Feel with little finger inside roof of mouth(cleft palate; high-arched palate = Marfan syndrome)and determine presence of suck reflex
Subconjunctival haemorrhages (trauma during delivery)
Check red reflex using ophthalmoscope (absent = congenital cataracts; white = retinoblastoma)
Shoulders: check aligned, feel clavicles
Extend arms and check equal length
Look at hands for
Single palmar creases (Down’s syndrome)
Extra digits (polydactyly)
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)
Comment on umbilical stump (any erythema, bleeding, discharge)
Palpate for masses, hepatosplenomegaly and ballot kidneys (Wilms tumour)
Genitalia and femoral pulses
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)
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.
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)
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.
Questions to ask the mother before a newborn baby check
Questions to test your knowledge
What are the three main types of spina bifida?
What is a cephalhaematoma and a caput succedaneum? What are their causes?
What are the causes of microcephaly and macrocephaly?
If you detect unstable hips during the examination, which condition would you be concerned about? How would you manage it?