Infant Vomiting and Urgent Assessment Mr. and Mrs. B arrive at in the urgent care clinic with their 6 week old infant S.B. As the practitioner you ask the couple why they have brought SB to the clinic. Mrs. B states “My baby breastfed well for the first couple of weeks but has recently been throwing up all the time sometimes a lot and really forcefully. He looks skinny and is hungry and fussy all the time.” You determine the couple is homeless and has been living out of their car for the past month. S.B. has had no primary care since discharge after delivery.

1. What additional information will you need to obtain from Mr. and Mrs. B.?
2. What assessments would you need to do for S.B. based on the information that you have so far?

Assessment of Infant S.B. and Additional Information Needed

Additional Information to Obtain from Parents

1. Feeding History

   • Frequency, duration, and amount of breastfeeding
   • Any recent changes in feeding pattern
   • Presence of difficulty latching or swallowing
   • Signs of dehydration (fewer wet diapers, dry mouth, sunken fontanelle)

2. Vomiting Characteristics

   • Frequency, volume, and timing of vomiting (e.g., after every feed, projectile)
   • Presence of bile or blood in vomit
   • Any relation to feeding position or activity

3. Growth and Development

   • Birth weight and any weight checks since discharge
   • Any developmental milestones or delays noticed
   • Changes in behavior (excessive sleepiness, irritability)

4. Medical and Birth History

   • Gestational age at birth, complications during delivery
   • Neonatal issues (e.g., jaundice, NICU stay)
   • Any known congenital conditions

5. Social and Environmental Factors

   • Living conditions and access to food, clean water, and sanitation
   • Any recent illnesses in the family
   • Access to healthcare and ability to obtain medications if needed

Physical Assessments for S.B.

1. General Appearance

   • Signs of malnutrition or dehydration (sunken eyes, poor skin turgor)
   • Alertness and activity level

2. Anthropometric Measurements

   • Current weight, length, and head circumference compared to growth charts

3. Abdominal Exam

   • Palpation for masses (e.g., olive-shaped mass in pyloric stenosis)
   • Bowel sounds and signs of discomfort

4. Hydration Status

   • Fontanelle assessment (sunken in dehydration)
   • Capillary refill, mucous membrane moisture

5. Neurological and Skin Exam

   • Tone and reflexes
   • Skin color (pallor, jaundice, mottling)APA