14: Chanelle

The HV ‘Janet’ visited a family with their first baby, a girl named Chanelle. Janet had already met the Mother Karen and her partner Darren antenatally. Karen and Darren were present for the birth visit, together with the maternal grandmother, Suzanne. Karen told Janet that Chanelle seemed to be restless and sometimes did not finish all her bottle feeds. Janet listened carefully to Karen’s concerns and discussed this at length, giving advice about bottle feeding and a comfortable position/environment for her and Chanelle. Once Janet had responded to Karen’s questions she weighed Chanelle. There were no concerns about Chanelle’s weight. Janet then observed Chanelle and performed a physical examination; during this she noticed that her skin was slightly mottled in appearance. Janet was concerned about this and telephoned the GP surgery to request that Chanelle be seen immediately. Later that day the GP advised Janet that Chanelle had been admitted to hospital as he had identified a cardiac condition, which required further investigation. At the end of the day Janet telephoned the hospital to enquire about Chanelle. Karen was brought to the telephone and gave Janet an update on Chanelle’s condition. She and Darren stayed at the hospital whilst Chanelle underwent tests. Janet ensured that Karen had her contact details and advised that she would phone again. Janet liaised with the hospital staff, including the Liaison HV on a daily basis, until Chanelle was discharged five days later.

Janet’s concerns about Chanelle’s circulation were triggered by the mottled appearance of her skin. She identified this issue as she was carrying out a physical examination of Chanelle during the birth visit. This involves checking primary reflexes (see www.healthofchildren.com/N-O/Neonatal-Reflexes.html) and an overall ‘top to toe’ check of the baby whilst they are naked, including responses to sound and light, motor skills, and skin condition.

  • Sometimes Health Visitors do not examine the baby at the birth visit. Why?
  •  Describe the role of the hospital-based Liaison Health Visitor.

› Suggested answers

  • Sometimes Health Visitors do not examine the baby at the birth visit. Why?

Parents are sometimes reluctant for the health visitor to undress the baby, particularly if the baby has been unsettled and/or has recently fallen asleep. If this was the case the health visitor would need to revisit soon after (next day or so) to examine the baby.

Some health visitors believe that there is no need to perform a physical examination of the baby as he/she will have been examined by a paediatrician or midwife within 72 hours of the birth. This has been debated for some time and is still a controversial area. However, the scenario described illustrates that problems can occur after the birth examination. If parents are expressing any concerns about a baby (as was the case in the scenario) then the health visitor should examine the baby.

  • Describe the role of the hospital-based Liaison Health Visitor

The hospital-based Liaison Health Visitor advises the child’s community-based Health Visitor when a child on their caseload is admitted to hospital or seen in A&E. They will share the child’s condition, diagnosis, plan of care and discharge plan/date of discharge. He/ she will keep in touch with the community-based Health Visitor throughout the child’s stay in hospital. This post often includes acting as the local Co-ordinator for the Care of Next Infant Scheme (CONi) which is offered to all families who have experienced (or are related to a family who have experienced) Sudden Infant Death Syndrome (SIDS) or who have experienced a ‘near miss’. The CONi scheme invites parents to complete documentation which is collected by the Liaison Health Visitor and submitted to a national centre for collation and publishing.

A summary of the role can be found here:www.beh-mht.nhs.uk/enfield-community-services/ecs-services/liaison-health-visitor.htm