Baby checks Flashcards
History
Maternal
- Obstetric
- medical
- surgical
- family/social
Present pregnancy
- maternal: antenatal, medical etc
- fetal
- investigations
Newborn
- Labour: gestation, gender type, infection, fetal distress
- Birth: delivery, APGAR, growth parameters, resuscitation
- Prognosis since birth: concerns, feeding, observations, stool/urine, medications, immunisations
Approach to examination
Generally appearance Growth Chest->respiratory and cardiac: easier when quiet Head, face, neck Shoulders, arms and hands Abdomen Genitourinary Hips, leg, feet Back Neurological Discuss, document, refer
Parent present
What to discuss with parents
Purpose Process Timing Limitations Parental concerns
When to perform checks
Initial immediately after birth
Detailed assessment within 48 hours, always prior to discharge
F/U at 5-7 days and 6 weeks
If unwell/immature, as clinically indicated
Environment for examination (5)
Lighting, warmth
Correct identifiction
Infection control
Privacy
Equiptment required
Warmer Stethoscope Opthalmoscope Tongue depressor Pensil Light Tape measure, scales, centile charts Pulse oximetry Documentation->infant personal health record, medical health record
Components to assess at general appearance
Skin colour, integrity, perfusion Alertness Activity, ROM Posture Tone
Growth status components
HC
Length
Weight
Check 3 times for HC
Head, face, neck components
• Head shape, size • Scalp, fontanelles, sutures • Eye size, position structure • Nose, position, structure • Ear position, structure • Mouth, palate, teeth, gums tongue, frenulum • Jaw size Neck Clavicles
Shoulders, arms and hand components
Length Proportion Symmetry Structure Number of digits
Chest components
• Size, shape, symmetry, movement • Breast tissue, nipples • Heart sounds, rate, pulses • Breath sounds, resp rate • Pulse oximetry (optional)
Abdomen components
Size, shape, symmetry
Palpate liver, spleen, kidneys
Umbilicus
GU components
Male- penis, foreskin, testes Females- clitoris, labia, hymen FEMORAL PULSES Anal position, patency Passage of urine and stool
Hip, legs, feet comopnent
Ortolani, Barlows
Leg length, proportions, symmetry, digits
Back component
Spinal column, skin
Symmetry of scapulae and buttocks
Neurological component
Behaviour Position Muscle tone, spontaneous movements Cry Reflexes->Moror, suck, grasp
Risks of DDH (4)
Female
First born
Feet first
Family history
Further investigations required if findings on growth and appearance- include the urgent and reasons
Dysmorphic- syndromes
Excessive weight loss- breast fed baby may lose up to 10% body weight in first few days
Petechiae not a result of mode of delivery->thrombocytopenia, coagulation, vascular disorders (autoimmune, infections etc)
Pallor
Hemangioma->may rarely cause high output CF
- Billious vomiting
- Jaundice
Further investigations required if findings on head and neck
Macro/microcephaly Caput/cephalohematoma Fused sutures Facial palsy/assymmetry Hazy/dull cornea Absent red reflex->retinoblastoma, congenital cataracts Unequal pupils/dilated/constricted Purulent conjunctivitis Dacryocyst->nasolacrimal duct obstruction= infection and epiphora Cleft lip/palate Unresponsive to noise Ear drainage Small receeding chin/micrognathia Neck masses/swelling/webbing Swelling over or fractured clavicle
- Enlarged/buldging/sunken fontanelle
- Subgaleal hemorrhage->+association with head injury
- Non patent nares
Further investigations required if findings on upper limbs
Limb hypotonia, contractures or palsy
Palmar crease pattern
Further investigations required if findings on chest
Abnormal HR, rhythm, regularity
Heart murmurs
- Respiratory distress
- Apnoeic episodes
- Weak or absent pulses
- Positive pulse oximetry
Further investigations required if findings on abdomen
Inguinal hernia
Further investigations required if findings on GU
Hypospadias
Penile chordee
Micropenis
- No urine/meconium in 24 hours
- Ambiguous genitalia
- Testicular torsion
Further investigations required if findings on Hips, legs and feet
Risk factors for hip dysplasia \+Barlows/Ortolani Contracture, hypotonia Fixed talipes DHD
Further investigations required if findings on back
Curvature of spine
Non-intact spine
Tufts of hair/dimple along the spine
Further investigations required if findings on neurological
Weak/absent cry
Absent reflexes
No response to consoling
Inappropriate carer response to crying
- Seizures
- ALOC
Discaharge requirements
Review discharge requirements->observations, feeding, output
Discuss:
- Routine tests->Hearing, hepatitis B, NNST
- Support agencies–>GP, Child/community health, lactation support, 13 health
- Health promotion
- Feeding and growth
- Jaundice
- SUDI (sudden unexpected death in infancy), injury prevention
- Immunisation
- Signs of illness - Infant personal health record
- Referral and follow-up->routine at 5-7 days and 6 weeks
Aspects of health promotion
Feeding and growth Jaundice SUDI, injury prevention Immunisation Signs of illness