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Written Case 3

ACT NOW ESC During Training (ESC Care Tool) Written Case 3

Read Written Case 3 before completing the Assessment. Enter your information below and click “Start” to begin the assessment. 

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  1. 40-week healthy baby boy born by c-section after failure to progress.
  2. Mom is 31 years old, in buprenorphine treatment for 3 years, doing well in recovery. Mom on Zoloft for depression. No other medication or substance exposure present.
  3. All assessments being performed every 3 hours.

Day of Life (DOL) 1

  1. Baby has problems staying latched. Does not seem interested in feeding much and has been spitty with clear fluid. Mom doing skin-to-skin (STS) contact. Baby has increased tone and difficulty sleeping for more than one hour due to tremors when disturbed.
  2. Since last assessment, taking ~15 minutes to calm with swaddling and holding. Being passed around between both grandparents (very excited about baby’s birth today). They talk a little loudly due to hearing problems. One family member holding baby at all times; baby swaddled in blanket.

DOL 2

  1. Mom on her own keeping baby with her in a calm and quiet room. Dad now at work and grandparents left per staff recommendations. Baby no longer spitting up.
  2. RN performed vital signs, ESC assessment, and exam 4 hours after last assessment. Vital signs and exam within normal limits, including tone and reflexes.
  3. Baby awoke approximately 3 hours after last assessment and was very fussy but able to calm down after a few minutes of STS contact. He was able to latch within a few minutes and breastfed well for 20 minutes. Mom swaddled baby using RN tips from DOL 1.
  4. Baby slept for approx. 3 hours in bassinet after feeding. Mom able to get a nap in also.

DOL 3

  1. Mom waking baby every 2 hours after placing baby STS and doing breast massage/hand expression as recommended.
  2. On last assessment 3 hours ago, baby took approximately 5-7 min to latch on but then able to bf well x 10 min. Baby noted to have tremors when disturbed, increased tone, and difficulties sleeping for more than 30 min due to increased startle with any noise or movement. Taking 15-20 min to console despite parents’ and LNA’s best efforts.
  3. Parents calm but a little stressed about how baby is feeling. Baby now having undisturbed tremors, crying lots, and having a harder time consoling.
  4. Continuously rooming-in, in a calm room. No visitors, holding baby STS all the time, except when swaddled effectively and safely for sleep in bassinet. Using gentle jiggling movements. Parents taking turns napping/going for walks while other parent cares for baby but still getting tired. No one else present to cuddle baby (including staff/cuddler).
  5. On this assessment, baby taking 20 minutes to calm despite parents’ (and lactation consultant’s) best efforts. Baby unable to latch within 30 minutes of mom trying. Only able to stay latched on for 5 min due to excessive rooting and tremors. Mom STS with baby for last few hours, offering a breastfeed every 1.5-2 hours to avoid him getting too hungry. Lactation consultant using colostrum on finger to help calm baby and organize suck prior to helping mom latch baby. Baby did not sleep in last 3 hours – startling lots.

Written Case 3 Rating Sheet

Written Case 3

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