ECSB - Parent Guide

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Plan for home care Mother’s name: __________________________________________________

Help your small baby survive


Baby’s name: ____________________________________________________ Parent’s guide

Date of birth: _ _ _ /_ _ _/ _ _ _ _ Date of discharge: _ _ _/ _ _ _/ _ _ _ _ _


Return to clinic as advised to monitor the baby’s growth dd mm yyyy dd mm yyyy
and have your baby immunized
Birth weight: ______________ Weight at discharge:_________________

Follow up appointment location:____________________________________

Follow up appointment date: _______________________________________

Summary of care provided:


_______________________________________________________________
_______________________________________________________________

Notes on home care

Feeding plan: ___________________________________________________


_______________________________________________________________
_______________________________________________________________ EDUCATION CHECKLIST
12
0 1 Medications:____________________________________________________
10 2
9
8
3
4
_______________________________________________________________ Family members of ______________________ (baby’s name)
have received education and demonstrated knowledge
7 5
6
Other:__________________________________________________________
_______________________________________________________________
and skills regarding:
_______________________________________________________________ Initials of educator/Date
_______________________________________________________________
_________________________________________________________________ Preventing infection ___________________
Keeping baby warm ___________________
Breast feeding ___________________
Assessing baby ___________________
Reporting Danger Signs ___________________
Plans for home care ___________________

© 2015 by American Academy of Pediatrics


JULY 2015
20-09446 Rev A
ISBN 978-1-61002-002-2
Prevent infection Keep baby warm Assess your baby
FAMILY - VISITORS - HEALTH WORKERS

H A N DS
A N
Before
CLE

3 2 1

After
Danger Signs
SEEK HEALTH CARE IMMEDIATELY

Breastfeed Not
feeding
Too hot or
too cold

EVERY 2-4 HOURS


N
RO U DI N
DAY

38
37
36
35
R

34
CLEAN S U

GS

Chest indrawing Convulsions


- or fast breathing

No
NIGHT movement
Feeding
intolerance

Yellow palms or soles of feet

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