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The Well Baby Check

The well baby check is used shortly after birth and in the following months to ensure that newborns are healthy. During the exam, keep the keep the baby warm, and be opportunistic - examine difficult areas when the baby is settled.

The Patient

Alertness

Settled, unsettled, lethargic, asleep
Colour

Jaundice, plethora, cyanosis
Work of Breathing

Resp rate, nasal flaring, tracheal tug, recession
Skin

Texture, rashes, naevi, haemangioma

The Head

Head Circumference

Compare with circumference at birth
Head Shape / Molding

Symmetry, length, height
Face

Symmetry, palsy, macrosomia, facies
Scalp

Caput, cephalhaematoma, lacerations
Fontanelles

Soft, non-bulging, non-sunken
Sutures

Mobile
Ears

Position, size, shape, pits, tags
Eyes

Distance apart, red reflexes, sclera
Nose

Symmetry, nares
Mouth and Palate

Cleft / high arched palate, cysts, tongue tie
Jaw

Size, symmetry

The Neck

Inspect

Shape, symmetry
Palpate

Lumps, swellings, excess skin folds
Range of Motion

Can move head to either side
Clavicles

Fractures

The Arms

Hands

No. and structure of fingers, simian crease
Brachial Pulses

Antecubital fossa, slightly medial + proximal

The Chest

Inspect

Size, shape, symmetry, nipples
Palpate

Apex beat, glandular breast tissue
Lung Fields

Clear, nil added sounds, good air entry
Heart Sounds

Dual, no added sounds, no murmurs

The Abdomen

Inspect

Distension, umbilicus / cord
Palpate

Softness, masses
Major Organs

Liver, spleen, kidneys, bladder
Auscultate

Bowel sounds

The Groin

Inspect

Herniae, genitalia
Femoral Pulses

Present bilaterally, strong
Testes / Penis

Descended / descendable testes, hypospadias
Female Genitalia

Clitoris, labia, discharge
Anus

Position, patency, fistula

The Hips

Inspect

Posture (esp. breech babies), symmetry, asymmetrical skin creases
Ortolani

Stabilise pelvis, flex and abduct both hips
Barlow

Flexed & adducted, posterior force to each hip

The Legs

Leg Length

Equal
Feet

Position, number of toes

The Back

Spine

Symmetry, scoliosis / masses, hair tuft
Lower Back

Sacral dimpling / sinus tracts, Mongolian spot

Neurological

Movement

Moving all four limbs
Tone

Passive / active
Cry

High pitched or hoarse
Suck Reflex

Gloved finger in mouth
Rooting Reflex

Touch on either side of mouth
Grasp Reflex

Touch palm
Moro Reflex

Warn the parents prior to performing this test

Support neck in upright position, suddenly change to supine

Read More...

Davis A, Elliman David. Newborn examination: setting standards for consistency. Infant. 2008; 4(4): 116-20. Howard WS. Physical Examination Of The Newborn. Can Fam Physician. 1974; 20(9): 5961. Paul Y. Examination of the Newborn. The Indian Journal of Paediatrics. 1973; 40(4): 156 - 166. Sasidharan P. An approach to diagnosis and management of cyanosis and tachypnea in term infants. Pediatr Clin N Am. 2004; 51: 999 1021. Valman HB. Routine Examination of the Newborn. The British Medical Journal. 1980; 280(6207): 91-94.

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