Six-Week Paediatric Check

Leo Vance attended today with his parents, Sarah and Mark, for his routine 6-week paediatric check. Leo has a history of an uncomplicated antenatal course, born at 39+2 weeks gestation via spontaneous vaginal delivery following spontaneous onset of labour.

He was delivered in good condition with Apgar scores of 9 at 1 minute and 9 at 5 minutes.

His birth measurements were: 3.42 kg, 50.5 cm in length, and 34.5 cm for head circumference.

He had a small, benign-appearing sacral dimple noted at birth with an intact base easily visualised.

His newborn screening and bilateral automated auditory brainstem response (AABR) hearing screen showed normal results.

He experienced mild physiological jaundice on day 3 of life, which resolved spontaneously with frequent feeding and did not require phototherapy.

Progress

In summary, Leo's progress has been excellent over the first six weeks of life.

Leo is currently exclusively breastfed on demand every 3 to 4 hours and feeds for 15 to 20 minutes per side.

Feeding has involved occasional mild posseting after large feeds, without any forceful vomiting or associated distress.

Bowel motions are described as soft, yellow, and seedy, occurring 3 to 4 times daily, accompanied by 6 to 7 heavy wet nappies per day.

There has been mild intermittent nasal congestion; apnoeas, cyanosis, and increased work of breathing have not been present; and he has been alert, responsive, and easily settled between feeds.

Leo has reached age-appropriate milestones, including fixing and following to the midline, social smiling, startling to loud noises, and briefly lifting his head during tummy time.

There has also been a mild erythematous nappy rash last week, with prompt resolution following frequent nappy changes and application of zinc oxide barrier cream.

He is thriving, waking independently for feeds, and sleeping in 3-hour blocks overnight.

Exam

Growth is assessed as tracking appropriately along the 50th–60th centiles, with the following measurements:

• Weight: 4.75 kg (55th percentile, 220 g/week)
• Length: 55.5 cm (60th percentile)
• Head circumference: 38.0 cm (50th percentile)

Leo underwent a full physical examination with entirely normal findings.

Mild seborrhoeic dermatitis (cradle cap) was noted over the vertex of the scalp, with otherwise clear, well-perfused skin and no jaundice.

Fontanelle findings were soft and flat, muscle tone was normal with symmetrical posture and intact Moro and palmar grasp reflexes, and red-reflex testing showed normal bilateral symmetrical reflexes.

Pulses were palpable and equal at the femorals, heart sounds were dual with no murmurs, chest examination was clear with equal air entry bilaterally, the abdomen was soft and non-tender with no organomegaly, genitalia were normal male with bilateral descended testes, and hip examination showed stable hips with negative Barlow and Ortolani manoeuvres and symmetrical skin creases.

Examination of the oral cavity revealed an intact palate and no ankyloglossia.

Plan

1. Discussed upcoming 6-week National Immunisation Program vaccines, safe sleeping guidelines (SIDS prevention), and increasing supervised tummy time.
2. Mild scalp seborrhoeic dermatitis – advised gentle massage with olive oil or baby oil prior to bathing to loosen scales.
3. Provided Royal Children's Hospital (RCH) fact sheets on "Reflux (GOR) in Infants" and "Skincare for Babies".
4. Directed parents to the Raising Children Network website and the state Maternal and Child Health Line for ongoing parenting support.
5. Advised continuation of exclusive demand breastfeeding, with maternal vitamin D supplementation as routine.
6. Routine review with the GP and Child and Family Health Nurse at 8 weeks for scheduled immunisations and ongoing growth monitoring.

"I would be pleased to review Leo again if a future need arises."