Well Baby Care
Roughly 5% of the NARM written examination — about 12–18 scored items of the ~300 on the exam.
Normal newborn adaptation. Support thermoregulation, feeding adequacy, and normal urine/stool patterns (roughly one wet/stool per day of life in the first days, transitioning to regular output as milk comes in; stool transitions from meconium → transitional → milk stool).
Jaundice. Distinguish physiologic jaundice (appears after ~24 hours, peaks around days 3–5) from pathologic jaundice (appears in the first 24 hours, rises rapidly, or is prolonged — a referral situation). Support feeding and know when bilirubin evaluation and phototherapy referral are warranted.
Screening and follow-up. Educate on newborn screening: the metabolic/genetic heel-stick screen, hearing screening, and critical congenital heart disease pulse-oximetry screening. Counsel on cord care, safe sleep, and follow-up.
Danger signs. Recognize and refer/transport for newborn warning signs — poor feeding, lethargy or marked irritability, temperature instability, respiratory distress (grunting, flaring, retractions, persistent tachypnea, cyanosis), dehydration, and signs of sepsis. When in doubt about a sick newborn, escalate early.
Sample questions from this domain
Three of the 23 questions in this domain, with the reasoning. The full set is in the question bank.
Which is the most reliable early indicator that a breastfed newborn is feeding adequately in the first week?
- A. Increasing numbers of wet and dirty diapers and appropriate weight trend ✓
- B. The baby sleeping through the night
- C. The baby never crying
- D. The mother feeling full breasts at all times
Why: Adequate output (rising wet/stool counts as milk comes in) and an appropriate weight trend are reliable signs of adequate intake. Sleeping through the night or constant breast fullness are not valid indicators.
The normal axillary temperature range for a newborn is approximately:
- A. 38.0–39.0°C
- B. 36.5–37.5°C (97.7–99.5°F) ✓
- C. 35.0–36.0°C
- D. 34.0–35.0°C
Why: A normal newborn axillary temperature is about 36.5–37.5°C. Temperatures below this suggest cold stress (or sepsis), and elevated temperatures warrant evaluation.
Most newborns lose some birth weight in the first days. Which pattern is expected and reassuring?
- A. A 20% loss in the first week
- B. Up to about 7–10% loss initially, with return to birth weight by roughly 10–14 days ✓
- C. Continuous loss for a month
- D. No weight change at all
Why: A physiologic weight loss of up to ~7–10% in the first days, regained by about 10–14 days, is normal. Loss beyond ~10% or failure to regain weight warrants feeding evaluation and possible referral.
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