Neonatal examination (baby check)

The baby check is a methodical examination of the baby in the first few days of life. Every health professional doing checks has a slightly different method; the author's scheme is to start at the arms, then work from the head down. The suggestion is that this scheme may serve as a template.

Note that although the baby check becomes very routine for the health professional, some parents find it quite stressful. To improve this it can be helpful to make positive noises throughout the examination, obviously avoiding negative noises if there are any minor findings.

Some of the abnormal findings and consequenses thereof have been included in the menus below the sections. Note that these menus are not intended to be exhaustive; a more exhaustive menu would include most of neonatology.

NICE have stated with respect to complete examination of the baby within 72 hours of the birth and at 6 to 8 weeks after the birth (1)

Carry out a complete examination of the baby within 72 hours of the birth and at 6 to 8 weeks after the birth (see the Public Health England newborn and infant physical examination [NIPE] screening programme). This should include checking the baby's (1):

• appearance, including colour, breathing, behaviour, activity and posture
• head (including fontanelles), face, nose, mouth (including palate), ears, neck and general symmetry of head and facial features
• eyes: opacities, red reflex and colour of sclera
• neck and clavicles, limbs, hands, feet and digits; assess proportions and symmetry
• heart: position, heart rate, rhythm and sounds, murmurs and femoral pulse volume
• lungs: respiratory effort, rate and lung sounds
• abdomen: assess shape and palpate to identify any organomegaly; check condition of umbilical cord
• genitalia and anus: completeness and patency and undescended testes in boys
• spine: inspect and palpate bony structures and check integrity of the skin
• skin: colour and texture as well as any birthmarks or rashes
• central nervous system: tone, behaviour, movements and posture; check newborn reflexes only if concerned
• hips: symmetry of the limbs, Barlow and Ortolani's manoeuvres
• cry: assess sound

At 6 to 8 weeks, assess the baby's social smiling and visual fixing and following.

Measure weight and head circumference of babies in the first week and around 8 weeks, and at other times only if there are concerns. Plot the results on the growth chart.

Reference:

1. NICE (April 2021). Postnatal care