Your baby 0-4 weeks
Within 72 hours of birth a trained healthcare professional such as a midwife, doctor or GP, should offer you a full physical examination for your baby. This examination is part of an assessment of the overall well-being of your baby and takes account of your family history, antenatal and postnatal events together with any concerns you may have. Depending on where you give birth, this examination will either be undertaken in hospital, at home, at a children’s centre or at a GP clinic, with your consent.
To enable the healthcare professional to carry out a thorough examination it is helpful if your baby is as quiet and calm as possible. You may therefore be asked to provide your baby with a comforting method such as sucking on a gloved finger/dummy to soothe him/her during the examination.
The healthcare professional will carry out an overall top-to-toe physical assessment of your baby which includes:
- observation of the skin to see that it is not dry. The folds of your baby’s neck, under the arms and groins will be examined to exclude any septic spots.
- colour discolorations, such as blue spots on a baby’s bottom or back, are normal in certain ethnic backgrounds and if present will be noted and recorded in your baby’s personal child health record (PCHR) book.
- examination of your baby’s eyes together with the gums and the roof of the mouth to verify that they are not yellow to exclude jaundice. Jaundice is a condition that is common to many babies and can be normal from the 3rd day of life. A small number of babies, however, may require treatment and, in such cases, the baby will be monitored.
- examination of your baby’s head and face to check that they are clear of infection.
- examination of your baby’s mouth to see that there is no cleft palate that may hinder feeding. This will require the examiner to insert a gloved finger into your baby’s mouth to feel deep inside. They will also look inside your baby’s mouth.
- examination of your baby’s abdomen to see that it is soft and all the organs are the appropriate size.
- assessing that your baby’s reflexes are present and normal and the spine is complete and straight.
- checking your baby’s arms and legs to check that they are straight.
- examination of your baby’s genitalia to check that they are healthy (in the case of girls, that the vagina allows secretions to flow, more explanation about baby boys’ testes is given below).
- observation of your baby to check that they maintain appropriate eye contact. A number of specific screening examinations will also be carried out to identify any problems or conditions which may need monitoring, further investigation or treatment.
The specific screening examinations include checking your baby’s:
- heart – for problems such as congenital heart disease (i.e. a problem with the structure of the heart or the way in which is blood is being pumped to and/or from the heart. The check is carried out by observing your baby’s colour, noting how well s/he feeds (babies with a serious heart problem sometimes feed poorly), feeling the pulses and listening to the heart using a special stethoscope.
- hips – for problems such as Developmental Dysplasia of the Hip (DDH) – where the hip joint is dislocated or the ball or socket part of the hip joint have failed to develop normally. If your baby is born with hip joints not properly formed then, left untreated, this could cause limp and joint problems such as arthritis. Each hip will be carefully examined.If your baby has been in a breech position from 36 weeks gestation, or if there is a family history of hip problems from childhood, then a routine hip ultrasound scan will be offered which checks the ball and socket joint in more detail.
- eyes – for problems such as cataract or retinoblastoma (a type of eye cancer). The movement and appearance of your baby’s eyes are checked using an ophthalmoscope (special torch).
- testes – for problems such as undescended testes. Your baby boy will be clinically examined to check that his testes are in the right place. Testes can descend into the scrotum of their own accord but it can take a number of months for this to happen. If this does not happen by a year old then an operation, at one to two years, may be advised.This examination will provide the healthcare professional with information
on how your baby has developed and adjusted to life so far. Anything identified during the examination, and any subsequent follow-up which may be required, will be discussed with you. As some conditions may not be present at birth, and can develop over time, another physical examination will be offered when your baby is 6 to 8 weeks of age. Your observations of your baby form an important part of these examinations. The outcome of the examinations will be recorded in your baby’s personal child health record (PCHR) book.
Hearing screening
During the first few weeks after birth you will also be asked if you wish to have your baby’s hearing checked. In most areas this check will be carried out before you leave the hospital but in some areas it will be done at home or at a community clinic. The test should be carried out by the time your baby is 5 weeks’ old.
One to two babies in every 1,000 are born with a hearing loss in one or both ears. The newborn hearing screen is important as early detection and diagnosis gives the best opportunity for putting the most appropriate support in place for baby and family. The hearing screening test is carried out by a trained hearing screener and is usually done while your baby is asleep or settled. It does not hurt and is not uncomfortable. The test involves placing a soft tipped earpiece in your baby’s ear (each ear is tested separately) which sends clicking sounds into the ear. In a healthy ear, the cochlea, produces a response to the clicking sound and the hearing screening equipment can detect this response. The test is quick and you can stay with your baby while it is being carried out.
You will receive the results of the screening test straight away and the hearing screener will explain these results to you. Your baby may need a repeat test but this does not necessarily mean they have a hearing loss. Other than the presence of a hearing loss, the test may need to be repeated if your baby was not settled, if there was background noise or there could still be fluid or a temporary blockage in your baby’s ears which is not uncommon after birth.
Even if your baby has a clear response from the hearing screening test, meaning that hearing loss has not been detected, it is still important to observe how your baby develops as they grow. Hearing loss can occur later in life for a number of reasons including injury, illness and hereditary medical conditions. Checklists on the sounds your baby should make and react to as they grow are available to help you monitor your child’s development (available in Screening tests for your baby, see below).
More information
Early detection and diagnosis of conditions and health problems gives the best chance for effective treatment and support. If you do not think you have been offered these checks for your baby then speak to your midwife, health visitor or GP.
More information about these screening tests is available in an NHS publication called Screening tests for your baby that you should have been given during your pregnancy and/or after the birth of your baby. If you have any questions about the information in this publication, in relation to the physical examination or hearing screen, then ask the healthcare professional performing the check or speak to your midwife, health visitor or GP.
In addition to these reviews your health visitor will encourage you to have your baby’s height and weight measured regularly at your local child health clinic. These measurements give you and your health visitor a good indication of how your baby is developing so that any problems can be identified early and appropriate support provided.
