CLINICAL REPORT Guidance for the Clinician in Rendering Pediatric Care

The Prenatal Visit

Michael Yogman, MD, FAAP,​a Arthur Lavin, MD, FAAP,​b George Cohen, MD, FAAP,
COMMITTEE ON PSYCHOSOCIAL ASPECTS OF CHILD AND FAMILY HEALTH

A pediatric prenatal visit during the third trimester is recommended for all abstract
expectant families as an important first step in establishing a child’s medical
home, as recommended by Bright Futures: Guidelines for Health Supervision
of Infants, Children, and Adolescents, Fourth Edition. As advocates for
children and their families, pediatricians can support and guide expectant
parents in the prenatal period. Prenatal visits allow general pediatricians to
establish a supportive and trusting relationship with both parents, gather aHarvardMedical School and Mount Auburn Hospital, Boston,
basic information from expectant parents, offer information and advice Massachusetts; and bAdvanced Pediatrics, Beachwood, Ohio
regarding the infant, and may identify psychosocial risks early and high-risk This document is copyrighted and is property of the American
conditions that may require special care. There are several possible formats Academy of Pediatrics and its Board of Directors. All authors have
filed conflict of interest statements with the American Academy
for this first visit. The one used depends on the experience and preference of of Pediatrics. Any conflicts have been resolved through a process
approved by the Board of Directors. The American Academy of
the parents, the style of the pediatrician’s practice, and pragmatic issues of Pediatrics has neither solicited nor accepted any commercial
payment. involvement in the development of the content of this publication.

Clinical reports from the American Academy of Pediatrics benefit from

expertise and resources of liaisons and internal (AAP) and external
reviewers. However, clinical reports from the American Academy of
Pediatrics may not reflect the views of the liaisons or the organizations
or government agencies that they represent.
As the medical specialty that is entirely focused on the health and well-
being of the child, embedded in the family, pediatric care ideally begins The guidance in this report does not indicate an exclusive course of
treatment or serve as a standard of medical care. Variations, taking
before pregnancy, with reproductive life planning of adolescents and into account individual circumstances, may be appropriate.
young adults, and continues during the pregnancy, with an expectant
All clinical reports from the American Academy of Pediatrics
mother and father of any age. This clinical report is an updated revision automatically expire 5 years after publication unless reaffirmed,
of the original clinical report from the American Academy of Pediatrics revised, or retired at or before that time.

(AAP) on the prenatal visit.‍1 Although survey results show that 78% of DOI: https://​doi.​org/​10.​1542/​peds.​2018-​1218
pediatricians offer a prenatal visit, only 5% to 39% of first-time parents Address correspondence to Michael Yogman, MD, FAAP. E-mail:
actually attend a visit.‍2 The prenatal visit offers the opportunity to create [email protected]
a lasting personal relationship between parents and the pediatrician, PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275).
one of the most important values in all ongoing pediatric care. The AAP
Copyright © 2018 by the American Academy of Pediatrics
has put forward the rationale and standards for the prenatal visit for
pediatricians in Bright Futures: Guidelines for Health Supervision of Infants, FINANCIAL DISCLOSURE: The authors have indicated they have no
financial relationships relevant to this article to disclose.
Children, and Adolescents, Fourth Edition (Bright Futures),​‍3 as well as for
FUNDING: No external funding.
parents and families (www.​healthychildren.​org).‍4 This clinical report
augments these approaches to making the prenatal visit an important POTENTIAL CONFLICT OF INTEREST: The authors have indicated they
have no potential conflicts of interest to disclose.
part of the practice of pediatrics.
Less than 5% of urban poor pregnant women see a pediatrician during
To cite: Yogman M, Lavin A, Cohen G. The Prenatal Visit.
the prenatal period although they are at higher risk of adverse pregnancy
Pediatrics. 2018;142(1):e20181218
outcomes; pregnant women in rural areas may have even more difficulty

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 accessing a prenatal visit.‍5,​6‍ To Adoptive Families at http://​ professional partnership, a crucial
attempt to reduce disparities in pediatrics.​aappublications.​org/​ part of the patient-centered
pregnancy outcomes, encouraging content/​130/​4/​e1040). If adoption medical home.
nonresident prospective fathers to occurs or is to occur across states or
2. To access pertinent aspects of
attend the prenatal visit along with internationally, review of records,
the past obstetric and present
expectant mothers is particularly need for waiting periods, scheduling
prenatal history; to review family
important, albeit challenging.‍7 of initial visits, concerns about
history of genetic or chromosomal
potential fetal exposure (eg, maternal
Prenatal contact with a pediatrician disorders and to review fetal
substance use or fetal alcohol
may begin with a contact from exposure to substances that may
spectrum disorders), and additional
a prospective parent to the affect the infant.
recommended screenings and/or
pediatrician’s office to ask whether
tests can be discussed.‍8,​9‍ If needed, 3. To introduce anticipatory
the practice is accepting new patients
pediatricians can consult experts in guidance about early infant care
and to inquire about hours, fees,
international adoption or the AAP and infant safety practices.
hospital affiliation, health insurance
Council on Foster Care, Adoption, and
accepted, and emergency coverage. 4. To identify psychosocial factors
Kinship Care.‍10
These questions may be answered (eg, perinatal depression) that
by a member of the office staff or The most comprehensive prenatal may affect family function and
the pediatrician, and this exchange visit is a full office visit, during family adjustment to the newborn
establishes an initial relationship which a trusting relationship can (eg, social determinants of
between the office and the parent. be established and expectant health, adverse child experiences,
During this conversation, the parents can have time to express and promoting healthy social-
expectant parent can be encouraged their needs, interests, and concerns emotional development and
to schedule a prenatal visit with the and receive initial anticipatory resiliency).
pediatric health care provider, and guidance. Most pediatricians believe
both parents can be encouraged that the prenatal visit is helpful in Establishing a Positive Pediatrician-
to attend. The prenatal visit can establishing a relationship with Family Relationship, a Crucial Part
be enhanced if the parents come families that is essential for the of the Patient-Centered Medical
medical home. Because they may Home
prepared with questions. Optimally,
this visit should occur at the beginning not be able to initiate these visits, The prenatal period is an ideal time
of the third trimester of pregnancy. pediatricians can discuss the concept to start building the health care
with referring obstetricians, family alliance that may last for many years,
A prenatal visit with the pediatrician physicians, and internists, who can, commonly until the patient reaches
is especially important for first- in turn, encourage their patients to adulthood.‍11 The prenatal visit often
time parents or families who are contact pediatricians for a prenatal is an opportunity for the family to
new to the practice; single parents; visit. Office Web sites and social determine whether their relationship
women with a high-risk pregnancy media can also be used to advertise and their mutual philosophies
or who are experiencing pregnancy this service to expectant parents. will form the basis of a positive
complications or multiple gestations;
The following objectives for a relationship.
and parents whose previous
pregnancies had a complication prenatal visit are suggested as The prenatal visit is also an
such as preterm delivery, an infant important topics to be addressed.‍2 opportunity for parents to invite
with a congenital anomaly, a The actual range of topics covered other supportive adults, including
prolonged course in the NICU, or a can be determined by the preference grandparents,​‍12,​13
‍ to establish a
perinatal death. Same-sex couples of the provider, the interest of the relationship with the pediatrician
and parents expecting via surrogacy expectant parent(s), or the presence and to encourage them to come to
may have questions unique to of an existing complication with the future visits and support the new
their circumstance. This visit also pregnancy or the fetus. Topics not parent(s). A prenatal visit can be
can be particularly valuable to covered prenatally can be presented used to introduce parents to the
parents who are planning to adopt to parents during the newborn or concept of a medical home for the
a child, because they may have had first postnatal visit. child’s health and development
previous experience with pregnancy needs. Parental familiarity with
complications and/or be sensitized the pediatric health care provider
to special vulnerabilities in their
OBJECTIVES prenatally may be helpful if a
infant (see the AAP clinical report 1. To provide a foundation on which referral or transfer of care occurs
The Pediatrician’s Role in Supporting to build a positive family-pediatric because of perinatal complications

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 or the newborn infant’s medical •• parents’ attitudes about and use life clear, but it is important to talk
condition.‍14 Adolescent parents‍15 of complementary and alternative about the special role fathers and
and older first-time parents may medications and health care. same-sex partners play in good
benefit from the opportunity to outcomes for children as well.‍21
If there are other children in the
share their specific concerns with a A key goal of positive parenting is
family, pediatricians can provide
knowledgeable professional. the reliable provision of the infants’
helpful advice about managing the
basic needs—food, shelter, love,
older sibling’s adjustment. Managing
Information From the Prenatal and and care—and in doing so, fostering
parental expectations about their
Family History the development of trust.‍22,​23
‍ The
child is important in laying the
adverse effects of poverty on child
Gathering information about foundation for positive attachment.
health have been well documented.‍22,​24
pregnancy complications, parental Questions useful to consider as the
Optimal use of supports and
depression, and family medical pediatrician approaches the prenatal
resources (eg, the Special
and social history (especially social visit are listed in the chapter on
Supplemental Nutrition Program for
determinants of health) is helpful the prenatal visit in Bright Futures:
Women, Infants, and Children [WIC])
as a background to the context of Guidelines for Health Supervision of
can be discussed and information
the pregnancy. This inquiry also Infants, Children, and Adolescents,
about access can be provided.
conveys to parents an interest in the Fourth Edition.‍3
Positive parenting also includes
broader psychosocial environment
Anticipatory Guidance and providing a steady emotional climate
of the infant, including areas in
Enhanced Parenting Skills; Social in which reasonable expectations are
which support would be most useful,
Determinants of Health sustained consistently.‍25 Avoiding
especially if there is any risk of
and/or buffering adverse childhood
domestic violence.‍16–‍ 18
‍ Answering The prenatal visit offers an experiences, such as parental
parents’ questions about the opportunity to discuss a range postpartum depression, increasingly
approach to pediatric care also is of concerns that may be of great is seen as an evidence-based part of
helpful. This is a good opportunity interest to the expectant parents and pediatric care, and this can begin by
to review how the practice uses the pediatric provider. The following identifying prenatal risk factors.‍26
tools of social media and e-mail to areas for discussion are meant to be It is important to share evidence-
communicate with families. a helpful reference. The conversation, informed online information sources
the specific concerns of the parents, and other local resources about
Additional topics that may be
and time allowed will define which parenting and child development for
addressed include:
of these issues are discussed at families. Many excellent resources
•• developmental dysplasia of the the prenatal visit. The prenatal are available, such as the Building
hip, early urinary tract infections, visit also offers an opportunity for “Piece” of Mind program from the
asthma, lipid disorders, cardiac assessment of family risk factors and Ohio chapter of the AAP (http://​
disease, sickle cell disease, connections to key evidence-based ohioaap.​org/​tag/​parenting/​), the
substance abuse, psychiatric and other early learning, health, Zero to Three program (http://​www.​
illness, domestic violence, chronic and development programs in the zerotothree.​org/​child-​development/​),
medical conditions, and ongoing community. the Triple P Positive Parenting
medications; Program (http://​www.​triplep-​
Positive Parenting
•• plans for feeding, circumcision, parenting.​net/​glo-​en/​home), and
child care, work schedules, and One of the pediatrician’s tasks is the Talk, Read, Sing tool kit available
support systems; to provide guidance to mothers, from the Clinton Foundation (Too
fathers, and other supportive Small to Fail [www.​toosmall.​org]).
•• parents’ plans regarding child care adults to become more competent
and expectations about work-life caregivers. This can begin with The pediatrician can share with
balance; discussion of the parents’ concerns, parents the knowledge that children,
planned strategies, and cultural and at an early age, can learn through
•• cultural beliefs, values, and
family beliefs and values. Advice playful serve-and-return interactions
practices related to pregnancy and
can be offered about shared roles in with adults and that playing with and
parenting;
parenting, such as diapering, bathing, daily reading, singing, and talking
•• concerns regarding tobacco, nighttime care, and helping with to children from birth onward are
alcohol, and other drug use‍19,​20
‍ feeding. Pregnancy and delivery recommended, as is providing a
and exposure to environmental make the central importance of the language-rich environment and
hazards; and mother in the newborn infant’s minimizing media exposure.

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 Connections to Community parents living with food insecurity, screening tests prospective mothers
Resources breastfeeding offers economic will experience. For example, the
advantages as well. Rooming mother is regularly screened by her
Office materials and Web sites can
in and avoiding unnecessary obstetrician to assess fetal growth
demonstrate provider awareness
supplementation can be mentioned and development and may have
of key early childhood resources in
as ways to support nursing. fetal testing for genetic diseases
the community, from home visiting,
and chromosomal abnormalities. In
Early Head Start, child care resource The benefits of breastfeeding
addition, the mother may be screened
and referral agencies, quality child can be reviewed if there are
for conditions that may affect the
care settings, local libraries, and no contraindications, and
fetus, such as gestational diabetes,
parent support groups, as well as lactation support services can be
pregnancy-induced hypertension,
cardiopulmonary resuscitation discussed.‍30–‍‍ 33
‍ However, ultimately,
and the presence of infectious agents,
courses. A discussion of the types of decisions about feeding the infant
such as hepatitis B, cytomegalovirus,
child care typically available (family are made by the parents. If formula
group B streptococci, and HIV.
care, in-home baby-sitting, family day feeding is the parents’ choice, they
care, child care centers) is helpful. can be supported in their decision For the infant, the main universal
and given advice on formula type screening programs are used to
Delivery and Nursery Routines and preparation and proper bottle detect metabolic diseases, sickle
A discussion of the hospital routines use. Ultimately, the goal is a growing, cell disease, cystic fibrosis, newborn
around delivery and nursery care healthy infant and parents who enjoy jaundice, critical congenital cardiac
may include: who will be in the feeding so that they can be supported disease, and hearing impairments.
delivery room and how new infants in whatever decision they make. Parents may seek more information
behave in the first hours and The Special Supplemental Nutrition about risk factors for the
days; qualifying who will provide Program for Women, Infants, and management of newborn jaundice.
newborn care in the hospital and Children (WIC) also is available to Some discussion of these conditions
what will happen if there is (1) an help with nutrition discussion and can be helpful to many families so
unanticipated urgent delivery away support prenatally, and mothers can they understand what is being looked
from the expected hospital, (2) a be referred to determine whether for, how the tests are performed,
home birth, or (3) an admission to a they are eligible for a nutrition and what the response to test results
special care nursery is also helpful. package during pregnancy, if not will be. Family history may have
This discussion might include the already participating in the program. led to detailed genetic testing and
newborn infant’s ability to seek and Parental expectations can be shaped counseling and may warrant special
attach to the mother’s breast right so that parents do not become discussion.‍35–‍‍ 38
‍ Routine postpartum
after delivery, the related concept of overly concerned if infants take care can be discussed. The rationale
skin-to-skin care, and the 12-hour a few days to learn to latch to the for routine recommendations for
postdelivery sleep phase after the breast and lose some weight before vitamin K to prevent gastrointestinal
adrenaline rush of labor. Mothers the mother’s milk comes in. Infants or cerebral hemorrhage, eye
often choose to have the infant with commonly lose weight for a few days ointment to prevent eye infection
them continuously during the entire before the mother’s milk comes in leading to blindness, and the birth
hospital stay, which aids successful but typically regain birth weight at hepatitis B vaccine can be explained.
lactation. or before 2 weeks of age. If mothers
Circumcision
who plan to breastfeed are taking
Thoughts on Feeding the Newborn any medication, a helpful reference Discussion of circumcision, including
Infant for the pediatrician to evaluate safety benefits, risks, the surgical process,
This is an appropriate teaching is the LactMed Drugs and Lactation and analgesia, can be presented at
moment for describing to both Database (http://​toxnet.​nlm.​nih.​gov/​ this visit, with particular attention to
parents the many advantages of newtoxnet/​lactmed.​htm).‍34 the family’s religious, personal, and
exclusive breastfeeding and how cultural views.‍39
it improves outcomes for both
Screening
the mother and infant.‍27,​28
‍ Special Screening for various infections and Infant Visit Routines and Care
Offered at the Office
breastfeeding training of expectant conditions that can affect the fetus
fathers or partners has been is an important part of pregnancy, Most parents are interested in
shown to increase their support of delivery, and birth. The prenatal visit understanding what to expect for
breastfeeding mothers as well as is an excellent time to discuss the a routine pediatric visit as well
the duration of breastfeeding.‍29 For benefit of screening and the specific as information about office and

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 telephone hours, the appointment home, smoke detectors and carbon depression is largely unappreciated,
scheduling process, and coverage monoxide monitors, and reducing because stigma prevents a majority
for night, weekend, and emergency exposures to toxins such as mold of parents from being identified
care. The prenatal visit also is a good and lead. and accessing services.‍48 Several
time to establish the pediatrician’s states have recommended universal
expectations of the family and explain Emotions in the Newborn Infant postpartum depression screening
the use of electronic communications For many families, including those by pediatricians, and insurers are
during and after routine office hours, with other children, the unique increasingly paying for these screens.
including billing for this service. The emotional life of a newborn infant is The prenatal visit offers mothers
routine periodic schedule of well- unfamiliar and can be challenging. a valuable opportunity to become
child care visits from Bright Futures: It is key to manage expectations and aware of the facts about depression
Guidelines for Health Supervision of raise parental awareness about the so they know to call for help from
Infants, Children, and Adolescents, range of temperaments infants can their primary care physician or
Fourth Edition‍3 can be shared with have as well as the strengths and their obstetrician if they experience
the parents (http://​brightfutures.​ challenges of them. There can be significant persistent sadness, which
aap.​org/​clinical_​practice.​html), some discussion on how crying can can be compounded by fatigue from
along with information from Bright be a normal mode of communication, lack of sleep.‍49–51
‍
Futures about behavior, development, explaining that a common peak The pediatrician can instruct parents
and the importance of social typically occurs during the evening that infants usually awaken to feed
determinants of health. hours at 6 weeks of age and giving every 3 hours during the night until
advice on how best to respond to approximately 3 months of age, when
The prenatal visit also is a good time
it. Parents can be given techniques brain maturation enables one longer
to ask parents about their preferred
for soothing fussy infants, such as sleep stretch in every 24-hour cycle.
approach to communication with
holding, including cuddling and skin- To shape this longer stretch to the
the office, clarifying office policies
to-skin contact‍47; rocking; singing; dark hours, parents can wake infants
on the availability of telephone and
talking quietly; and dimming lights every 3 hours to feed during the
electronic communications. Preferred
and playing soft music. day, keep the lights dim after dark
Web sites (HealthyChildren.org)
for sharing information and other The prenatal visit provides an to entrain circadian rhythms, and
helpful resources and books can be opportunity to discuss how to schedule a bedtime feeding at
recommended. recognize when crying is an 11:00 pm right from birth so that
indicator of actual pain or illness. It the longer sleep stretch after
Safety is important to establish strategies 3 months of age begins then.
for parental coping with the stress of At the prenatal visit, pediatricians
Safety is an important topic to
an infant crying and the demands of can listen for and make note of
discuss with the parents, particularly
infancy, including setting clear plans fathers’ or partners’ feelings
advice on “safe sleep”‍40 and the
for strategies to deal with stress. about lack of parenting skills and
importance of proper bedding,​‍40,​41
‍
proper holding of the infant, water Emotions in the Parents decreased marital intimacy. This is an
temperature during bathing, the opportunity to lay the groundwork
proper use of a pacifier, and hand The experience of enhanced, for pediatric providers to be available
washing. Encouraging a good family powerful emotions of a wide variety to fathers as well as mothers after the
diet, regular checkups with the is likely universal to most parents birth of the infant.
family physician or obstetrician‍42 during and after delivery. Even if no
and dentist,​43,​44
‍ and appropriate serious difficulties with emotions Decreasing the Risk of Serious
rest and exercise also is important. emerge, it is helpful for expectant Illness and Effective Response to
parents to be aware of the special Medical Problems Should They Occur
Guidelines from the American
College of Obstetricians and power of both positive and negative The prenatal visit is a good time to
Gynecologists (ACOG) increasingly emotions that surround a new person review family history of any illnesses
emphasize attention to oral health being born and entering their life. or congenital diseases or any
and smoking cessation during It is also important for all expectant concerns the parents have had during
pregnancy, and pediatricians can parents to be aware that it is the pregnancy. Adolescent parents
reinforce these recommendations common for many mothers, as many often benefit from more guidance
during the prenatal visit.‍45,​46
‍ Specific as 10% to 20%,​‍48 and some fathers to than more experienced parents,
safety issues to discuss include the experience depression before, during, and older-than-usual parents also
use of car seats, gun safety in the and/or after delivery. Postpartum feel stressed and insecure. Single

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 parents may not have family or other the timing of taking their newborn Nurse practitioners can have a
support systems and may benefit infant out in crowded public places significant role in conducting
from postpartum referral to social or inviting visitors/relatives to their prenatal visits. The objectives listed
service agencies, evidence-based home. With regard to preventing previously are accomplished through
home visiting programs, or parenting infections, this is a good moment to an in-person discussion with the
programs (Incredible Years, Triple P) discuss and encourage parents and provider. Discussion can include
in local communities, if available, family members to be immunized office and telephone hours; fees;
for help. The absence of the father, against pertussis and, if during the office staff; hospital affiliations;
parental conflict, a chronic parental right season, influenza. Tetanus- coverage for night, weekend, and
physical condition or concern about diphtheria-acellular pertussis (Tdap) emergency care; arrangements for
mental health, and preterm birth immunization is recommended newborn care after delivery both
or a birth defect in the infant may for every pregnant woman after
at the hospital the pediatricians
require additional medical visits and 20 weeks’ gestation, for every
visit and at a hospital where the
involvement of specialists‍52–‍‍ 55
‍ and pregnancy, and for fathers as well.‍65
pediatrician is not on the staff; and
can present physical, emotional, and Underimmunized siblings at home
the pediatrician’s expectations of
financial burdens for the parents. also present a risk to a newborn
the family. A handout containing this
Many expectant parents wish to infant, and expectant parents can be
information can be helpful for the
discuss the value of cord blood encouraged to ensure siblings are
banking and the relative merits of fully immunized before the delivery. family, including information on how
private– versus public–cord blood and when to schedule the first visit
Many parents have questions about after newborn discharge and how to
donation.56 the recommended schedule of
retrieve the discharge summary if
During the pregnancy, maternal immunizations. The prenatal visit
care was provided by a hospitalist.
obesity and maternal drug is a valuable opportunity to discuss
This type of visit is most important
use‍8,​9‍ are risk factors for labor the value of immunizations and
for first-time parents, for adolescent
complications, birth defects, and/or the reason for the recommended
and other young parents, when
developmental impairment.‍57–59 ‍ schedule. It is an opportunity to listen
pregnancy complications or newborn
Maternal diet is important, and to any parental concerns well before
ACOG recommendations about the the infant is born, and the decision problems are anticipated, or when
weight gain during pregnancy can be is on the family. It is also important parents are unusually anxious for
emphasized. for the pediatric provider to outline any reason. The establishment of
office immunization policy with a mutual commitment to a sound
New data are increasingly available
regard to parents who wish to alter and rewarding family-physician
about the adverse health effects
the standard immunization schedule. relationship usually results from the
of environmental toxins during
visit.
pregnancy (eg, mercury and fish), Information Sharing With the Family
and pediatricians can work with
obstetricians and the ACOG to Although the volume of information If women with high-risk pregnancies
knowledgably respond to parents’ and advice may seem overwhelming require bed rest, there may be a
questions on this topic.‍60–‍‍ 63
‍ Pediatric to expectant parents, they can need for a prenatal visit with only
providers may want to request direct be given appropriate handouts 1 parent and/or telephone calls.
contact with obstetric providers and to supplement and reinforce These contacts can include the same
request obstetric records to clarify information provided at the prenatal content as the full prenatal visit.
prenatal complications, particularly visit. A follow-up visit or telephone The outcome should be the same
regarding abnormalities detected on call can be offered if they still have mutual commitment as from the
prenatal ultrasonography that may questions. A Web page can be a good full prenatal visit in the office. If an
require postnatal follow-up. New source of information and can include infant is born prematurely, before a
understanding of the relationship parent questionnaires for subsequent prenatal visit could occur, it is often
between environmental toxins visits.
helpful to meet with the parents
and epigenetic modifications have in a modified prenatal visit before
provided a stronger evidence-based the infant is discharged from the
TYPES OF PRENATAL VISITS
recommendation highlighting NICU. In the tragic circumstance of a
the fetal programming of adult The Full Prenatal Visit pregnancy loss after a prenatal visit,
diseases.64 The most comprehensive form of a follow-up expression of sympathy
The prenatal visit also is a good time prenatal visit is a scheduled office by the pediatric provider can feel
to give parents guidelines about visit with both expectant parents. supportive.

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 The Brief Visit To Get Acquainted the visit will be covered by the internists, and family physicians,
expectant parent’s insurance and and with expectant parents.
Some pediatricians may offer a
whether a referral will be required. 5. Pediatric residents can effectively
less formal prenatal visit than a
A discussion of insurance plans be taught during residency about
full consultation, and some parents
that the practice accepts may be the content and importance of the
also may prefer this option. A meet-
included. Payment for a prenatal visit prenatal visit.
and-greet session, individually or
often requires advocacy with third-
in a group, can include meeting 6. Increased partnerships with
party payers, both individually and
key staff members such as the colleagues in obstetrics and
through pediatric councils. Both the
practice manager, taking a short gynecology, who are now
recommendations of Bright Futures:
tour of the office, and receiving routinely screening mothers
Guidelines for Health Supervision of
other administrative information for perinatal depression, are
Infants, Children, and Adolescents,
and handouts. This type of visit encouraged. Whenever risk
Fourth Edition‍3 and this clinical
may be appropriate for parents factors are identified, obstetric
report can provide further support
before deciding on scheduling a and gynecologic colleagues can
for advocacy. Pediatric providers
full prenatal visit. Other models be encouraged to refer expectant
may seek advice from AAP coding
include group visits at the maternity parents for prenatal pediatric
resources and may review acceptable
hospital as part of a prenatal class or visits so that postpartum family
codes with their health plans.
at community events for expectant care is optimized.
parents.
7. A comprehensive review of this
The Basic Contact or Telephone Call RECOMMENDATIONS topic with suggested questions and
specific suggestions for expectant
The initial prenatal contact often 1. A prenatal visit is an important parents can be found in the Bright
is an expectant parent’s call to first step to help expectant Futures: Guidelines for Health
the pediatrician’s office. The staff families (especially first-time Supervision of Infants, Children, and
member can offer a brief description parents) establish their child’s Adolescents, Fourth Edition.‍3
of the practice, basic information medical home. The visit is a
including a source of referral, 8. Parents can find resources of
unique opportunity to address
expected delivery date, and type of value during the prenatal period
the relationship between the
insurance and can be invited to make at www.​healthychildren.​org.‍​‍4
family and practice and for
an appointment for a full prenatal the bidirectional sharing of
visit. An office information handout information between the parents EXAMPLES OF QUESTIONS TO USE IN
may be sent to the expectant parents, and pediatric provider. THE PRENATAL VISIT‍66
if requested.
1. What kinds of previous
2. Pediatric practices can effectively
No Prenatal Contact experience with infants have you
incorporate prenatal visits into
had?
If no prenatal contact has been made, their routine. Services can be
flexible and designed to meet 2. Are you working? Are you
the objectives and discussion of the
the needs of expectant parents. planning to return to work after
prenatal visit can be presented to
A full prenatal visit is preferred, delivery?
the parents in the newborn visit
or first postnatal visit. Because of if feasible. 3. How are the siblings adjusting to
other priorities, the parents may the pregnancy?
3. Payment for full prenatal visits
not absorb some of this discussion; 4. Have you attended prenatal
is supported by the evidence in
therefore, a handout containing classes, and have they been
Bright Futures and this report.
pertinent information may be used helpful?
State chapters of the AAP (as
at this type of visit. At the infant’s
through pediatric councils) and 5. What kind of relationship did
first office visit, parents should be
pediatric practices can advocate you have with your parents
encouraged to have an additional
to payers the short-term and long- when you were growing up?
family member accompany them to
term benefits of prenatal visits on
care for the infant while the parents 6. Are you planning to rear your
the health outcomes of infants and
and pediatrician confer. infant in a manner similar to
their parents.
or different from the way your
Payment 4. Pediatricians can share their parents reared you?
Pediatricians or office staff can established practices on prenatal 7. What expectations do you have
discuss with parents whether visits with local obstetricians, about this infant?

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