Examining the Newborn

Every newborn baby should have a thorough examination by a suitably qualified person within 24 hours of birth. This should preferably be done when the mother and father are present.

The general body tone of the baby, that is, if she is firm and able to do certain reflex actions, or if she is limp and floppy is a good indication of whether the nervous system is functioning as it should. The doctor is also able to judge whether the baby was born prematurely and by how many weeks. The spine will be examined to make sure it is straight and that there are no abnormalities.

The testes will be examined in a boy to see that they have descended into the scrotum or that they can easily be made to move into the scrotum. The opening to the urethra, the meatus, will be checked to ensure that it is correctly positioned and patent (open). In a girl, the vaginal area is usually enlarged and there may be a discharge from the vaginal opening. This is normal and due to the effects of the mothers hormones.

The anus will be checked to ensure that it is open and normal. The babys ears will be checked internally and externally. There may be a great deal of wax but this works its way out on its own. The shape of the outer ear and its placing on the head can tell the doctor if there is a possibility of certain internal defects. In a premature baby the folds of the ear are not fully formed and the ears are softer than those of a full term baby.

The femoral pulse in the groin is felt to make sure there is no narrowing of, the main blood vessel leading from the heart to the lower limbs (coarctation of the aorta). The groin is also examined for signs of an inguinal hernia. The collar bone which is easily damaged during birth, will be felt for any displacement or fracture.

When forced open, the arms should return firmly to a position close to the body, indicating good reflex and tone. The babys chest is felt to see if there is any enlargement of the heart. The liver and spleen are felt for correct position and size. The lungs and heart are listened to through a stethoscope. Heart murmurs are common and are not an indication that there is something wrong except in rare instances.

For the important examination of the hip joints the doctor will splay the childs legs in a frog-like position with a special grip to see if the hip bones fit into their sockets as they should. If there is a click when the examination is done or the bones are not in the correct position, the child could have dislocation of the hip which needs early treatment.

The hands are checked for normal palms as a child with certain chromosomal abnormalities such as Downs syndrome would have unusual crease marks. If the childs palm is pressed with the thumb she should close her fingers into a fist.

The feet are stimulated to see if the child curls her toes inwards in a normal reflex. Premature babies do not have well defined lines on the soles of their feet. The ankles are bent to check for signs of club feet.

The eyes will be examined for defects such as cataracts caused by German measles during pregnancy. The roof of the mouth will be felt for any opening that would mean the baby has a cleft palate. At the same time the doctor will test the sucking reflex. A strong sucking reflex is a sign of a healthy mature baby.

The soft spot or fontanelle on the top of the babys head will be checked for any signs of bulging which could indicate pressure in the brain, if it is sunken it could mean that the baby is dehydrated or has lost a lot of mass after birth.

The baby will be measured around the widest part of the head which averages 3 5 cm in a full term baby. The babys length will also be measured the average is 51 cm – so that growth can be checked against these measurements later on if necessary.

A comprehensive examination of the newborn child is a complex procedure and should preferably be done by a neonatologist or paediatrician.

While your baby is in the observation or admission nursery the staff will fill in a card with details of your pregnancy and labour, blood groups and any complications that may have arisen. Your babys temperature and breathing will be checked and the nursing staff will observe the child for the least sign that all is not well. Some nursing homes give babies their first BCG injection soon after birth because it is one of the few diseases in which early protection is possible. Your discharge card (record card) will indicate whether she has had the first BCG and when subsequent shots are due.

If you have had a Caesarean section your baby may be put in an incubator and kept under observation for up to 12 hours. You should see your baby as soon as possible after the birth even if you have to be wheeled to the incubator. Your baby should be removed so that you can hold her for a while and she should also be taken out for breast feeding (77). The separation of mother and child after a Caesarean in which the mother has not seen the baby being born can affect their relationship adversely. Many women whose babies were born by Caesarean feel alienated from their child for a long time, while the incidence of battering and behaviour problems is higher in babies who have been kept from their mothers through prematurity or other factors. Although most mothers do make up for the initial lack of bonding, by breast feeding or simply through the process of caring for their child, the process is much smoother when there has been early contact.

Babies with a mass below 2 500 g are also kept in a special care area even if they are not preterm (premature). They need to be observed and to be kept warm because their temperature regulating mechanism is particularly inefficient.

Another significant pointer to the need and importance of early contact between mother and child is the way in which the mother of a baby in an incubator will bend her head so that she looks her infant straight in the eyes. This vital eye-to-eye contact that is so important for the bonding process takes place instinctively if mother and child are given a chance. So even if the baby is tiny, the mother should handle her in or out of the incubator.