Birth trauma: caput succedaneum, subconjunctival haemorrhages (pressure), cephalhaematoma (ventouse), forceps marks
Dysmorphic features: dysmorphia, cleft lip, low set ears/epicanthic folds (Down’s syndrome), small jaw(Pierre Robin syndrome)
Posture, tone and movements: hypotonia (Down’s syndrome), hypertonicity, hemiparesis, opisthotonos, myoclonus
Top to toe
Cranium: look for cephalhaematoma, caput succedaneum, cranial moulding/deformities, micro-/macrocephaly, feel fontanelles (bulging = raised intracranial pressure, e.g. hydrocephalus; sunken = dehydration), feel sutures (check fused)
Face: dysmorphic features, cleft lip, ears (low set/preauricular skin tags/deformity= Down’s syndrome), feel with little finger inside roof of mouth(cleft palate; high-arched palate = Marfan syndrome)and determine presence of suck reflex
Eyes: check red reflex using ophthalmoscope (absent = congenital cataracts; white = retinoblastoma), erythema/discharge (conjunctivitis), icteric sclera, subconjunctival haemorrhages (trauma during delivery)
Shoulders: check aligned, feel clavicles
Upper limbs: extend and check equal length; look for single palmar creases (Down’s syndrome), extra digits (polydactyly),or fused digits (syndactyly)
Look for signs of respiratory distress (indrawing of intercostal muscles)
Feel for chest expansion
Auscultate lung and heart sounds (check for murmurs; normal heart rate is 120-150bpm)
Inspect for distension (bowel obstruction), scaphoid abdomen (diaphragmatic hernia), and comment on umbilical stump (any erythema, bleeding, discharge)
Palpate for masses, hepatosplenomegaly and ballot kidneys (Wilms tumour)
Genitalia: boys – feel testes (check both are descended and for a hydrocele); check foreskin and for hypo-/epispadias; girls – check for labial fusion and for cysts/tags; both – check anus is patent
Femoral pulses (absence suggests coarctation)
Hip tests: for both tests grasp their flexed knees in your palms, placing your thumbs over the medial aspects of their knees and your fingers over the lateral aspects. Hold both knees throughout but test one side at a time.
Detects dislocatable hip. Flex adducted hip to 90˚, then push posteriorly in the line of the femoral shaft. Dislocation is felt as a click.
Detects hips which are already dislocated (‘out’). Flex hip to 90˚, then abduct hip (turn it out). On full abduction, apply anteriorly directed force to the upper leg (pull upper thigh towards you with your fingers, keeping the knee steady in your palm). Relocation is felt as a click.
Lower limbs: extend and check equal length; test range of movement at ankles; check feet for talipes (‘club foot’) and calcaneovalgus (abducted forefoot and dorsiflexed ankle); look for extra digits (polydactyly),or fused digits (syndactyly)
Back: turn baby prone
Inspect forlipomas, tufts of hair (spina bifida),‘port wine’ stains, and Mongolian blue spot
Palpate for spinal abnormalities (spina bifida) and natal cleft
Grasp reflex: place finger in baby’s palm. They should grasp it.
Moro reflex: warn parents first. Hold the baby in a sitting position a few inches above a soft surface, supporting their head in one of your hands and their bottom in the other. Allow the baby to rock backwards quickly but very slightly towards the bed (with your hands still supporting their head and bottom). Their arms should abduct, adduct, then the baby will usually cry.
What questions should be asked to the mother before a newborn baby check?
Labour – How long since delivery – Type of delivery – Problems in labour (including breech, premature rupture of membranes) – Medications in labour
Mother – Any temperatures – Overall health in pregnancy – History of congenital hip dysplasia