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Health checks and screening

In the hours after they are born, your baby will have several tests and examinations to check that they are healthy and that all is well. Here’s an outline of what your midwife and doctor will be looking for when they carry out these tests.

What tests will my baby have?

Your baby will have a few checks and examinations in the first hours of his life. The first is the APGAR score, which your midwife will record at one minute, then again at five minutes after your baby’s born.

Your midwife can do this test by watching your baby’s colour, breathing, behaviour, activity and posture. This will indicate whether your baby has any immediate problems which need medical support.

Most babies are fine, or may just need to be watched for a while. If your baby does need some help, your midwife may give them oxygen or clear their airways to help them breathe.

Next, your midwife will;

  • weigh your baby
  • check their temperature
  • measure the circumference of the head.

These measurements will later be added to the developmental charts in the ‘red book’ (personal child health record).

A full newborn examination is carried out at between four hours and 48 hours after your baby’s birth. This gives your baby time to adjust to the outside world and allows for prompt medical attention in the unlikely event of any problems being found.

Who does the full newborn examination?

Your baby may be examined by a paediatrician, a midwife with extended training or, if you had a home birth, your midwife or GP.

The examination will be carried out while you are present, so you’ll be able to ask questions. The examiner will probably ask you questions about your family’s medical history, so now’s the time to mention any childhood problems common to your family.

What does the examination involve?

The examination takes a head-to-toe look at your baby to check for any problems or conditions.

The doctor or midwife will look at the shape of your baby’s head. A squashed or moulded head is a very common feature in newborns. This is caused by your baby being squeezed on their journey through the birth canal, and should right itself within 48 hours.

Your baby’s head can mould in this way because of the soft spots, called the sutures and fontanelles, between the bones in his skull. These soft spots will be looked at by your midwife or paediatrician.

If your baby’s birth required assistance with ventouse or forceps there’s a small risk of bruises appearing on his head or skull bone (cephalhaematoma). But rest assured this will clear up by itself.

A midwife will have already looked at your baby’s eyes to check for any obvious problems. During the full examination, the doctor or midwife will shine a light into your baby’s eyes to look for a red reflex. This is the same as the red-eye effect from flash photography. If a red reflex is shown, cataracts can be ruled out.

Your baby may have a hearing test shortly after birth, either in hospital, a community clinic, or at home. It only takes a few minutes and doesn’t hurt your baby.

The doctor or midwife will put a finger in your baby’s mouth to check that the roof of their mouth (palate) is complete and their sucking reflex is working.

They will also check your baby’s tongue for tongue-tie. This happens when his tongue remains more anchored to the bottom of his mouth than it should be, restricting movement.

The doctor or midwife will listen to your baby’s heart with a stethoscope to exclude extra sounds or heart murmurs. These are common in the first few days, as your baby’s pattern of circulation undergoes a major change after birth.

In the uterus (womb), the two sides of your baby’s heart beat together. When your baby takes his first breath, the two sides begin to work separately. At this stage, your baby’s heart is working hard and may be enlarged, though it will settle down over time.

Heart murmurs may require a second opinion and further investigation, or will be checked at future examinations. Rest assured that heart murmurs often disappear on their own.

A further test for a heart condition is to feel for a pulse in your baby’s groin (the femoral pulse).

The doctor or midwife will listen to your baby’s breathing pattern and lung function with a stethoscope.

Your baby’s genitals may appear swollen and dark-coloured, because your baby was exposed to your hormones before birth. These hormones may also cause your baby to have engorged breasts, regardless of your baby’s sex. Girls may have a clear, white, or slightly bloody vaginal discharge for the first few weeks due to these hormones.

For boys, the scrotum is checked for undescended testes. The penis will be checked to ensure the opening is at the tip of the penis, and not on the underside.

The doctor or midwife will check your baby’s bottom to ensure the opening to his back passage is normal. You will probably be asked if your baby has had a wee or passed a dark-coloured poo (meconium),

Your baby’s skin will be checked for birthmarks, including:

  • stork marks (reddish or purple V-shaped marks on the back of his neck)
  • Mongolian spots (a bluish patch of darker pigment, most commonly over the bottom)
  • strawberry marks (raised red areas)

The doctor or midwife will check your baby’s arms, hands, legs and feet. His fingers and toes will be counted and checked for webbing.

Your baby’s palms will be checked to see if two creases, called palmar creases, run across them. Single palmar creases are less common. However, 10 per cent of the population have one palmar crease on one hand and five per cent have one palmar crease on both hands.

The examiner will look at the resting position of your baby’s feet and ankles. This is to check for talipes (clubfoot), where the front half of the foot turns in and down. If your baby has talipes, you may already know due to an ultrasound scan.

Your baby’s spine will be assessed for straightness. It is quite common for babies to have a tiny dimple at the base of the spine, called a sacral dimple. In most cases this will cause no problems. Occasionally, a deep sacral dimple may indicate a problem with the lower part of your baby’s spinal cord. This could affect nerve function in this area.

If your baby has a deep sacral dimple, they will be checked for other symptoms such as leg weakness, cold and blue feet, and incontinence.

Your baby’s hips will be gently moved to check the stability of their hip joints. If the examiner detects any instability, or clicky hips, further investigations will be performed.

Your newborn baby has several reflexes such as sucking, rooting and grasping. The doctor or midwife will check these reflexes by watching your baby. But if they are concerned or can’t see the reflex, they may encourage your baby to demonstrate it.

The most commonly tested reflex during the examination is the Moro reflex. Your baby’s head is allowed to gently and safely fall for a short distance. They’ll then respond by flinging out both arms with their fingers spread and legs outstretched. They may also cry a little. Rest assured your baby will be fine, and their responses are simply showing that all is well.

What happens after the full examination?

Most babies pass their newborn examinations with flying colours. And when problems are found, they often resolve themselves in time and without any treatment at all. If the doctor or midwife who examines your baby has any concerns, they may decide that further tests and investigations are needed.

For the few babies who do have problems, there are many benefits to having these identified early on. Though bear in mind that screening tests may not pick up every problem. Your doctor or midwife should give you information about the suspected problem and answer any questions you may have. You should also be offered advice about where to find more information and support.

The next routine test your baby will have is a heel-prick test before they are a week old. Your midwife will carry out this test by taking a tiny amount of blood from your baby’s heel. Your baby may cry a little when the blood is taken, but he will recover very quickly.

The next screening test you and your baby will have will be your postnatal check with your doctor. This will take place between six weeks and eight weeks. If you have any concerns about your baby before then, don’t hesitate to call your midwife, health visitor or doctor.