With the pediatrician hunched over the newborn baby, listening with that tiny stethoscope, poking and prodding, many parents probably wonder, “What exactly is he looking for?”
If surely can be a source of anxiety for parents as the doctor listens intently to their newborn’s heart or examines his eyes. It is probably at times also a source of confusion, as it is not always obvious for what we are searching. For those times when we fail to completely explain ourselves, the following can serve as a sort of play-by-play for the most important parts of the exam.
The first newborn exam, while usually entirely normal, is still of great importance. It can offer much information regarding the baby’s general health and development. Here are the highlights from head to toe...
We’ll start with the overall appearance of the baby. Is he alert and active, or lethargic? Is he pink, pale, or blue? And is he comfortable or in any distress? The general appearance is very important, allowing the examiner to make a quick assessment of whether or not he is dealing with a sick baby.
In examining the head, we will check for things like molding (the cone-shaped head), lumps in the scalp from either swelling or small blood collections resulting from the delivery process. We will also check the fontanel to make sure it is of a normal size and soft. Finally, it is important to check the circumference of the head to determine whether it is abnormally large or small.
Some babies will develop subconjunctival hemorrhages, or small spots of blood in the white parts of the eyes. These are not uncommon and occur during the birthing process. They will reabsorb in about 2 -3 weeks. We also check the pupils with a special instrument to make sure there are no cataracts or other abnormalities within the eyes.
In checking the ears, we are making sure they are normally formed. It is not uncommon to find some minor deformities about the ears, such as small skin tags in front. The tops of the ears are sometimes folded over, but that resolves with time.
Important things to examine in the mouth include the palate, to make sure it is fully intact (no cleft palate), the gums, assessing that no teeth are present, and generally to determine that the structures are normal.
After observing the baby breathe to ensure there is no difficulty, the breathing rate will be checked, and the lungs listened to with the stethoscope. We will listen to determine that the breath sounds are clear and equal on both sides.
This part of the exam always seems to make parents most anxious. What we are listening for is that the heart rate is not too fast or slow, that it is regular and whether or not a murmur is present. This is an important part of the exam, as a number of very serious heart problems are possible with certain types of murmurs. We may take extra time here!
Here we are making sure the liver and spleen are not unusually large, and that there are no masses felt. A large mass in the abdomen could be something like an enlarged kidney, and would need to be evaluated further.
Here is another very important part of this exam. Some babies are born with hips that are dislocated. The doctor will rotate the thighbone in the hip joint to make sure no “clunks” are felt, as this would represent the thighbone coming in and out of place.
Both boys and girls will be examined to make sure the genitalia appear normal, and for boys, that both testes are down in the scrotum. The testes are up in the abdomen early on in fetal development and need to migrate down to the scrotum. It is important to know as early as possible if either testes are not in the proper place.
There are a number of normal newborn baby rashes that are of no concern. Things that would be suspect would be a very pale or blue baby, one who has already developed jaundice (yellow skin) on his first day of life, or an unusual appearing rash.
Of course, this is not the entire examination, only the highlights. But, as you can see, it is quite thorough. Although the majority of newborn babies are perfectly normal, it is still important to go through this examination in order to pick up subtle abnormalities. And because it is so detailed, you can be assured that a baby who passes this exam is off to a great start!