The Newborn Health Check: How Your Baby Will Be Examined

14/08/2014 16:57 | Updated 20 May 2015

Newborn baby tests

In the minutes after your baby is born, they will be assessed using the Apgar score – but this is only the first of many checks your baby will undergo. Don't worry – it's all perfectly harmless and designed to ensure your newborn is happy, healthy and developing normally.

Assuming your baby's Apgar score is satisfactory, and they don't need any extra help during those first few precious moments, the midwife, or a paediatrician will then start another examination.

They will take your baby's temperature, measure their head circumference and weigh them (ah, the all important weight – your work colleagues might well have had a sweep stake on it!). All this information will be recorded in your child's Red Book, which you'll be given later, and will be used to monitor your child's physical progress up until the age of five.

Some time later, when you and your little one have had some time to get to know each other, the full newborn check will take place.

This will be done before your baby is 48 hours old, often much sooner, and you will be present for it so do ask any questions you have. This is quite a detailed examination, and you might find it a bit strange to see your baby being prodded and pulled this way and that, but don't fret.

Whether it's a midwife, paediatrician or your GP (if you gave birth at home) who does the check, they know what they're doing. And even if your newborn seems grumpy about the whole process, well, it's proof that newborns are not made of porcelain!

So what are they looking for?

First, they will examine your baby's head. Birth can be quite a physical strain for your baby as well as for you, and many babies end up with a slightly misshapen head as a result of their journey through the birth canal.

If your baby is a bit lopsided or conical, don't worry, it's perfectly normal. Their head is able to change shape because of the soft spots in their skull, a brilliant design which helps them arrive in the world. It's likely your baby's head will have settled into a more normal shape within 48 hours.

If your birth was assisted with forceps or ventouse, then your baby might have a bit of bruising. Again, this will be examined and noted – but bruising won't last for long.

Next, your baby's eyes and ears will be checked. Your little one might be surprised to have a bright light briefly shone into their eyes. It's so the midwife or doctor can see the 'red reflex' (which can be seen sometimes in photos taken with a flash). If the red reflex is apparent, then that shows your baby does not have cataracts.

Hearing is tested with two different methods. First there is the otoacoustic emissions (OAE) test. A small earpiece, containing both a speaker and a microphone is placed inside each ear. A clicking sound is played – and if the cochlea (inner ear) is functioning properly, the microphone should pick up a faint echo.

Secondly, the automated auditory brainstem response (AABR) test is performed and this records brain activity which occurs in response to sounds.

Three sensors will be placed on your baby's head and clicking sounds will be played to your baby through headphones. The equipment is attached to a computer and, if all is well, strong activity should be recorded when the sounds are played.

A few babies get referred for further hearing tests following these initial ones – but rest assured, if your baby is referred, it doesn't definitely mean they have hearing loss. What's more likely is the tests were not quite conclusive.

There are various reasons why the first results might not have been satisfactory. If your baby was awake when the tests were carried out, he or she might have been restless (or annoyed!), making it difficult for the computer to record the necessary responses.

Additionally, your baby might well still have have amniotic fluid in their ears, which could also affect the results. Chances are, when your baby is re-tested a couple of weeks later, they'll be fine – but if any hearing problems are diagnosed, it's much better they are found at an early age.

Once hearing has been covered, your baby's mouth will be checked. This takes just a few seconds – the midwife or doctor will be checking that your baby does not have a cleft palate. They will also lift your baby's tongue to look for tongue-tie, which can affect feeding and, later on, if significant, speech. If tongue-tie is discovered it can usually be treated easily.

Your baby's heartbeat will be checked. Many babies have little heart murmurs in their first few days of life but if yours does, it's unlikely to be any cause for concern. Now your baby is separate from you, their heart is working hard to circulate blood all by itself. It should settle down very soon.

Their lungs are working hard too. The doctor or midwife will use a stethoscope to check that both lungs are working well, and evenly.

Your baby's skin will be examined for birthmarks, and their hands and feet will be checked. The examiner will be looking for webbing, and also looking at the resting position of your baby's feet and ankles (an abnormality could be a sign of club foot). The palms of your baby's hands will be checked for their creases. Most babies have two creases in their palms – a minority have only one crease.

One crease in the palm can be a marker for Down's Syndrome – but if your baby does have Down's Syndrome, there will be other signs, as well, and you might well have known before they were born.

The examiner will look at your baby's genitals. Both boys and girls can have dark and swollen genitals for a short time after birth, and this is caused by your hormones still circulating their body. Both boys and girls can also have swollen breasts for the same reason, and girls might have a little vaginal discharge.

Boys will be examined to see that both their testicles are descended, and that the opening of their penis is at the tip, rather than underneath. Your baby's bottom will be checked to see that the opening is normal.

The examiner will turn your baby over to have a look at their back – they'll check that the spine is straight, and look for a little indent at the bottom of the spine, called the sacral dimple. Many babies have this little dimple, but if it is deep, it could signal problems with the spinal chord, in which case your baby will undergo some further checks.

The real pushing and pulling comes when your baby's hips are checked. Their legs will be manipulated backwards and forwards, to check their bendiness, and outwards, to check for what is know as 'clicky hips'.

It's important to check for hip stability at this early age, because clicky hips could lead to developmental displacement of the hip (DDH) which, if untreated, can cause complications down the line. For most babies who have clicky hips after birth, the problem sorts itself out of its own accord – but it's something to keep an eye on.

If your baby gets troubled by all this pushing and pulling, resist the urge to grab them back and make a run for the door (which is what your hormones might tell you to do!). The test isn't hurting them, it's just irksome.

Finally, your baby's reflexes will be checked – and these are ever so sweet to watch. The examiner might stroke the sole of your baby's foot, looking for their toes to curl (the Babinski reflex). They'll look for the grasping reflex by putting a finger in your baby's palm, and waiting for that finger to be grabbed.

The rooting reflex will be checked by stroking the side of your baby's cheek – they might turn their head in that direction.

The startle reflex will be checked by momentarily (and safely) removing support from your baby's head – they'll likely fling their arms and legs out, with fingers splayed.

And the stepping reflex will be checked by holding your baby upright, as if standing, with their feet on a flat surface – their little feet will start pedalling as if trying to take steps.

The stepping reflex doesn't last long in newborns – but in fact, when your baby is tested, they might not 'perform' all these reflexes. It doesn't mean there is anything wrong, they might just be preoccupied (hungry/tired), or irritated!

Most babies sail through their newborn check – for those showing signs of any potential problems, the check is done early enough that issues can be dealt with very promptly.

Your baby will probably be very pleased to have their check over and done with and be back in your arms. But they (and you) have one more little hurdle: the heel prick test before one week.

Often, a midwife will visit you at home to do this. After a chat and a weigh in, she will prick your baby's heel, to take a tiny spot of blood. This sample will be used to check for various rare illnesses, including sickle cell disease and cystic fibrosis.

Be warned, your little one might scream bloody murder, but try to process your absolute knowledge that it really didn't hurt all that much – and take the opportunity to practice a phrase you will probably say many times over the coming years: "It's all for your own good, darling!"

More on Parentdish: Your baby's first month

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