Baby checks

Question 1

History

Answer 1

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

Question 2

Approach to examination

Answer 2

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

Question 3

What to discuss with parents

Answer 3

Purpose
Process
Timing 
Limitations
Parental concerns

Question 4

When to perform checks

Answer 4

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

Question 5

Environment for examination (5)

Answer 5

Lighting, warmth
Correct identifiction
Infection control
Privacy

Question 6

Equiptment required

Answer 6

Warmer
Stethoscope
Opthalmoscope
Tongue depressor
Pensil Light
Tape measure, scales, centile charts
Pulse oximetry
Documentation->infant personal health record, medical health record

Question 7

Components to assess at general appearance

Answer 7

Skin colour, integrity, perfusion
Alertness
Activity, ROM
Posture
Tone

Question 8

Growth status components

Answer 8

HC
Length
Weight

Check 3 times for HC

Question 9

Head, face, neck components

Answer 9

• 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

Question 10

Shoulders, arms and hand components

Answer 10

Length
Proportion
Symmetry
Structure
Number of digits

Question 11

Chest components

Answer 11

• Size, shape, symmetry,
movement
• Breast tissue, nipples
• Heart sounds, rate, pulses
• Breath sounds, resp rate
• Pulse oximetry (optional)

Question 12

Abdomen components

Answer 12

Size, shape, symmetry
Palpate liver, spleen, kidneys
Umbilicus

Question 13

GU components

Answer 13

Male- penis, foreskin, testes
Females- clitoris, labia, hymen
FEMORAL PULSES
Anal position, patency
Passage of urine and stool

Question 14

Hip, legs, feet comopnent

Answer 14

Ortolani, Barlows

Leg length, proportions, symmetry, digits

Question 15

Back component

Answer 15

Spinal column, skin

Symmetry of scapulae and buttocks

Question 16

Neurological component

Answer 16

Behaviour
Position
Muscle tone, spontaneous movements
Cry
Reflexes->Moror, suck, grasp

Question 17

Risks of DDH (4)

Answer 17

Female
First born
Feet first
Family history

Question 18

Further investigations required if findings on growth and appearance- include the urgent and reasons

Answer 18

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

Question 19

Further investigations required if findings on head and neck

Answer 19

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

Question 20

Further investigations required if findings on upper limbs

Answer 20

Limb hypotonia, contractures or palsy

Palmar crease pattern

Question 21

Further investigations required if findings on chest

Answer 21

Abnormal HR, rhythm, regularity
Heart murmurs

• Respiratory distress
• Apnoeic episodes
• Weak or absent pulses
• Positive pulse oximetry

Question 22

Further investigations required if findings on abdomen

Answer 22

Inguinal hernia

Question 23

Further investigations required if findings on GU

Answer 23

Hypospadias
Penile chordee
Micropenis

• No urine/meconium in 24 hours
• Ambiguous genitalia
• Testicular torsion

Question 24

Further investigations required if findings on Hips, legs and feet

Answer 24

Risk factors for hip dysplasia
\+Barlows/Ortolani
Contracture, hypotonia
Fixed talipes
DHD

Question 25

Further investigations required if findings on back

Answer 25

Curvature of spine
Non-intact spine
Tufts of hair/dimple along the spine

Question 26

Further investigations required if findings on neurological

Answer 26

Weak/absent cry
Absent reflexes
No response to consoling
Inappropriate carer response to crying

• Seizures
• ALOC

Question 27

Discaharge requirements

Answer 27

Review discharge requirements->observations, feeding, output

Discuss:

1. Routine tests->Hearing, hepatitis B, NNST
2. Support agencies–>GP, Child/community health, lactation support, 13 health
3. Health promotion
   - Feeding and growth
   - Jaundice
   - SUDI (sudden unexpected death in infancy), injury prevention
   - Immunisation
   - Signs of illness
4. Infant personal health record
5. Referral and follow-up->routine at 5-7 days and 6 weeks

Question 28

Aspects of health promotion

Answer 28

Feeding and growth
Jaundice
SUDI, injury prevention
Immunisation
Signs of illness