like to leave the group or break for morning teaFacilitator to talk 1:1 during break or after session concludesNB: These strategies can be utilised by the MACH Nurse within all group sessionsAppendix 4: New Parent Group- Play/ Development/ Attachment SessionPlayPlay is valuable to babies and children because it allows for all of their senses to be used and stimulated, and it is the main way for babies to learn. Play also assists the baby in learning about relationships. When a baby is looking at their mum or dad as they are playing, they are noticing faces and expressions, copying these expressions and watching the responses of their parents. Some parents feel unsure of how to “play” with their baby. Strong building blocks to developing relationships can be built through play by:Being close to your baby, for example, cuddling her/him, baby massage. Talking to and engaging with your baby, with eye contactSinging simple repetitive songs (even if you think you don’t have a nice voice, because your baby is not a critic, your baby is a fan) Reading simple books to your baby, regularlyEncouraging turn-taking, e.g. parent pokes out her tongue then infant does - this is the very early beginnings of conversationStarting to learn cause and effect, egg. if they hit a rattle it makes a noiseProviding regular tummy time on a safe play mat on the floor, with a parent nearby talking and interacting with the baby. Some simple toys like soft bright coloured squeaky or rattle toys can be used to entertain your baby while he/she is on the mat, and these can encourage interest and the baby reaching for and holding toys. If an infant loses eye contact or interest quickly, and is requiring lots of distraction or stimulation, consider tiredness.Increasing floor time as baby develops, avoiding props such as baby chairs, infant walkers, jolly jumpers etc. Helping baby practice at sitting- when baby’s neck muscles are stronger, but still needing torso support can be another time for play, by placing simple toys in or near baby’s hands and interacting with baby at this time while baby is on your lap. Another way of providing support is to sit on the floor with your infant sitting between your legs.Playing pretend games such as “Peek-a-boo” valuable in encouraging imagination and the concept of object permanence.Avoiding television use – Young Media Australia recommends very little time for under 2’sResourcesHandouts Activity-ASQ –Play Activities for 1-4, 4-8 monthsAsk mothers to pair up or in small groups to discuss what play activities their infant enjoys most.Tummy Time (RedNose)DevelopmentAs infants develop they reach specific milestones. Some infants reach some milestones sooner. Other infants may take longer to learn a new skill and still be within the expected range, and others may require some professional intervention, for example, for speech. If you are concerned about your child’s development, your MACH nurse or GP may offer reassurance, or refer for early intervention if necessary. ResourcesHandoutsDVD’sMilestones (Parentlink)Baby Play and Baby PlaygroupsReady to Move(Australian Physiotherapy Association)AttachmentAttachment is the pattern of relationship between an infant and a caregiver which enables the infant to feel safe and free to learn and explore. A secure attachment in the first year of life has been shown to have a positive effect on social, emotional and mental development.Attachment is a relationship that is not present at birth but develops over the first few months of life in response to sensitive care (Parenting & Child Health, Child & Youth Health). Nurturing responsive relationships in the early years builds connections in your baby’s brain.Discussion Points“Building a secure attachment for baby” (laminated resource) “Building the Circle” (laminated resource)“Travelling Around the Circle of Security”Accessing help - Sometimes there is a problem with the relationship with the main caregiver, e.g. if the mother is emotionally unwell or unavailable. A secure attachmentrelationship with another caring person can help to balance this.Suggested Activity - Whiteboard- “How to respond to infant cues” Learn your baby’s signalsTreat your baby as an individual with his own likes/ dislikes.Be predictable- tell your baby what is going to happenBe flexibleNotice when your baby is trying to get your attention with looks, smiles or criesProvide comfort when your baby is upsetResourcesHandoutsDVD’sLiving with Babies (Parentlink)Getting to Know You (NSW Institute of Psychiatry)Right from the Start (Parentlink)Hello Dad (NSW Institute of Psychiatry)Building Brains for Young Children 0-3 Years (Ngala) Appendix 5: New Parent Group - Family Wellbeing Relationships with partners and other family membersIntroduction:A new baby in the family causes great excitement, but also increases fatigue and causes a shift in family dynamics. Acknowledge that there are many ways to define family, but all family members need to look after themselves and each other to function at their best.Effective Communication Communicating is the best way to reduce and prevent disagreements and arguments. It’s not uncommon for parents to get so consumed by their baby’s needs that they forget to take the time to talk to each other. Something that may be a small irritation may grow if it is not discussed. IssuesChange in focus/priorities –partners or older siblings may feel jealous because the baby takes up so much timeFamily members, friends and strangers offer advice about their own experiences with feeding, sleep and settling and parentingVisitors ‘popping in’, unannouncedSleep deprivation and feeling anxious may affect the way you respond to those close to you Feeling unable to meet unrealistic expectations of being a motherIntimacy – changes following birth: tired, self-conscious re body image, less interested ACTIVITYAsk the group- “What issues have you found difficult?” Discuss Myths of Motherhood- Appendix 19StrategiesCommunicate your feelings and needs clearly- if something is irritating or upsetting you, your partner/family member may be unaware. Try to pick the right time (e.g. when the baby is sleeping rather than crying)Be honest - listen to your partner’s point of view too Include your partner in baby’s daily care- it’s easy to become “the expert”, remember partners may do things a little differently, and are building confidence in parenting tooDiscuss household and baby responsibilities – divide the duties so that everyone knows what is expected of themWork on solutions to issues together, acceptable to both of youAim for regular family time and relationship time.Keep in touch with family and friends – this will be especially helpful when you experience difficult times. You may need to set parametersSeek helpACTIVITYACTIVITYAsk the group- what other things have helped keep communication open……DVD – Keys to Living Together - Then We Were Three Looking After Yourselfaccepting support when people offer (meals, washing, walk dog, sit with baby for appointments, exercise class/walk etc.)asking for help from trusted friends and family – they may want to help, but fear they might be interferingshowering/self-care – managing these daily tasks with a babyexercise: Post-natal exercise classes/pram pushers walking groups/yoga/gym.good nutrition, healthy snacks, easy options pre-prepared food stored in the freezerdrink plentySleep vital for emotional health and physical wellbeingsleep deprivation is a reality of parenthood especially in the early weeks and monthstips: Top up the sleep bank whenever possible, powernaps, limit commitments to activities/outings, grab the opportunity to lie down- even if you don’t sleep.10-30 minute time out ideas for every day Use snippets of time to regroup and refresh and recharge and relaxhave a bath or showerlisten to music/audio book read a book/magazinewalksit outside in the sunhave a cat-napcall a friend or relativeACTIVITYHave a grab bag to hand around with magazine, lipstick, hand cream, book, Sudoku, movie tickets, back massager etc to generate discussionWhen things are not going so wellpractice positive self-talkif worry is interrupting sleep, write it down, and set specific time during the day to reflectseek help ACTIVITYstrength cards for kidsWhere to find general community parenting, relationship and emotional wellbeing supportMaternal and Child Health clinic- phone CHI (Community Health Intake) 62079977Child and Family Centres – Tuggeranong, West Belconnen, GungahlinGPPANDSIEarly Parenting Counselling Service (EPCS) 62079977Appendix 6: New Parent Group - Common Childhood Illnesses SessionCommon Childhood Illness Topics – (specifically for infants)The following topics are frequently mentioned by NPG attendees:ColdsColic in BabiesCradle CapConjunctivitis Eczema Ear InfectionEvaluating Health Information on the InternetFever Febrile Convulsions GastroenteritisHand Foot and Mouth Disease Hot weather and babies (2) Infectious Diseases – exclusion times Nappy RashPassive Smoking Pain Relief – using Paracetamol and IbuprofenRecognition of Serious Illness in ChildrenThrushAppendix 7: Circle of Security, Building a Secure Attachment for Your Baby, Travelling Around the Circle of SecurityTravelling Around the Circle of Security(To be used in conjunction with the Circle of Security graphic)Looking at the top half of the circle- providing a Secure Base Use this as a starting point for taking a tour around the Circle of Security.(See ‘Support My Exploration “on the circle.) This is one of the two transition needs on the circle. Since children depend so much on their parents to protect them while they explore, young children also watch to see if their parent is paying attention to them for that protection. Young children don’t actually think about this- remember they are wired to do this automatically! With their parents support children head out for grand adventures.Even though what children need from their parent changes as they travel around the circle, it is important to remember that children need their parent all the way around the circle.(see Watch Over Me” on the Circle). When a child is exploring, it is usually the parents’ job to watch out for danger or be there in case something happens – if the parent becomes unavailable, the child’s exploration ends.(see “Help Me” on the circle) This requires the parent to provide the necessary help without taking over. Children just need enough help to do it themselves.(see “Enjoy with Me” on the circle) At times the child simply wants their caregiver to enjoy with them. These shared moments provide children with a sense that the caregiver is attentive, available and attuned. It also makes children feel they are worthy of such attention.(see ”Delight in Me”) At times, children need to know that no matter what they are doing, their parent finds delight in them, for no other reason than their simply being alive. During moments of exploration- moments that often to do with building autonomy and mastery- a child will look back just to make sure the parent is delighted. Moments like these build a well-engrained sense of self worth in the child.Looking at the bottom half the of the circle – Providing a Safe Haven“Welcome My Coming To You”. Unless the child is very frighted the first thing children need on the bottom half of the circle is a sign from their parent that they are welcome to come back to the parent. It is the second transition need of the circle. Like support for exploration, a child’s sense that they are welcome to come back is a combination of a history of support, as well as an immediate cue.(see “Protect Me ”on bottom circle) Providing protection from clear and immediate danger is a basic part of parenting that we clearly understand – however children are sometimes frightened and need to be soothed even when, to the adult, there is no clear danger. (see “ Comfort Me” on the Circle). Although most parents understand the idea of comfort, not all parents have experience of either comforting or being comforted and so they struggle giving comfort to their children.(see” Organised My Feelings” on the circle) Sometimes children need help organising an internal experience that is overwhelming. Most parents understand that their children need help organising their internal world. Whatever the cause, children need their parent’s help because they are still too young to do it alone. It is through the repeated process of parents helping their children organise internally that children learn how to manage feelings both by themselves and in relationships.Appendix 8: New Parent Group Useful WebsitesParenting:.au.au Health & Wellbeing: ( Hey Dad- downloadable book) illnesses:kidshealth.chw.edu.au/fact-sheets.au.au/kidsinfoAppendix 9: Sleep Group: 3-8 MonthsNormalise crying. Explain realistic age appropriate crying, tired signs and sleep patterns. Infant mental health is protected by observing and responding to the level of distress rather than the length of time an infant criesSupport parents to recognise and respond to their infant’s/child’s communication cues including tired signsDiscuss the benefits of sleep and sleep requirements. Best to add up total in 24 hours than looking at each individual sleep time. You can try Feed – Play - SleepListen to type of cry, support infant with SSSShing, gentle patting, rocking Benefits of Wrapping - Swaddling can promote more sustained sleep by reducing the frequency of spontaneous waking for babies who are not yet rolling. Red Nose guidelinesDiscuss Period of PURPLE CryingPromote consistency of approachSettle in own sleep space. Sleep environment importantBe aware and observe infant behaviour for tired signsDiscuss sleep associations –Comfort toys not recommended for <7m (Rednose) Use rituals/cues – e.g. darkened room, book, lullabyMight need to give up on this sleep and try later. May try other techniques e.g. walk in the pram, pouch, massage, bath and relaxation music.Encourage use of sleep diary where appropriate Promote connectedness and support from family, friends and communityDiscuss balance between meeting baby’s sleep needs and getting out of the house and seeing peopleResourcesDVD’s: A gentle guide to settling babies 0-12 Months-Safe Sleep SpaceHandoutsSleep DiaryWebsitesTresillian Website Website Website Website Red Nose A Sleep & Settling- A reflective workbook for parents may be useful 10: Sleep Group 9-18 MonthsSupport parents to recognise and respond to their infant’s/child’s communication cues including tired signsDiscuss sleep associations some are helpful and others not able to be sustained ‘Camping out’ in infant’s room for reassuranceSleep infant in appropriate sleep wear e.g. sleeping bagPromote routine – discuss appropriate ones for families- use their suggestions in the group.Use rituals/cues – e.g. darkened room, book, lullabyEncourage use of sleep diary where appropriate promote connectedness and support from family, friends and communityDiscuss sleep associations – from 7 months, may introduce a special bed toy but the child will need the opportunity to develop an attachment prior ie let baby hold comfort object while feeding to promote attachmentDiscuss importance of play and physical activityTransitioning to bed (if baby is a climber or cot side is below shoulders cot is no longer a safe sleep environment even with sleeping bag) ResourcesDVD’s: A gentle guide to settling babies 0-12 Months-Safe Sleep SpaceA gentle, loving guide to settling your toddler: 1 to 3 yearsConversations about Sleep: NgalaHandoutsSleep DiaryWebsitesTresillian Website Website Website Website Red Nose A Sleep & Settling- A reflective workbook for parents may be useful 11: Sleep Group 19 Months – 3 yearsSupport parents to recognise and respond to their infant’s/child’s communication cues including tired signsNightmares/Night terrorsNew siblingMeeting nutritional requirementsTransition to a bed (see above)Carer considerationsNormalising behaviour expectationsDiscuss sleep associations (see above) ‘Camping out’ in infant’s room for reassuranceSleep child in appropriate sleep wear EnvironmentCircle of Security Promote predictable routines, and establishment of sleep rituals, exploring individual Planning for sleep success , write down your sleep planEncourage use of sleep diary where appropriate promote connectedness and support from family, friends and communityChild careBottle use overnightResourcesDVD’s: A gentle guide to settling babies 0-12 Months-Safe Sleep SpaceA gentle, loving guide to settling your toddler: 1 to 3 yearsConversations about Sleep: NgalaHandoutsSleep DiaryWebsitesTresillian Website Website Website Website Red Nose A Sleep & Settling- A reflective workbook for parents may be useful Appendix 12: MACH Early Days Flow Chart Information and Referral504444057150Community Health Intake(CHI)00Community Health Intake(CHI)402336064770General Practice00General Practice3101340106680MACH Nurses00MACH Nurses219456072390MACHLiaison00MACHLiaison126492049530Self-Referral00Self-Referral057150Midwives 00Midwives 166751016319500431927024765003453765933450025590506286500478790933450049898301968500632460173990Early Days GroupNo appointment requiredFeeding, settling, early parenting support and education,Every weekday morning (except Wednesday)Not available public holidays00Early Days GroupNo appointment requiredFeeding, settling, early parenting support and education,Every weekday morning (except Wednesday)Not available public holidays402971036830001477010400050033515307620Complex issue identified00Complex issue identified8686808890No specific issue00No specific issue479933030480003580130304800012941303048000197993067945MACH Early Days booked follow-upsAt early days location Home visitWed afternoon follow upVia phone call00MACH Early Days booked follow-upsAt early days location Home visitWed afternoon follow upVia phone call447167066675Referral toQE2, GP, Allied Health,Maternity Assessment unit (MAU) Tongue tie clinicand emergency 00Referral toQE2, GP, Allied Health,Maternity Assessment unit (MAU) Tongue tie clinicand emergency 12573086995UNIVERSAL MACH SERVICES00UNIVERSAL MACH SERVICESAppendix 13: List of Resources required for Early Days ProgramPamphlets Breastfeeding and your baby: nipplesPositioning and attachmentBreastfeeding and bottle feedingStorage and handling of expressed breast milkWhat to expect from my babyNipple vasospasmDads, Partners and support peopleMastitisLow milk supplyTongue tie Sleep and Your BabyBreastfeeding: Using a supply line in the community ACT Health Good Nutrition while Breastfeeding Red nose -Safe Sleeping Sleep Diary- single page (Appendix 18)PANDSI- Information Guide- Pathways to WellnessBeyond Blue- Emotional health during pregnancy and early parenthood New Parent Group InvitationQueensland Health Baby feeding cuesMultilingual breastfeeding fact sheetsDinka and Karen Burmese’s“A Gentle Guide to Settling Babies 0-12 Months”-Safe Sleep SpaceMother and Baby by Sue CoxNgala “Conversations About Sleep”WEBSITES .au .au parenlink..au 14: Early Days Attendance RecordDate of Session __________________ Location __________________Time of ArrivalMother’s Name andDate of BirthPartner’s Name and Date of Birth(If attending)Baby’s name and Date of BirthPhone contactPresenting IssueACTPASAppendix 15: Circle of SecurityAppendix 16: Circle of RepairAppendix 17: Parent Evaluation of Developmental status (PEDS)Appendix 18: Weekly sleep feed chartTo fill in the chart, shade the area to show when your child is asleep on each day. When your child is awake, leave the spaces clear. When she/he has to be fed, write an F in the box. You will begin to see the patterns in your child’s life.6AM7AM8AM9AM10AM11AM12MD1PM2PM3PM4PM5PM6PM7PM8PM9PM10PM11PM12MN1AM2AM3AM4AM5AMMonTueWedThuFriSatSun-914401016000Denotes Sleeping-9144014287500Denotes Awake FDenotes FeedAppendix 19: MYTHS of MOTHERHOODMotherhood equals non-stop joyfulnessMedia and clever advertising tell us that motherhood is sunny days and happinessExpectations that mothering should be “easy” can leave us feeling overwhelmed or even incompetent!What can I do?Try to have realistic expectations of yourself & your babyTalk honestly to some other mum’s you trust to find out what their highs and lows are – it can help you feel that your experiences are not uncommonMotherhood is naturalMotherhood is a learned set of skills like most skills in lifeWhat can I do?Give yourself a breakAccept that you are on a steep learning curve for a whileUnderstand there is not one right way – you will find what works for you and your babyI am the only one feeling like thisIf you are finding the transition from work to motherhood difficult you are not aloneMany women feel organised, competent and confident in the workplace, but suddenly out of control as a new mumWhat can I do?Take heart that you are not the only one feeling like this and it will improveBe gutsy- talk to other mums- they might admit it too4. Other people get Post Natal Depression- not me PND effects 16% of new mums, and is often a topic that is tabooMany women find it difficult to admit they are not coping even to people close to themSome women feel worried that they may be prescribed medicationWhat can I do?There is much greater understanding around PND in the community and by health professionalsIf you feel able, talk to your partner about how you are feeling and make an appointment to see your MACH nurse or GPsome mothers are prescribed medication, but many find other strategies such as joining a group, counselling or exercise are helpful. You have choices in the pathway you take but it is important to speak to a health professionalvisit the Beyond Blue website for more information I’m OK, I’ll look after myself laterIt is very hard to nurture a baby if you aren’t taking care of yourselfWhat can I do?Enlist as much support as is possible to make some time for yourselfMake yourself a priority over some tasks that could be done later, or by someone selfYou will be more able physically and emotionally to care for your baby if you make some time to fulfil your own needs ................
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