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Newbirth examination

Newbirth examination

All babies receive a thorough medical examination within the first couple of days of life to check for any abnormalities. This is usually done by a paediatrician before hospital discharge, but if you have a home delivery your GP will check the baby instead.

Firstly, the doctor will ask about any problems during pregnancy or delivery and about any family history that may be relevant. Then the baby will be undressed completely so the doctor can observe his or her general appearance and movements. Minor skin blemishes are common. Jaundice (a yellow discoloration of the skin and eyes) is a common finding after the first day of life, but if it occurs on day 1 or is severe, blood tests will be needed.

Head

New babies have two soft spots (fontanelle) that can be felt on their skull, which gradually close in the first year of life. The head circumference is measured and will be measured again, together with the baby's weight, at the 6 week examination to check for normal growth. The baby's eyes will be examined with an instrument that shines a light into your baby's eyes, in order to exclude a rare congenital cataract or tumour. Also, the baby's mouth will be examined to look for a small cleft at the back of the mouth (cleft palate). Additionally, a check for extra skinfolds on the neck may detect Down's syndrome.

Heart and circulation

The doctor will listen to the baby's heart early on in the examination. This is to detect a murmur, which may be a sign of a small hole between the heart chambers. Nowadays if there is any doubt, an echocardiogram can be done, which is a scan that can show clearly the anatomy of the baby's heart. The doctor will also check the baby's pulses in the groin to detect any asymmetry, which may be caused by a narrowing of the body's major artery, the aorta.

Chest and abdomen

It is more important to watch the baby's breathing than to listen to the lungs. The normal respiratory rate is less than 50 breaths per minute. If the baby is grunting or if the breathing looks laboured, further investigation is needed. The doctor will also check the belly button and feel the abdomen for any enlarged organs.

Genitals

The doctor will examine a boy's scrotum to check that the testicles are fully descended. At birth around 2% of full-term male babies have an undescended testicle. If this is the case he will be carefully rechecked during the first year of life and if the testicle has not descended spontaneously, surgery will be needed.

Occasionally the foreskin may be hooded which can be a sign that the opening of the urethra in the penis is at an abnormal site. This requires surgical treatment later on, but it is very important that these boys should not be circumcised in the meantime. Girls are checked to see if their labia are fused and that their anatomy looks normal. The doctor will also look at the baby's anus to check that it is open.

Hips

Gentle examination for dislocated hips (developmental dysplasia of the hip - DDH) is an essential part of the newbirth examination, but unfortunately this test often makes the baby cry. Risk factors for DDH are a breech delivery, family history and female sex. During this examination, a definite clunk indicates a dislocated hip, but slight clicks may simply be due to lax muscles. If in doubt, the doctor will organize a follow up ultrasound examination and possibly an orthopaedic check up.

Back and limbs

When the doctor checks the baby's hands, he or she is checking for extra fingers and counting the number of creases in the palm. Most (but not all) normal babies have two skin creases in their palm, whereas Down's syndrome babies usually have only one.

The doctor checks that the baby's feet are flexible and face in the right direction, in order to exclude clubfoot (talipes equinovarus), which requires orthopaedic referral. The doctor will also check for a common self-limiting condition where the heel is facing inwards and the foot is pointing downward because of the way that the baby was lying in the womb; this is called positional talipes. In contrast to clubfoot, positional talipes is easily corrected by gentle stretching exercises when you change the baby's nappy. The next part of the examination is to turn the baby over to check the spine. By handling the baby the doctor can also detect floppiness or stiffness of the limbs.

The newbirth examination is an excellent opportunity to discuss any worries with the doctor. This examination forms the first part of the Child Health Promotion programme for children up to 5-years-old, performed by doctors and health visitors. The next examination is a physical and developmental check up when the baby is around 6 weeks old and is usually done by a GP from your practice.