Effective Guidelines for Counseling Parents Before Discharging a Newborn
Am Fam Physician. 2006 Mar 1;73(5):771.
Taking a newborn home is an exciting and anxious time. This may be an opportunity for physicians to educate patients, or it may be a time when the mother is tired and the family is too distracted to benefit from physician counseling. In this issue of American Family Physician, Dr. Langan provides a list of topics for physicians to discuss with parents before their baby is discharged from the hospital.1 His recommendations are similar to the American Academy of Pediatrics’ policy on discharging newborns from the hospital.2 Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents3 lists many more topics, however, including further safety education (e.g., safe cribs and playpens, bathwater temperature, siblings and pets, handwashing, gun safety) and provides an assessment of the home situation. Even this short list of topics constitutes a significant investment of time for discussion, and the wide variations in newborn discharge recommendations can be troublesome. Physicians may ask, is this the right information? Is my time with the patient productive? What do I know about the evidence that supports these recommendations?
A recent review4 of preventive pediatric interventions revealed that the evidence is scant at best. The limited evidence shows that counseling can change some risk behaviors associated with childhood injury and can improve car seat use; counseling patients on smoking cessation has a small but real effect; and multifaceted breastfeeding-support programs help breastfeeding continuance. Regarding other items mentioned in Dr. Langan’s article, evidence is lacking that these methods are beneficial or improve outcomes.
Even if good evidence existed to support the numerous recommendations on parent counseling, many questions would remain. Who should provide this information and how? It might be provided by the nurse; a patient educator; or through audio, video, or written materials or interactive computer programs. Important information may need to be delivered using more than one approach. Where and when should the counseling be provided? It could occur during prenatal care, during hospitalization, or just before discharge, and it could be delivered individually or in a group setting. Should the information be given only to the parent or to other possible caretakers? All of these questions warrant further investigation to clarify the most effective way to deliver this information.
Evidence regarding newborn counseling is lacking, but physicians need guidance even when evidence is unavailable. High-quality guidelines and health policies explicitly describe the evidence when it is available and only rely on expert consensus when evidence is unavailable. Physicians can rely on these guidelines for the best outcomes. In addition, checklists can help physicians remember to cover all of the important topics with parents.5
The bottom line is that physicians should use guidelines and checklists that are based on the best available evidence so that limited resources (especially time) can be used to implement effective services. Physicians should cautiously implement services that have unknown effectiveness.
VIRGINIA A. MOYER, M.D., M.P.H., is professor of pediatrics and internal medicine at the University of Texas (UT) Medical School at Houston. She is the associate director of the Center for Clinical Research and Evidence-based Medicine at the UT Health Science Center at Houston.
Address correspondence to Virginia A. Moyer, M.D., M.P.H., 6431 Fannin St., #2.106, Houston, TX 77030 (e-mail: firstname.lastname@example.org). Reprints are not available from the author.
1. Langan RC. Discharge procedures for healthy newborns. Am Fam Physician. 2006;73:849–52.857–8.
2. The American Academy of Pediatrics Committee on Fetus and Newborn. . Hospital stay for healthy term newborns. Pediatrics. 2004;113:1434–6.
3. Green M, Palfrey J. Bright futures: guidelines for health supervision of infants, children, and adolescents. 2nd ed. Arlington, Va.: National Center for Education in Maternal and Child Health, 2002.
4. Moyer VA, Butler M. Gaps in the evidence for well-child care: a challenge to our profession. Pediatrics. 2004;114:1511–21.
5. Schectman JM, Schorling JB, Nadkarni MM, Lyman JA, Siadaty MS, Voss JD. The effect of physician feedback and an action checklist on diabetes care measures. Am J Med Qual. 2004;19:207–13.
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