Healthy Kids 9 Month Assessment
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1Under 5s Program
January 2009
9 Month Assessment
Child Health Nurse, RAN or AHW to complete
Discussion points are in a black box. Tick as completed
Immunisation
First Name
HRN
□
Given
(record on immunisation sheet)
Surname
Date Review
/
/
□
Up to date
□
DOB
/
/
Age (Weeks)
Carer attending
Unable to give - placed on recall
Problems identified at previous check
Growth satisfactory?
Yes
No
Weight
Action plan needed?
Yes
No
Plot on growth chart
Since this time yesterday has the baby had
Breast milk
Formula
Other milk
Tea
Water
Soft drink/cordial/fruit juice
Other
(these can damage teeth)
Is the child eating solids regularly?
Yes
No
What foods
Nutritional information and advice given?
Yes
No
Use NT Infant feeding guidelines
□
□
□
□
□
Skin
Clear
Scabies
Sores
Ringworm
R ear
NAD
AOM
AOM w Perf.
CSOM
OME
□
□
□
Dry Perf.
Otitis Ext.
Other
Other
(specify)
(specify)
□
□
□
□
□
L ear
NAD
AOM
AOM w Perf.
CSOM
OME
□
□
□
Dry Perf.
Otitis Ext.
Other
Treatment
(specify)
Treatment
Recurrent otitis media? (3 or more episodes in 6 months)
Yes
No
Persistent otitis media? (more than 3 months with perforation)
Yes
No
Hearing referral required?
Yes
No
(if yes record below)
“lift the lip”
General appearance and comments
Oral health
and check for colour changes in baby’s teeth
white, brown or black spots
Spots seen? Yes
No
Referred to dental therapist?
Yes
No
Referred to dentist?
Yes
No
PLAY GIve your child clean safe household things to handle, bang and drop
COMMUNICATE Respond to your child’s sounds and interests. Tell your child the names of things and people. Read books to your child
and talk about the pictures
NUTRITION Introduce lumpier food (Use the flipchart ‘A story about feeding babies’ nutrition advice from NT Infant Feeding Guidelines)
HYGIENE Keep face/hands clean to stop germs spreading from pus affected ears and runny noses. Use tissue spears to clean ears.
Bath baby regularly - at least every second day
ORAL HEALTH
Start caring for baby’s new teeth when they first come through. Clean with a damp clean cloth (don’t use toothpaste until 18
months). Check teeth and gums regularly for any colour changes. It is important for mum and dad and baby to clean teeth twice a day
Domestic and family violence (DFV) assessment. Has a DFV screen been done in the last 6-12 months? If not offer to do a screen today
with the mother or carer. Do not force people to participate in the screen if they do not want to.
If the mother/carer agrees to the screen, ensure privacy and reassure them that all people are asked the same questions.
Offer to follow up and support mother/carer with any problems identified.
Was DFV screen done at this visit?
Yes
No
Referral made
Yes
No
Use S&E Assessment form
Action and follow up
Make a note on the 12 month form of any problems that need follow up
Issue or problem
Referral or action made
Referred to
MO
Paed
Other
(specify)
MO
Paed
Other
(specify)
MO
Paed
Other
(specify)
□
Prompt for 12 month check
□
Monthly recall for GAA
□
Weekly recall if concerns and engage community supports (eg SWSBSC, community liaison, family workers)
Name of person
Signature
AHW
RN
Date
/
/
completing check
9 Month Assessment
9
D E PA R T M E N T O F H E A LT H A N D FA M I L I E S
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