Our Care
Notebook
A few gifts and tools to help you enjoy and
get the most out of this time in your life.
Logo of sponsoring
organization here
Logo of sponsoring
organization here
On this page we placed a letter from our Neonatal Medical Follow Up
Clinic staff. It discussed the purpose of the care notebook, instructions on
how to personalize and use the care notebook, and who to contact with
any questions, or suggested changes.
Note: The photos we used throughout this Care Notebook template are
photos from the web. In our own Care Notebook, we chose to use actual
children of the mothers in our program. We wanted to include photos of
real children and babies to show moms entering the program how
beautiful and healthy their babies would be. We encourage you to use
actual photos, as we feel they can help to dispel the misconception that
babies born to addicted moms or moms on methadone are not as healthy
or “normal” as other babies. Within Vermont, please contact ICON for
photos of babies to use. Outside of Vermont, please feel free to use these
web (generic) photos, or your own.
Logo of sponsoring
organization here
Logo of sponsoring
organization here
Logo of sponsoring
organization here
~ Dedication ~
To the families who are living the
experience and are striving to improve their
lives and the health of their children
You’re not alone…
Stories from mothers who have
shared the struggle
The pages in this section were filled with personal accounts, written by mothers who have
undergone treatment for their addictions during their pregnancies. Their accounts were real,
and unedited to preserve their authenticity. They were written with sincerity in the vernacular
of this subculture, about how their lives were prior to their pregnancies, their
personal treatment experience, labor and delivery, meeting their child, life as new mom, and
the changes they have made in their lives. These were stories of pain, frustration, fear and
ultimately, hope.
Here is one woman’s account of her struggle. We hope this is a beginning for you to continue
with other stories of recovery.
The overwhelming pain and anguish I feel when I think about my life six years ago
can be unbearable at times. I hated the person I was. I hated the things I did. I hated
myself and my life and the way I hurt myself and my loved ones. Sometimes when
I talk about my life six years ago, I feel like I’m talking about someone else; that
I’m looking at someone else’s life. But the truth is, it wasn’t someone else doing
those things—it was me. I was the one who was addicted to opiates. I was the one
who became pregnant and couldn’t stop. I was the one who stuck needles in my
arm while I had a baby growing in my belly. Truth be told: it was all me.
The pain, anguish, and devastation I felt when I was pregnant and using can never
be truly expressed in words. I always said I would never become addicted to drugs;
I did. When I was addicted, I always said that if I became pregnant I would stop
using immediately; I couldn’t. The truth is, if you are an opiate addict and become
pregnant, simply stopping is not an option. I thought I was weak, immoral, and the
lowest, most pathetic, disgusting, horrible, nastiest scum of humanity because I
couldn’t stop using when I became pregnant. Don’t get me wrong, I tried to stop; I
really, really tried with every ounce of my being to not use.
When I was three months pregnant, a friend of mine who was also a pregnant
addict, tried to detox herself. She went into labor at six months gestation, and gave
birth to her baby girl. Her daughter lived for an hour and then died. It was not the
actual using that hurt the baby, it was the detox. Because of what happened to her,
I was terrified to stop using because I didn’t want my baby to die. I didn’t want to
continue using, but I had no clue what to do or where to go for help. Six years ago,
the help and programs that are set up now were not available. All I thought was
that DCF was going to take my baby. I saw them as vultures, circling overhead and
just waiting for me to admit my problem so that they could swoop down and take
my baby away from me.
I kept searching until I did find the help I needed. I got myself into this situation
and I was going to get myself out. When I was seven months pregnant; I finally
found someone to help me after my long search. I was admitted into the hospital
and stabilized on methadone. I was afraid to put myself and my baby on another
substance, but I also knew I needed help beyond what I had already tried.
While I was at the hospital, I learned a lot about being a pregnant addict. I learned
that I wasn’t the first person who had used drugs while pregnant. I learned that
methadone had been extensively studied and used successfully for over thirty years
to treat pregnant addicts and addiction in general.
I am an addict, and addiction is a disease which should be treated as any other
illness. Some of the medical staff treated me as a person who was suffering from a
medical problem, with the respect and dignity that I deserved. There are two
people I still remember from my hospital stays. One nurse and I became very close
during one of my stabilizations after my son was born. She came into my room late
at night, sat at the foot of my bed, and just talked to me. She genuinely cared and
was making every effort possible to let me know that she was there not to judge
me, but to simply listen to me and my story. Another nurse that I remember vividly
was not so kind and caring. My son had to be admitted to the NICU to be stabilized
on methadone because he was showing signs of withdrawal. This nurse let me
know directly that I was a horrible person and did not deserve to be a mother to my
son. Unfortunately, most health care providers back then shared the same
animosity towards pregnant addicts.
Fast forward six years later and I honestly feel that the overall view of addiction in
the healthcare field has improved. Don’t get me wrong, I know there are still many
who still see us as degenerate, no-good, scum of the earth, but on the whole I truly
do believe that a lot of opinions have changed. The reason for that change is
education. I have had the honor and privilege of being a part of an amazing group
of women, some in the healthcare field, that are pioneering the issue of educating
the healthcare field about the disease of addiction, and more specifically,
pregnancy and addiction. Our groups called VCHIP/ICON truly feel that if people
are educated about addiction they’ll acknowledge that it is a medical disease and
should be treated as such. Most addicts are good, decent, hard-working people that
are intelligent, artistic, musically inclined, that come from all walks of life. Addicts
should be treated with respect and dignity, just as if they had any other medical
problem. When I am speaking at one of our many seminars, I truly feel as though I
am reaching people, and helping to enlighten people about the disease of addiction.
I always use an analogy that has helped me come to terms with my own feelings
about addiction, pregnancy and methadone: An addict using methadone can be
compared to a diabetic who uses insulin. The diabetic takes their insulin and lives a
happy, healthy life. I, as an addict, never chose to be an addict, but I take my daily
dose of methadone, and live a happy, healthy life.
Over the past six years, my life has changed dramatically. Two years ago, I was
blessed with my second child, a beautiful baby girl. My daughter did not need
pharmacological treatment with methadone like my son did, but if she had; I know
that it would have been alright. My son is an extremely intelligent, bright, happy,
beautiful, and well-rounded normal little boy. I now have two points of reference:
using, getting pregnant, and getting on methadone; and the second which is being
on methadone and then becoming pregnant. I know that many opinions about
addiction in the healthcare field have changed over the past few years partially in
part of how I was treated in the hospital when my daughter was born compared to
my experience of my son’s birth. All of the providers I came in contact with
treated me with respect and dignity that I now know that I deserved.
My life has come a long way in the last six years. My partner and I have been
together for almost nine years. He and I did use together and we got clean together.
Many addiction specialists claim that couples who use together cannot get clean
together, but we prove that statement wrong every day. We have a wonderful
relationship and a wonderful life with our two beautiful children. He has a great
job, and I have been working on my college degree for the last five years. I am
happy to say that I will be walking at the graduation ceremony at Champlain
College in May 2009 for my Bachelor’s Degree. After that, I am planning to
continue my education by pursuing my Master’s Degree. I’ve done very well in
college—I make the Dean’s List every semester and my GPA is a 3.78 out of 4.0. I
have been working with VCHIP/ICON (Improving Care of the Opiate exposed
Newborn) for the past five years with the goal of educating the healthcare
community about the disease of addiction with the hopes that every addict—
pregnant or not—will be treated with respect, and will be viewed as the good
person they are.
I am still on my maintenance program, and many people ask me when I will get off
of it. I don’t plan on staying on it for the rest of my life, but as for now, I’m fine
with staying on it for today. Methadone does three main functions: it stops physical
withdrawal symptoms, it blocks the euphoric effects of other opiates, and most
importantly to me, it blocks cravings. I could always deal with the physical
withdrawal; it was the mental part that I could not deal with. It is the days, weeks,
and months after the 3-5 day physical withdrawal that the MMT is made for. Day
after day I had the addict voice in my head telling me to use. With methadone, I
don’t have cravings and I can live a normal, healthy life. I did all of the work to get
myself to where I am today, but I would not be where I am if I was not on MMT.
My son saved my life. I always tell him that he was the one who saved mommy
and daddy’s lives and made us a family, and then our daughter came along and
completed our family. It’s hard to be a college student and a mom, but I get out of
bed every morning and work hard for my children. I want them to have a
wonderful life and I want to give them everything that a child should have:
constant love and affection, bed-time stories, piano lessons, soccer camps, ballet,
and so on. But most importantly, their mommy and daddy need to stay clean
addicts. We will always be addicts, but I hope and pray that we will always be
addicts in recovery. Because of the genetic predisposition to addiction, I will
educate my children about the disease. I feel that education is key – it gives people
power to make informed decisions. Having my children equipped with knowledge
won’t necessarily guarantee that they’ll never try a drink or a drug, but hopefully it
will arm them with the education to make the right decision.
I have an amazing life and an amazing family. When I was using, I never thought
that happiness would ever be possible for me. But the truth is that as long as I stay
sober, I will continue to have my amazing life of happiness. Any addict will be
happy and have a better life in recovery. I know that recovery isn’t easy. Every day
is a work in progress, but my worst day in recovery is a million times better than
my best day as a using addict. I will do everything in my power to never go back to
my old life. I’ve worked too hard and I have too much to lose. Not only the
physical stuff like my nice home and nice cars, my beautiful son and daughter and
the respect and trust of my family and friends, but also my self-respect and dignity.
My life is a complete 180 degree turn from what it was six years ago. I devote my
life now to bettering myself for my children and also trying to better the lives of
other addicts by helping to educate the community.
I am not a rare case—anyone can have the same successful outcome that I have. As
long as you become clean from drugs—the sky’s the limit. Anything you want or
desire, all of your hopes and dreams are obtainable. You can do anything you
dream in recovery. All it takes is hard work, motivation, and a goal. If I can do it
anyone can!
You may choose to put this note to mothers
in your notebooks, as we did in ours:
This Care Notebook is being updated
frequently. If you would like to share your
story and/or pictures, please let us know so
that we can include them.
Personal
Information
Medical Information
Personal/Child
Name: _________________________________________ Birth date: _______________
Address:
__________________________________
__________________________________
City:
__________________________________
Telephone:
__________________________________
Child’s Name: __________________________________
Zip:
__________________
Nickname: ______________
Date of Birth: __________________________________
Social Security Number: __________________________
Blood Type: __________________________________
Allergies:
__________________________________
Parents/Primary Caregiver
Name
Address/City/Zip
Telephone
Day:
Evening:
Day:
Evening:
Day:
Evening:
Relationship
Insurance Information
Primary Insurance: ______________________________
Telephone: ____________________
ID #: _________________________
Group #: ______________________
Secondary Insurance: ______________________________
Telephone: ____________________
ID #: _________________________
Group #: ______________________
Medical/Surgical History
Date
Diagnosis/Condition
Procedure
Doctor
My Child’s Family/Sibling Information
Name
Birth date
Family History of Difficulties Similar to my Child’s
Problem
Name
Relation
Family History of Other Conditions
Problem
Allergies
Behavioral
Cardio Vascular
Emotional
Gastro-Intestinal
Hearing Loss
Learning
Mental
Retardation
Neurological
Respiratory
Seizures
Speech and
Language
Urological
Visual
Other
Name
Relation
Notes:
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Notes:
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Resources
&
Contacts
The following pages list contact names and
numbers of Vermont resources. Feel free to
insert your own contact information for
useful services such as clinics,
transportation services, home health
agencies, pharmacies, emergency numbers,
and financial services.
Neonatal Medical Follow up
Clinic
Vermont Children’s Hospital
Fletcher Allen Health Care
Anne Johnston, MD
Susan White, FNP
Jerilyn Metayer, RN
Allison Miller, MA
(802) 847-9809
1-800-358-1144 (ask for extension 79809)
Comprehensive Obstetrical
and Gynecological Service
(COGS) Clinic
Fletcher Allen Health Care
Marjorie Meyer, MD
Christine Barup, MA
Roberta Soll, MSW (voice mail: 847-5474)
(802) 847-1400
1-800-358-1144 (ask for extension 71400)
~Vermont Nursing Association~
Home Health Agency Directory
Addison County Home Health &
Hospice
Bennington Area Home Health
Agency
Phone number:
Fax number:
Phone number:
Fax number:
802-388-7259
802-388-6126
802-442-5502
802-442-4919
Caledonia Home Health Care &
Hospice
Central Vermont Home Health &
Hospice
Phone number:
Fax number:
Phone number:
Fax number:
802-748-8116
802-748-4628
Dorset Nursing Association
Phone number:
Fax number:
802-362-1200
802-867-0115
802-223-1978
802-223-6835
Franklin County Home Health
Agency
Phone number:
Fax number:
802-527-7531
802-527-7533
Lamoille Home Health & Hospice
Phone number:
Fax number:
802-888-4651
802-888-7822
Manchester Health Services
Phone number:
Fax number:
802-362-2126
802-362-4884
Orleans, Essex VNA & Hospice
Phone number:
Fax number:
802-334-5213
802-334-8822
Visiting Nurse Association and
Hospice of Vermont and New
Hampshire
Phone number:
Fax number:
802-295-2604
802-295-3163
Rutland Area Visiting Nurse
Association & Hospice
Phone number:
Fax number:
802-775-0568
802-775-2304
Visiting Nurse Association of
Chittenden and Grand Isle
Counties
Phone number:
Fax number:
802-658-1900
802-860-4464
Emergency Contacts
Neighbor or Babysitter
Name: __________________________
Phone: __________________________
Family Member
Name: __________________________
Phone: __________________________
Work
Name: __________________________
Phone: __________________________
School
Name: __________________________
Phone: __________________________
Counselors
Provider:
Clinic:
Address:
____________________
____________________
____________________
____________________
Specialty:
_____________________
Phone:
_____________________
Fax:
_____________________
Hours: _________ Email: ___________
Provider:
Clinic:
Address:
____________________
____________________
____________________
____________________
Specialty:
_____________________
Phone:
_____________________
Fax:
_____________________
Hours: _________ Email: ___________
Substance Abuse
Provider:
Clinic:
Address:
____________________
____________________
____________________
____________________
Specialty:
_____________________
Phone:
_____________________
Fax:
_____________________
Hours: _________ Email: ___________
Provider:
Clinic:
Address:
____________________
____________________
____________________
____________________
Specialty:
_____________________
Phone:
_____________________
Fax:
_____________________
Hours: _________ Email: ___________
(Note: You may want to include 24-hour pharmacies on this page.)
Fletcher Allen Outpatient Pharmacy
Location:
University Health Care Campus
Address:
One South Prospect Street
Burlington, VT 05401
Phone Number:
802-847-3784
Hours:
M-F 8:30 am – 5:30 pm; Sat 9:00 am – 1:00 pm;
Closed Sunday and major holidays

Name:
Medical Center Campus
Address:
ACC-3rd Floor, Main Lobby
Burlington, VT 05401
Phone Number:
802-847-2821
Hours:
M-F 7:30 am – 6:30 pm, Sat and Sun 9:00 am – 2:00 pm
ECONOMIC SERVICES
(formerly PATH)
We listed financial services here by county:
Barre District Office
Bennington District Office
Phone Number:
Phone Number:
Fax Number:
802-479-1041
800-499-0113
802-287-0589
Fax Number:
802-442-8541
800-775-0527
802-447-6972
Brattleboro District Office
Burlington District Office
Phone Number:
Phone Number:
Fax Number:
802-257-2820
800-775-0515
802-257-6394
Fax Number:
802-863-7365
800-775-0506
802-863-7686
Hartford District Office
Middlebury District Office
Phone Number:
Phone Number:
Fax Number:
802-295-8855
800-775-0507
802-295-4148
Fax Number:
802-388-3146
800-244-2035
802-388-4637
Morrisville District Office
Phone Number:
Fax Number:
802-888-4291
800-775-0525
802-888-1345
Newport District Office
Phone Number:
Fax Number:
802-334-6504
800-775-0526
802-334-3386
Rutland District Office
Phone Number:
Fax Number:
802-786-5800
800-775-0516
802-786-5882
Springfield District Office
Phone Number:
Fax Number:
802-885-8856
800-589-5775
802-885-8879
St. Albans District Office
St. Johnsbury District Office
Phone Number:
Phone Number:
Fax Number:
802-524-7900
800-660-4513
802-527-5403
Fax Number:
802-748-5193
800-775-0514
802-751-3272
Transportation
Here we listed examples of companies that offer discount or free transportation in the
state.
Name: CCTA
Address:
15 Industrial Parkway
Burlington, VT 05401
Phone Number:
Name:
Address:
802-864-0211
Benway’s Taxi
666 Riverside Avenue
Burlington, VT 05401
Phone Number:
802-862-1010
~ Other Helpful Resources ~
The following organizations have been helpful to mothers in this program:
What do I do if I need help and don’t know what resources to contact?
 Vermont 211: Provides confidential help for everyday needs and difficult times. Call
specialists provide the human touch; help solve problems, and link individuals and
families with local, statewide, regional and nationwide resources.
Telephone: 211 (a local call anywhere in VT) & 1-866-652-4636
Website: www.vermont211.org
What if I need help providing food for myself or my family?
 WIC: Provides nutritious food to eligible women, infants & children
Telephone: 1-800-464-4343, ext. 7333 & 802-863-7333
Website: http://healthvermont.gov/family/wic/wic_vt.aspx
Where can I look for housing information?
 Housing and Homelessness Resources: Vermont Commission on Women
Website: www.women.state.vt.us/hh.html (a great list of housing help)
What if my baby needs to stay at Fletcher Allen and I need a place to stay in
Burlington?
 Ronald McDonald House: Housing for families while their child is hospitalized at
Fletcher Allen. Cost is by donation; no set charge.
Telephone: 802-862-4943
Website: www.rmh-vermont.org
Where can I go to get help with my pregnancy or parenting?
Where can I live before & after I have my baby and also receive treatment?
 Lund Family Center: Provides many services for parents including a Parent Child
Center and a residential treatment program for pregnant and parenting young women and
their children.
Telephone: 1-800-639-1741 & 802-864-7467
Website: www.lundfamilycenter.org
Is there a support group for moms with substance abuse issues?
 Rocking Horse Circle of Support: For women - especially moms with young children to talk about taking care of themselves and the impact substance abuse has on their
children/families. Childcare & transportation assistance provided.
Telephone: Beth Holden, 802-863-1326
Is there support for Grandparents or other relatives who are caring for
children?
 Grandparents as Parents Support Group: Offers weekly support and discussion
groups for grandparents and other relative caregivers, led by trained professionals. They
also offer a concurrent supervised playgroup for children.
Contact: Milton Family Community Center, Charlotte Parot 802-893-1457
What if I am concerned about my infant’s development?
 Family Infant Toddler Program: A family-centered program with early intervention
services for infants and toddlers who have a delay in their development or a health
condition which may lead to a delay in development.
Contact: Kathy Boulanger, (802) 241-3602
Who can I call if I am being physically or verbally abused?
 Domestic Violence Hotline: 1-800-ABUSE95 (1-800-228-7395)
Who can I call if I am concerned that my child may be at risk for abuse?
Who can I call if I am frustrated or upset and afraid that I may shake or hurt my
child?
 Prevent Child Abuse Vermont: 1-800-CHILDREN
Who can I call if I am feeling sad after my pregnancy…like I am not enjoying
my new baby and things I once enjoyed… worthless and guilty… rejected… if I
am having thoughts of death or suicide?
 Postpartum Depression Support: The #1 complication of childbirth is depression; It
affects one in eight new moms. It is treatable.
Telephone: 1-800-944-4PPD
Website: www.postpartum.net
Who can I contact to find out about baby massage?
 Visiting Nurse Association:
Before Birth
Signs and Symptoms of Preterm Labor and What to Do
What Is Preterm Labor?
Preterm or premature labor happens when you go into labor before 37 completed weeks of
pregnancy. This is too early for your baby to be born. Babies born too soon can have lifelong or
life-threatening health problems.
Can Preterm Labor Be Stopped?
Many women are given drugs to try to delay or stop preterm labor. In some cases, birth can be
delayed long enough to transport Mom to a hospital with a neonatal intensive care unit (NICU).
Women may also be given medications that can improve the baby's health, even if the baby
comes early.
Warning Signs
Here are the warning signs:






Contractions (your abdomen tightens like a fist) every 10 minutes or more often
Change in vaginal discharge (leaking fluid or bleeding from your vagina)
Pelvic pressure—the feeling that your baby is pushing down
Low, dull backache
Cramps that feel like your period
Abdominal cramps with or without diarrhea
What Should I Do If I Think I'm Having Preterm Labor?
Call your health care provider (nurse, doctor or midwife) or go to the hospital right away if you
think you're having preterm labor, or if you have any of the warning signs. Call even if you have
only one sign.
Your health care provider may tell you to:



Come into the office or go to the hospital for a checkup.
Stop what you're doing. Rest on your left side for one hour.
Drink 2-3 glasses of water or juice (not coffee or soda).
If the symptoms get worse or do not go away after one hour, call your provider again or go to the
hospital. If the symptoms get better, relax for the rest of the day.
From www.marchofdimes.com 5/15/07
Medication-assisted Treatment during Pregnancy

If you become pregnant and are using opiates (such as heroin, or prescription painkillers
like OxyContin, Percocet, Vicodin, etc.), methadone is a treatment option that can help
you and your baby have a stable and healthy pregnancy.

When you are using opiates regularly and are sick when you don’t use them, chemical
changes have happened in your brain that makes it almost impossible to stop without
help.

When a pregnant woman goes into withdrawal, the baby also experiences withdrawal.
Withdrawal for an unborn baby is so dangerous that the baby could die.

Methadone has been used for over 30 years to treat pregnant women with opiate
addiction during pregnancy.

Buprenorphine is a newer medicine that is now being studied as an alternative to
methadone; you and your doctor will decide which medicine is best for you.

Methadone and buprenorphine help you and your baby. These medicines stop withdrawal
and decrease your cravings to use.

Not all babies born to mothers on methadone or buprenorphine will need medicine for
withdrawal. About 50% of them will need medicine.

The amount of your dose has nothing to do with your newborn baby’s need for medicine.
You could be on a low dose (40 mg of methadone or 8 mg buprenorphine) and your baby
may need medicine, or you could be on a higher dose (140 mg of methadone or 24 mg of
buprenorphine) and your baby may not need medicine.

If your baby needs medicine for withdrawal it does not mean your baby is an addict.
Your baby needs the medicine for a short time to grow and be healthy.
Babies who need medicine for withdrawal are just as healthy, happy and smart as any
other baby.
Pain Relief During Labor and after Delivery
What will help me with the labor pain?
It is important to ask questions about pain relief when you are at your pre-natal visits.
Understanding what your choices are before you are in labor is very important for you and your
baby.
There are three methods widely available to provide relief of the labor pain:
1. The first and easiest method that will help you with the pain of labor is using the breathing
exercises that you will learn during your prenatal classes. Having one or two supportive
coaches can be very helpful too.
2. If breathing methods are not working well for you, IV narcotic medication can be used.
This is most often used only in the very early stages of labor. The side effects are feeling
sleepy and/or dizziness, although you may be more tolerant to the effects because of the
medication you are on for opiate dependence. These alone or in combination can take away
up to 30% of the pain and many women are able to relax enough to not need an epidural.
3. Epidurals and/or spinals are used when breathing methods are no longer helping you and
your labor is progressing. The spinal medication is injected through your back and goes
directly into the fluid surrounding the nerves- the relief is very fast. The epidural is a small
plastic tube (a lot like an IV) put into your back by an anesthesiologist. The pain
medication is given continuously, through this tube, as a drip using a pump until your baby
is born. It can take 20 minutes to feel the full effect of the epidural, which is why the
spinal is often used with the epidural. When you have an epidural, the amount of pain
relief can be adjusted as your labor progresses. If the pain starts to change and you get
more uncomfortable, there is a button attached to the pump that you may press to give
yourself more medication. The goal of pain relief with an epidural is to make you more
comfortable without being completely numb. This means that you will still feel the
pressure that goes along with contractions but should not have sharp pain. We do not take
all sensation away because it would make pushing the baby out more difficult.
When can I get medication for the labor pain?
The method and the type of medication your doctor and the anesthesiologist will recommend
may depend on the stage of your labor. In general, during early labor intravenous medication
may be used during later labor spinal or epidural analgesia is offered.
Will I get the same amount of pain medication that other mothers receive?
These methods of pain relief are offered to everyone in labor and delivery. You are entitled to
the pain relief method of your choice if there is no medical reason that it can not be done. The
use of methadone or buprenorphine does not affect our decision to give you an epidural; many
women need some adjustment to get the right level of medication to make them comfortable.
Will an epidural slow down my labor?
A common question is whether or not the epidural will slow the labor or make you more likely to
need a cesarean section. Epidurals have been shown to make labor longer by about 40 minutes
on average. However, if you are in a good labor pattern, it usually does not slow things down.
Epidurals do not increase your risk of cesarean section, although you do have a slightly higher
chance of needing oxytocin to help your labor progress.
What if I have to have a Cesarean Section?
If a C-section is planned and you have an epidural in place, the anesthesiologist gives more
medication through the epidural to make you completely numb. Surgery only starts when you
are numb. If you do not have an epidural in place, then a spinal anesthetic is used. With either
of these methods you are awake for the delivery of your baby and you can have a support person
in the operating room with you. If there is no time at all to do either of these things, then a
general anesthetic is given. It is quite rare to require general anesthesia for C-sections.
What are the risks of the pain medication for me and my baby?
When you are in labor, you should ask as many questions as you need to. It is very important to
the doctors and the nurses that you know what is happening. The risks that go along with an
epidural are: bleeding and infection (rare), nerve damage (rare), headache (rare) or it doesn’t
work well and may need to be re-done (20%). Some of the common side-effects of epidurals are
low blood pressure and itching.
Will any of these medications affect breastfeeding my baby?
None of the medications given routinely in labor will alter breastfeeding. Some women with
very long or complicated labors can have a slow start to breastfeeding, as do many first time
mothers. The nursing staff is very committed to breastfeeding and helping you breastfeed
successfully. Be prepared to be patient as your baby figures out the food system.
Will I be able to have pain medicine after the baby is born?
The amount and type of pain medication given after delivery will be determined by how much
pain you have, and whether you delivered vaginally or by C-section. Most of the time, Motrin
and Tylenol will take care of the pain from a vaginal delivery. More complicated deliveries and
C-sections may require stronger medication. No matter what, the nursing staff is committed to
excellent pain control. Pain medication is adjustable to individual needs. If you have pain,
please discuss this with your nurse who will help you develop a plan for optimal pain relief.
After Delivery
INSERT BABY PHOTO
Once your baby is born
 Most importantly, love and cuddle your baby!
 Hold your baby skin to skin.
 This is a special time to bond with your baby.
 Ask your nurse to help you limit the number of visitors – you and your
baby need lots of rest.
 Ask your nurse to call the Neonatal Medical Follow-Up Clinic @ 8479809 to let them know your baby has been born.
 Notify your health insurance about your baby’s birth or obtain a
Medicaid number for your baby as soon as possible. Financial Services
at Fletcher Allen can assist you with completing the necessary form.
 For additional information about the Dr. Dynasaur program, call (800)
250-8427.
 Review the Newborn Abstinence Syndrome (NAS) Scoring Instructions
and participate in the scoring with your nurse.
INSERT BABY
PHOTO
Neonatal Medical Follow-up Clinic
Children’s Specialty Center at Fletcher Allen Health Care
Dr. Anne M. Johnston, Director
Susan A. White, FNP
Jerilyn S. Metayer, RN, BSN-Nurse Clinician
A newborn baby’s withdrawal symptoms are not related to the mother’s dose.
In Vermont, about 30% of infants exposed to methadone or buprenorphine during
pregnancy will require medicine for withdrawal.
We encourage breastfeeding. There are only trace amounts of methadone or
buprenorphine in breast milk. If you are on buprenorphine, the package insert discourages
breastfeeding. However, medical experts have agreed that it is safe to breastfeed on
buprenorphine (subutex not suboxone). As always, it is important to tell your doctor
about other medications you are taking.
Your infant will need to remain in the hospital for at least 4 days to be observed for
symptoms of withdrawal. The nurses will use the Neonatal Abstinence Scoring (NAS)
form. It is important to be present and participate while the nurse is scoring your baby.
Your infant may have a urine and meconium (first bowel movement) sample obtained for
screening.
Your infant will be followed by the Neonatal Medical Follow-up Clinic for the first 12-18
months of life. Your infant will receive a full developmental screening around 8-10 months of
age.
Breastfeeding Your Baby
Can I breastfeed?
YES! Women being treated for opiate dependency/
addiction with methadone or buprenorphine CAN
breastfeed. In fact, they are encouraged to do so!
Why breastfeed?
Breastfeeding is the best birthday gift you can give your
new baby. For most newborns, breast milk is the only
food needed for the first six months of life. There are
many health benefits for both mother and child.
What are the health benefits for my baby?
Fewer colds, allergies, ear and other infections
Improved brain development
Reduced chance of developing obesity, diabetes, asthma and certain types of cancer
What are the health benefits for the mother?
A wonderful bond and closeness with your baby
Earlier return to pre-pregnancy weight
Less post partum bleeding
Decreased risk of certain types of cancer
Tips to Prepare for Breastfeeding Before your Baby is Born:
Make a commitment to breastfeed your child.
Use your Home Health Nurse as a breastfeeding resource.
Begin breastfeeding your baby as soon as possible after birth.
For more information:
Visit one of the following websites:
www.nlm.nih.gov/medlineplus/breastfeeding.html
www.aap.org/healthtopics/breastfeeding.cfm
www.breastfeedingbasics.com/
www.lalecheleague.org/
www.promom.org
Breastfeeding Issues Specific to the
Opiate Exposed Infant
Will my baby be harmed by methadone or buprenorphine that is passed through my
breast milk?
No, the amount of methadone or buprenorphine passed through breast milk is very small
and causes no harm to your baby.
Will it be hard to get my infant to breastfeed?
Occasionally, infants who experience withdrawal have a more difficult time establishing
breastfeeding. Our team is staffed with lactation experts who can offer tips to help you
and your baby through this difficult time.
In what situations should I NOT breastfeed my infant?
Mothers who are abusing drugs (“street drugs”) should not breastfeed.
Mothers infected with human immunodeficiency virus (HIV) should not
breastfeed.
Can I breastfeed if I am infected with hepatitis C virus?
YES! Mothers who are infected with hepatitis C virus may breastfeed. However, if your
nipples are cracked or bleeding you should use a breast pump to express breast milk from
that affected breast, and discard the milk until nipples have healed. If only one breast is
cracked and bleeding, you may still breastfeed from the other breast.
What if I have other questions?
Please ask! If you have any other questions or concerns regarding specific medications or
conditions as they relate to your ability to breastfeed your baby, we would be happy to
discuss them with you.
“My baby was born needing methadone
maintenance. Breastfeeding was one of the
most important decisions I made
regarding his health and treatment plan.”
BABY PHOTO HERE
Newborn Opiate Withdrawal: How you can help your baby
Control your baby’s environment

Reduce stimulation (quiet, low light, no loud TV!)

Limit the number of visitors

Keep your baby skin to skin (dads can help, too)
Learn your baby’s cues

Distress cues: yawning, sneezing, hiccups, tremors, color change, frowns

If you see the above signs, stop what you are doing; your baby may be overstimulated
When your baby is crying, try to calm him or her before your baby
becomes really upset

With baby swaddled, pacifier in mouth, curl him/her firmly against your body

Sway gently from side to side
NAS Scoring for withdrawal while in hospital

Call your baby’s nurse every 3-4 hours when your baby is starting to wake up

The scoring should be done in your room so that you and the nurse can do it together

You know your baby; your input is important

Remember, it can take 4 days or longer for signs of withdrawal to appear
MRN
Name
Neonatal Abstinence Syndrome Scoring Sheet
DOB
Addressograph
Birth Weight: __________ grams (x 90% = _________ grams)
Daily Weight: __________ grams
(Observations from past 3-4 hours)
Start new scoring sheet each calendar day
DATE:
SIGNS AND SYMPTOMS
Score
High pitched cry: inconsolable>15 sec.
OR intermittently for < 5 min.
High pitched cry: inconsolable>15 sec.
AND intermittently for  5 min.
Time
Time
Time
Time
Time
Time
Time
Time
2
3
Sleeps < 1 hour after feeding
Sleeps < 2 hours after feeding
Sleeps < 3 hours after feeding
3
2
1
Hyperactive Moro
Markedly hyperactive Moro
1
2
Mild tremors: disturbed
Moderate-severe tremors: disturbed
1
2
Mild tremors: undisturbed
Moderate-severe tremors: undisturbed
1
2
1–2
Increased muscle tone
Excoriation (indicate specific area):
1–2
Generalized seizure
8
Fever  37.2° C (99° F)
1
Frequent yawning ( 4 in an interval)
1
Sweating
1
Nasal stuffiness
1
Sneezing ( 4 in an interval)
1
Tachypnea (rate > 60/min)
2
Poor feeding
2
Vomiting (or regurgitation)
2
Loose stools
2
 90% of birth weight
2
Excessive irritability
1-3
Total Score
Initials of Scorer
Printed Name
Signature/Title
(Adapted from L Janssen, 2009)
Initials
Printed Name
Signature/Title
Initials
Neonatal Abstinence Syndrome Scoring and Treatment Guidelines
HOSPITALIZED INFANTS
1. Neonatal Abstinence Syndrome (NAS) Scoring
a. NAS score at 2 hours of age and every 3 to 4 hours thereafter;
continue scoring for the duration of hospitalization (minimum of
96 hours). You may need to wake the infant if necessary.
b. Initial treatment consists of providing a supportive environment
and non-pharmacological treatment (decrease sensory
stimulation, skin to skin, positioning, swaddling, pacifier)
c. Score infant before feeding.
d. NAS score < 9, continue NAS scoring
e. NAS score > 12, discuss with attending physician and consider
treatment
f. NAS score 9 – 12, repeat the score (after feeding), within the hour
i.
NAS score < 9, continue NAS scoring
ii. NAS score ≥ 9, discuss with attending physician and
consider treatment
2. Treatment
a. If infant has 2 consecutive scores (e.g. before and after feed) of ≥
9, consider treatment.
Continue to provide a supportive environment (decrease sensory
stimulation, positioning, swaddling, and pacifier)
(Adapted from L Janssen, 2009)
Neonatal Abstinence Syndrome (NAS)
Scoring Explanation Reference for the revised Finnegan Score
Assessment & Documentation
The infant is scored at 2 hours of age and every 3-4 hours prior to a feeding
The NAS score will be recorded for the 3-4 hour period immediately before the scoring
activity
Signs and symptoms are documented on the NAS form and totaled for a score
Sleeping
Use the longest single continuous time sleeping since last feeding
Sleeps 3 or more hours continuously (Score = 0)
Sleeps 2-3 hours after feeding (Score = 1)
Sleeps 1-2 hours after feeding (Score = 2)
Sleeps less than 1 hour after feeding (Score = 3)
When repeating a score within 1 hour after a feeding: use the same sleep score
obtained before the feeding.
MORO Reflex
Cup infant’s head in your hand and raise his/her head about 2-3 inches above the
mattress, then drop your hand while holding the infant.
The infant should be quieted if irritability or crying is present. This will insure that the
jitteriness, if present, is due to withdrawal rather than agitation.
Hyperactive Moro: arms stay up 3-4 sec with our without tremors (Score = 1)
Markedly Hyperactive Moro: arms stay up > 4 sec with or without tremors (Score = 2)
Tremors
Tremors = jitteriness
Involuntary movements that are rhythmical
If the infant is asleep, it is normal to have a few jerking movements of the extremities
Mild tremors: hands or feet only, last up to 3 seconds (Score = 1)
Moderate-severe tremors: arms or legs, last more than 3 seconds (Score = 2)
Undisturbed: tremors that occur in the absence of stimulation
Increased Muscle Tone
While the infant is lying supine, extend and release the infant's arms and legs to observe for
recoil
Infant supine, grasp arms by wrists and gently lift infant, looking for head lag
Difficult to straighten arms but is possible, but head lag is present (Score = 1)
No head lag noted or arms or legs won’t straighten (Score = 2)
Excoriation
Red or broken skin from excessive rubbing (eg: extremities or chin against linens)
Skin red but intact or is healing and no longer broken (Score = 1)
Skin breakdown present (Score = 2)
Sweating
Wetness felt on the infant’s forehead, upper lip (Score = 1)
Sweating on the back of the neck may be from overheating such as swaddling
Nasal Stuffiness
Any nasal noise when breathing (Score=1)
Runny nose may or may not be present
Sneezing
Infant sneezes 4 or more times in the scoring interval of 3 – 4 hours (Score = 1)
Tachypnea
The infant must be quieted if crying first; count respirations for full minute
Respiratory rate > 60/min (Score = 2)
Nasal Flaring
Outward spreading of the nostrils during breathing (Score = 1)
Poor Feeding
Poor feeding is defined as any 1 of the following (Score = 2)
Infant demonstrates excessive sucking prior to a feeding yet sucks infrequently
while feeding and takes a small amount of formula
Demonstrates an uncoordinated sucking reflex (difficulty sucking and swallowing)
Infant continuously gulps the formula while eating and stops frequently to breathe
Inability to close mouth around bottle
Feeding takes more than 20 minutes
Regurgitation/Vomiting
Frequent regurgitation (vomits whole feeding or vomits 2 or more times during feed)
not associated with burping (Score = 2)
Loose Stools
Infant has a stool that is at least half liquid (Score = 2)
When repeating a score within 1 hour after a feeding: use the same stool score
obtained before the feeding.
Current Weight  90% of Birth Weight
W eight is  90% of birth weight (Score = 2)
Continue to score until infant gains weight and is > 90% of birth weight
Excessive Irritability
Distinct from, but may occur in conjunction with crying
Marked by frequent grimacing, excessive sensitivity to sound and light
Infant becomes fussy or irritable with light, touch or handling despite attempt to
console
Consoling calms infant in 5 minutes or less (Score = 1)
Consoling calms infant in 6-15 minutes (Score = 2)
Consoling takes more than 15 minutes or no amount of consoling calms child (Score = 3)
(Adapted from L Janssen, 2009)
3/10/2005
Example:
Date
15 min Right side and left
10:30
12:00
10 min Left side and right
8:00
Breastfeed/Formula Feed
Time Ozs. or length of feeding
fussy, crying until 3pm
asleep by 11:15
asleep by 9:30
Behavior/Activities






Wet/Soiled Diapers
Urine
Soiled
Medicine
Date
Breastfeed/Formula Feed
Time Ozs. or length of feeding
Behavior/Activities






Wet/Soiled Diapers
Urine
Soiled
Medicine
Date
Breastfeed/Formula Feed
Time Ozs. or length of feeding
Behavior/Activities






Wet/Soiled Diapers
Urine
Soiled
Medicine
Date
Breastfeed/Formula Feed
Time Ozs. or length of feeding
Behavior/Activities






Wet/Soiled Diapers
Urine
Soiled
Medicine
Date
Breastfeed/Formula Feed
Time Ozs. or length of feeding
Behavior/Activities






Wet/Soiled Diapers
Urine
Soiled
Medicine
Frequently Used Medical Words
Antibiotics – medications used to treat bacterial infection or used when one is strongly suspected.
Apgar score – a score taken at birth to measure the condition of your baby including heat rate,
respiratory effort, muscle tone, reflexes, and color.
Apnea – not taking a breath for longer than 20 seconds.
Bilirubin – a product of the breakdown of red blood cells. It is filtered out of the blood by the
liver. In preemies the liver is more immature than in full term infants so it doesn’t filter as well
as it should. (See jaundice and bili lights.)
Blood Pressure (BP) – a measure of the force of blood moving through blood vessels. BP is a
vital sign that lets us know many things such as, the need for more fluid or less and it the baby is
in pain. It also lets us know how well the heart is pumping.
Bradycardia (brady) – a decrease in the regular heart rate.
Cardio-respiratory monitor – this monitor gives us waveforms and numerical readings of the
baby’s heart rate and respirations. Three adhesive electrodes (leads) stick to the baby’s skin. An
alarm rings if the readings are not within normal limits. False alarms are common and usually
happen when a baby wiggles or a lead becomes loose.
CBC (complete blood count) – a blood test to determine if an infection is present and/or if the
baby is anemic .
CC’s – metric measure of liquids (30cc = 1 ounce and 5cc= 1 teaspoon)
CPAP (continuous positive airway pressure) – a continuous flow of air/oxygen into the lungs
through little prongs in the baby’s nose to help keep the smaller airways, distant airways open. In
premature babies these airways can collapse easily.
Cyanosis – dusky, bluish color of the skin, lips, and/or nailbeds as a result of not having enough
oxygen in the blood.
Desats (desaturation) – when the oxygen saturation level goes below 85 on the SAT monitor
(see Sat monitor).
“Do up” – refers to the time when your baby’s nurse has scheduled care to include vital signs,
diaper change, and feeding, etc. In the NICU it is important to group nursing care/procedures to
allow the baby to have uninterrupted periods of rest.
ET tube (endotracheal tube) – a soft plastic tube placed into the baby’s mouth (or sometimes
nose) and down the windpipe (trachea) to give oxygen and to help the baby breathe. Placing the
tube is called intubation and removing it is called extubation. The ET tube is connected to the
ventilator.
Gavage feeding – when babies aren’t able to nipple or breast feed yet. A soft plastic tube can be
placed down the baby’s nose or mouth and down to the stomach. Formula or breast milk can be
slowly dripped through the tube.
Gestational age – the number of weeks you were pregnant with your baby.
Glucose – a type of sugar in the blood.
Heelstick – the baby’s foot is warmed. Then the baby’s heel (or toe) is pricked to draw blood
work.
Hypoglycemia – low blood sugar (see Glucose).
Hypoxia – a decreased oxygen level in blood.
Intubation – (see ET tube).
Isolette (Incubator) – a bed with a heater and a plastic cover to see the baby through.
IV (intravenous) – a small catheter placed a short distance into the baby’s vein to provide fluids
and medications. An IV may be placed in a baby’s hand, foot or scalp vein.
Jaundice – the yellow color seen in the skin due to the build up of bilirubin (a breakdown
product of red blood cells) (see bilirubin & photo therapy).
LGA (large for gestational age) – babies who are larger than usual for the amount of time the
baby has been in the womb.
Lumbar Puncture (LP) – placing a small needle into the lower part of the back to withdraw
spinal fluid for testing.
Meconium – the first, thick black stools passed by the baby.
Milia – a normal condition in which the glands on the baby’s nose and face show up as small
white dots (in babies who are close to term). It goes away on its own.
Murmur – a sound of blood going through the heart a different way than usual. Murmurs are
common in infants and children.
NAS (Neonatal Abstinence Syndrome) – symptoms a baby may show when withdrawing from
opiates.
Nasal cannula (NC) – short plastic prongs placed in the nose to deliver a small amount of
oxygen to the baby.
Neonatal – the period of time from birth to 28 days.
Newborn screen – a routine blood test done on all babies. This test checks for rare but serious
disorders. The results are sent to your baby’s doctor.
NICU – Neonatal Intensive Care Unit.
NPO – Nothing by mouth (no oral feedings).
NTS - Neonatal Transition Suite Open bed – a bed with a heater over the top to keep the baby warm without clothes or covers.
This bed makes it easier to observe the baby and do procedures.
Oxygen (02) – an odorless, colorless gas needed by body cells. Up to 100% oxygen can be given.
Room air is 21% oxygen.
Phototherapy (bili lights) – a special ultraviolet light used in the treatment of some types of
jaundice. Blinders are placed on the baby to protect the eyes.
Pneumonia – inflammation or infection of the lungs.
Pram – the way we gradually decrease the isolette temperature and increase the clothes and
blankets on a baby. If the baby’s temperature remains stable then he is moved into a little open
crib (also referred to as a pram).
Premature – a baby born before 37 weeks gestation.
Pulse oximeter – (see SAT monitor).
Respirator – (see ventilator).
Respiratory Distress Syndrome (RDS) – the most common serious problem of premature
babies. The air sacs in the lungs collapse (instead of opening up and stretching like little
balloons), making it difficult to get enough air into the lungs.
Room air – the air we all breathe normally (21% oxygen).
Sat Monitor – a bedside monitor that shows the amount of oxygen in the blood. The lead (which
looks like a Bandaid) is attached to the baby’s foot or arm. This monitor may alarm if the baby
moves or wiggles.
Sepsis – an infection that occurs in the blood. If there is any question of an infection, tests are
done and the baby is put on antibiotics until the test results come back.
Sepsis workup – a series of lab tests required to rule out an infection (see sepsis)
SGA (small for gestational age) – a baby smaller than the usual size for the amount of time
spent in the womb.
Surfactant – a substance that is put down the ET tube within the first few hours after a premature
infant is born. It helps keep the small air sacs in the lungs open.
Tachycardia – a heart rate that is faster than the average range.
Tachypnea – a breathing rate that is faster than the average range.
TPN (total parenteral nutrition) – a yellow IV solution that contains nutrients to help a baby
grow. TPN is used while a baby is unable to take all his food by mouth.
Trachea – the section of the airway just before branching to each lung.
UAC (umbilical artery catheter) a clear, soft catheter placed into one of the arteries in the
umbilical cord and used to give fluids or draw out blood for tests, and to monitor blood pressure .
UVC (umbilical venous catheter) – a clear, soft catheter placed into one of the vessels in the
umbilical cord and used to give fluids or draw out blood for tests.
Ultra sound – a procedure that uses sound waves (from a machine) to produce a picture of an
internal organ (brain, heart, kidney, etc.).
Umbilicus – belly button.
Veins – blood vessels that carry blood back to the heart.
Ventilator (or respirator) – a machine used to help a baby breathe. The machine is connected to
the baby by an ET tube (see ET tube).
Vernix – the thick white substance that protects the baby’s skin in the womb, and can be seen
especially in creases after the baby is born.
Vital sign – the combination of temperature, heart rate, blood pressure and breathing rate
recorded on a baby’s bedside chart.
Vitamin K – a vitamin shot given once, shortly after birth, to help the blood to clot normally.
X-ray – a picture taken at the bedside necessary to check ET tube and IV line placement as well
as lung, heart and intestinal changes.
Tips for a Good Visit
Information about my child you will want to know
Child’s Name: _______________________
Nickname: _________________________
My child is verbal
□ yes
□ no
My child likes it when you:
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
My child doesn’t like it when you:
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
Things that will help if my child doesn’t want to do something:
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
What will my baby be doing? What fun games can we play?
1-2 MONTHS
 Raises head & chest when lying on
tummy
 Tummy-time with bright/shiny objects,
such as a spoon, in front of the baby
 Fixes on objects with eyes
 Wave colorful bandana above baby’s head
 Smiles/Coos
 Rock baby while talking/singing/reading
book
3 – 4 MONTHS
 Reaches
 Blow bubbles; show baby how to reach
out and pop them; talk with them about
what you are doing
 Follows object with eyes/head
 Keep sponges/towels/scarves around
during diaper changes, rub different
textured items on baby’s tummy, cheek,
arm
 Laughs
 Put music on and dance with baby; sing
5 – 6 MONTHS
 Sits with arms supporting
 Sit baby up using their arms as support; try
using small pillows to help them
 Rolls over
 Lie baby on blanket with arms stretched
out in front; gently& slowly pull blanket
up, rolling them over.
 Babbles
 When baby babbles, imitate their noises;
try this while reading with baby
7-8 MONTHS
 Crawls on all fours
 Make a “cushion mountain” with pillows
of different sizes/textures; show baby how
to crawl around & up them
 Looks for disappearing toy
 Take a paper towel tube & a colorful cloth;
stuff the cloth in the tube, encourage baby
to look for it
 Mimics simple sounds
 Talk with baby showing them your eyes,
nose, mouth, ears etc. Show them their
own, and on a doll; sound out words
slowly, let baby watch how your mouth
moves & encourage them to try out
different sounds
o
9-10 MONTHS
 Stands, holding onto a support
 Put favorite toys up on couch; encourage
baby to pull up and “cruise” along the
couch to get them
 Grasps with thumb & index finger
 Give baby 1-3 Cheerios (so they don’t
grasp a handful at a time)
 Says mama/dada, specific to you
 Play peek-a-boo, hiding behind a wall,
when you pop out say “mama!” or “dada!”
11-12 MONTHS
 Walks with hand held
 Put heavy objects in laundry basket, allow
baby to use for support while standing;
remove some & baby can push like cart
 Finds hidden toy
 Hide toy in shoebox and play hide-andseek to have baby find it
 Knows several body parts
 Play in front of mirror ask baby to show
you different body parts; read books, ask
baby to point out characters’ body parts
SUMMARY OF INFANT DEVELOPMENTAL MILESTONES
AGE*
GROSS/FINE MOTOR
ABILITIES
LANGUAGE/SOCIAL
1 month
 Prone: raises head, chin  Visual fixation
 Smiles
2 months
 Prone: raises head,
chest
 Tracks mother’s
face
 Coos
3 months
 Prone: rests on elbows
 Bats at objects
 Recognizes parent
4 months







 Tracks objects,
vertically and
horizontally
 Inspects hand
5 months
Reaches
Sits, propped
Rolls front to back
Sits, hands supporting
Reaches, attains
Transfers hand to hand
Rolls back to front
 Laughs
 Smiles at self in
mirror
 Vocalizes for
attention
6 months
 Reaches with one hand
 Up on hands and knees
 Takes one cube
 Babbles
7 months
 Sits unsupported
 Holds 2 objects
 Belly crawls
 Takes 2 cubes
 Looks for
disappearing toy
 Separation anxiety
 Mimicking simple
sounds begins
8 months





 Pulls string to
attain toy
 “dada”, “mama” nonspecific
9 months
Creeps, all fours
Comes to sit
Rakes
Immature pincer
Pulls to stand
 Drinks from cup
 Waves bye-bye
10 months
 Mature pincer
 Cruises
 Follows simple
directions
 “mama”, “dada”
specific
11 months
 Walks, 2 hands held
 Recognizes words
as symbols
12 months
 Voluntary release
 Walks, 1 hand held
 Searches and finds
hidden toy
 Knows several body
parts
 Uses jargon
 Parallel play;
cooperates with
dressing
 Vocabulary of 1-2
words
* Use corrected gestational age
SUMMARY OF TODDLER DEVELOPMENTAL MILESTONES
AGE*
GROSS/FINE MOTOR
ABILITIES
LANGUAGE/SOCIAL
18 months
 Walks without help
 Runs stiffly, eyes on
ground
 Pulls, pushes, dumps
things
 Pulls off hat, socks,
mittens
 Turns pages in book
 Scribbles with crayon
 Stacks 2 blocks
 Identifies object in
picture book
 Looks for objects
that are out of sight
 Follows simple 1step directions
 Solves problems by
trial and error
 Says 8-10 words that
parents can
understand
 Looks at person who is
talking to him
 Asks specifically for
mother or father
 Uses “hi”, “bye” with
reminders
 Asks for something by
pointing or using 1
word
 Separation anxiety
 Seeks attention
 Recognizes self in
mirror
24 months
 Walks up steps with
help
 Tosses or rolls large
ball
 Bends over to pick up
toy without falling
 Takes steps backwards
 Opens cabinets,
drawers, boxes
 Feeds self with spoon
 Drinks with straw
 Helps in washing hands
 Puts arms in sleeves
 Helps to build tower of
3-4 blocks
 Likes to take things
apart
 Explores
surroundings
 Points to 5-6 parts
of doll when asked
 Several hundred word
vocabulary
 Uses 2-3 word
sentences
 Says names of toys
 Hums or tries to sing
 Likes to imitate
parents
 Temper tantrums
 Acts shy around
strangers
 Shows awareness of
parental approval or
disapproval for actions
 Takes turns to play
with children
 Uses “me” or “mine”
* Use corrected gestational age
My Notes
&
Thoughts
To Do List
Date
Item
Completed
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My daughter’s name is the perfect name for her; “life” is what it means. She’s
almost 2 years old now, and developmentally she’s more advanced than that. I
thank God every day that things have turned out the way they did.
To Do List
Date
Item
Completed
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
My daughter’s name is the perfect name for her; “life” is what it means. She’s
almost 2 years old now, and developmentally she’s more advanced than that. I
thank God every day that things have turned out the way they did.
I started using heroin when I was just 15 years old. I wanted to see what was
so special about it that my father would allow it to take him away from me
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Telephone Log
I called them  They called me
Date: _______________
Telephone Number: __________________
Name: ______________________________
Title: ________________________
Discussion: _____________________________________________________________
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Follow-up
My Follow-up Items
Their Follow-up Items
I called them  They called me
Date: ____________________
Telephone Number: ___________________
Name: ______________________________
Title: ________________________
Discussion: _____________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
My Follow-up Items
Follow-up
Their Follow-up Items
Telephone Log
I called them  They called me
Date: _______________
Telephone Number: __________________
Name: ______________________________
Title: ________________________
Discussion: _____________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
Follow-up
My Follow-up Items
Their Follow-up Items
I called them  They called me
Date: ____________________
Telephone Number: ___________________
Name: ______________________________
Title: ________________________
Discussion: _____________________________________________________________
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My Follow-up Items
Follow-up
Their Follow-up Items