1. Introduction
As parents, you naturally want to make sure that your baby is fit and healthy. The newborn baby check is the first time someone, other than the baby’s family, has performed a health assessment and so it is natural and normal to want to prepare. You may be new to the healthcare system and feel quite uncertain about what to expect. Or you might be an experienced parent but believe that when it comes to your baby you can never have too much information! The newborn baby check is an opportunity for you to talk to a professional about any concerns you have about your baby’s health. You may need to ask more questions than the professional has time to cover, or some parents may have no questions at all about their baby’s health. This article may help those parents who wish to become better informed about what happens during the newborn baby check while reassuring all parents of the benefits of newborn check and how the experience will unfold.
1.1. Purpose of Newborn Checks
The purpose of these checks is manifold. The first and foremost is to make sure the baby has enough fluid or gets enough fluid. Babies need breast milk or formula milk to ensure they stay hydrated. If a baby is dehydrated, it can lead to serious medical infections. The body should not have too much fluid either. If the baby has more fluid than what their body can handle, the baby might have fluid build-up that may cause water in the brain. This is a dangerous medical emergency called “water in the brain,” put simply. Another important aspect of newborn checks is similar to regular check-ups that grown-ups undergo – they need to get rid of waste products in the body. Unlike grown-ups who get rid of fluids and other waste products in the form of urine or sweat, newborn babies get rid of these in the form of a substance called meconium.
Antenatal classes cover topics like pain during labor, stages of labor, and breastfeeding, all of which are necessary for preparing you emotionally and physically for labor and care of the new baby. However, they sometimes do not cover the important check-ups that a newborn baby should receive. Newborn checks are essential to ensure that the baby doesn’t suffer from any imbalance in fluids and gets rid of any waste products in the body. This article highlights 10 important checks that newborn babies should follow in the first few days and weeks of life and gives a brief description of why these checks are important. The post is meant to be used as a quick checklist for new parents.
2. Physical Examination
The cost of carrying out an appropriate physical examination can be high for busy clinical staff because it requires time, attention to detail, and skill to draw accurate conclusions from a varied group of examinations. Because of the need for specialized training and the complicated range of checks, most services use highly trained staff members or nurses to carry out the examination. It requires much competence and practice to ensure that the examination is carried out competently, since it needs to balance being very thorough with fast, reliable treatment. Any evidence of abnormality or potential problem must be noted and communicated to the baby’s medical team. In conditions like retinoblastoma blindness can be prevented or minimized if the issue is told early to a pediatrician.
The physical examination will check your baby’s physical development against what is considered normal at that age, as well as looking for signs of congenital defects or abnormalities. The examination should include all areas of development, including checks of skull shape and development, body tone, reflexes, and skills such as hand grip strength or sucking reflexes. Your baby’s eyes, ears, heart, and skin will be checked, along with other physical features. Children of this age are not able to actively participate or assist with the exam, so it is essential that the examination takes place in a carefully standardized way to ensure consistent results. It is important that both the fontanelle and ears be checked over. Some studies have suggested that it is important to inspect the ears before examining other parts of the body to ensure that any fluid in the ear has not interfered with results.
2.1. Assessment of Vital Signs
Assessment of Vital Signs: The vital signs for a neonate are different from those for an adult. The nurse should repeat the assessment performed by the obstetrician and obtain the pulse rate and temperature at every visit, as well as monitor respiration and blood pressure. The pulse rate can be counted by auscultating the apical area or palpating the brachial or femoral artery. The apical rate is generally considered a faster route than peripheral pulses. The normal pulse rate for a newborn ranges from 120 to 160 beats per minute and remains on the higher side if the infant is crying or not yet crying. To measure the respiratory rate, one should observe the chest to count the rise and fall of each breath for at least one minute. The normal rate for a newborn may be irregular and range from 30 to 60 breaths per minute. The acceptable and desired range for an infant is indicated on an infant’s BP scale. The fact is most newborns will never need to have their blood pressures taken.
Physical examination is an evaluative process that often uses the eyes, ears, and touch to detect changes from normal. The first goal is to evaluate the patient’s general state of health; this includes skin color, signs of acute or chronic distress, and state of nutrition. The patient is observed for signs of acute or chronic diseases. Vital signs, usually defined as temperature, pulse, respirations, and blood pressure, are often considered as the baseline of health. Most often, the patient’s chest is inspected to evaluate the respiratory status and listen to the breath sounds. The otoscope and penlight are both part of the examination used to enhance the practitioner’s senses of hearing and sight. Other physical examinations involve inspection of the head, eyes, neck, ears, abdomen, musculoskeletal system, and nervous system. Because children grow so rapidly, the physical examination is the best chance health care professionals have to identify problems.
3. Weight and Measurements
Your baby will be weighed and measured at the newborn check. Weight and length measurements are most important and telling at your newborn check. Around 10-14 days, nursing professionals will request a baby check. Family nursing professionals should execute the test two to three days following discharge from the hospital in the first 24 hours when home birth has been conducted. Place and ensure that this check is placed between 10-14 days after birth. This check also involves getting the newborn baby a second hearing assessment. The checks are standard processes that form part of the National Screening Program. At the baby check, the medical professional should offer detailed explanations as well.
Between birth and 10 days after birth, your baby will have their newborn check. This check can last up to 72 hours. Your baby’s newborn check will then take place between 10 and 14 days after birth. The check will involve measuring your baby at different levels. It is good for parents to be informed as to what these checks involve. Weight and measurements will be taken. This is important as the medical professional will need to know the rate of growth chart development and will also be able to detect any concerns or problems. 90% of the time, the baby’s weight, length, and head circumference are alright.
3.1. Growth Charts and Percentiles
For Head Circumference percentile, aspects of cognitive development and the presence of neurologic and systemic illness can be influenced and can be related to the rate of change in head circumference.
For Length percentile, the speed of length growth, necessitating the requirement for regular assessments, is also of great significance as the timing of introduction of complementary food depends greatly on this parameter. Furthermore, the extent of length-for-age growth failure reflects enduring nutritional insufficiency in the home environment.
Percentile measurements compare your baby’s growth against other babies of the same age and sex. For Weight percentile, the importance of exclusive breastfeeding for the initial 6 months needs to be highlighted. More specifically, health benefits are the greatest for babies born to HIV-infected mothers, babies being small for gestational age, and preterm babies – regardless of whether they grow as per the percentile or not.
As a parent, you can contribute greatly in corroborating these measurements with those documented in a Home-Based record or Health Cards. You can chart out growth or percentile rates at home and question your pediatrician in case you feel alarmed about some fluctuations in growth percentile over the months or at any given point in time.
Growth charts are indicative of your baby’s development and well-being. When your little one undergoes the newborn or a postpartum check-up, the pediatrician will weigh your baby in order to track the baby’s growth in terms of weight, length, and head circumference. Besides weight, length, and head circumference measurements, the rate of growth as well as the baby’s growth percentile, which has been recommended by the renowned World Health Organization (WHO), are also necessary to be checked.
4. Feeding and Nutrition
Supplementation – Iron – Your baby will likely need additional iron when baby is between four and six months. The need and when to start and how much will be calculated based on the type of milk you are feeding (breast milk or formula) and how much milk you are feeding baby. Timing of introduction of solid food – Delaying the introduction of solid food is associated with the increasing incidence of food allergies. Data is constantly changing in this area as new research on this important topic is constantly being done, and your practitioner will provide you with the latest information.
Here are a few important questions regarding baby’s feeding and nutrition habits that the healthcare practitioner will discuss with you: How are you feeding baby? Are you breastfeeding? Your practitioner will coach you regarding proper positioning of baby and latching. Are you bottle-feeding? Proper technique will be discussed. Iron-rich food like baby’s first food. Here you will be coached about when and how you will transition to baby’s first solid food. It will most likely be an iron-fortified single-grain infant cereal. Vitamin D drops – The need to supplement with vitamin D drops from the age of one month to two years. If you are formula-feeding, the need to feed baby with a vitamin D fortified formula every day.
4.1. Breastfeeding or Formula Feeding
Are the baby’s bowels and wind normal? Is your baby passing meconium (the initial sticky green stool made in utero) and are the stools changing in color, texture, and number with time? What needs to be observed in the nappy about the wind? The first 6 weeks can be a learning curve for parents in understanding the various sounds that a baby makes. In time, you will be able to distinguish between different cries and be able to recognize a hungry cry. If the baby is crying a lot, it may be that they are hungry or they have a full nappy. Then the mom or dad may feed their baby or change their nappy. The baby’s comfort takes priority over the schedule, and by responding to your baby’s needs, you will help them to feel secure.
Breastfeeding or formula feeding? Are the feeds “comforting” as well as feeding? Is the baby’s latch-on correct (ideally you should be pain-free)? Have the nurses fed your baby? If you are formula feeding – have you been shown how to sterilize bottles, prepare formula, and also interrupted during feeds for cuddles? Is your baby producing wet and soiled nappies? Does your baby demand very frequent feeds? (The actual frequency of feeds varies depending on the age of your baby, your baby’s weight, and the advice you have been given. However, if the interval between feeds is often less than 1-1.5 hours, then a breastfeeding baby is perhaps not feeding well. If unsure, feed more often and seek advice.) Does your baby seem settled after a feed?
5. Developmental Milestones
As children grow older, they meet certain expected milestones, or developmental stages. For example, learning to roll over and crawl usually precedes learning to walk. Learning to eat with a spoon and making sounds usually come before speaking. Building blocks are often the first stage of what will later be academic learning. Each baby achieves these milestones in his or her own way and own time. Therefore, children grow and develop at different rates. The most important part is that each child progresses in a continuous pattern. Like seeds in a garden, children bloom at different times and sometimes take different shapes. A one-centered ruler to the child might put the child’s development at risk.
Your child’s first twelve months are usually marked by many firsts. Parents usually eagerly look forward to these key developments in their baby’s abilities during their child’s first year. Rolling over from tummy to back, then from back to tummy, sitting, babbling and cooing, rolling a ball, responding to his or her name, crawling, clapping, scooting, using thumb and index finger together, understanding “no”. Each and every baby grows at his or her own unique pace. The most important part is that your child attains each of these milestones one after another. You should not be concerned about his or her ability to stand, walk, talk, and begin basic learning skills. Each individual develops at his or her own pace – you should not compare your child to others and parent at your child’s own pace.
5.1. Motor Skills
From birth, a baby’s brain is able to control their movements. Newborn reflexes are signs that the nervous system is functioning. There are hundreds of reflexes; some of these are present at birth and fade as the baby matures. Other reflexes are inhibited at the time of birth and appear later. For newborn babies, the movements occur because of primitive reflexes. These are helping the newborn baby to develop voluntary control over their body. Most primitive reflexes disappear by the age of 6 months; some persist longer. The baby’s Babinski reflex, stepping reflex, and grasp reflex affect motor development. It is important to identify any neurological problems as soon as your baby is born. Parental concerns begin with any concerns about clumsy movement patterns, delayed gross motor skills (pushing back his head while lying on his stomach, pulling to stand, sitting unsupported, rolling over, or moving in leaps or series while scooting on his tummy), or persistent asymmetrical motor patterns (holding his head in the same position or favoring one side).
6. Hearing and Vision
Hearing tests were done right after birth or before you are sent home. Many babies are tired or sleepy at this time, so it’s normal for a baby to not turn towards the sound the first time the test is done. What concerns might I have in the future? Possible reasons for hearing loss in the baby: Meniere’s disease, when part of the ear inside is swollen and secretes a lot of mucus, preventing a normal hearing process. Ear or head injury. High fever or severe cold or flu. Family history of hearing problems. Pregnant women who take drugs like ‘quinine’, ‘streptomycin’, ‘ifosfamide’, ‘gentamicin’, and ‘vancomycin’ would increase the incidence and severity of hearing impairment in infants. Always check both eyes. If you only check one eye, you could miss some serious problems. All children can see very small and light things at birth. Hearing or vision is closely related to your baby’s muscle development and neck flexibility. A doctor’s assessment after birth and follow-up appointments can solve any of these concerns. Be calm, and be prepared to answer any of the questions above for doctors.
Were any hearing tests done? If so, did your baby pass? Are there any concerns or family history that might affect your baby’s hearing? Are both of your baby’s eyes clear and symmetrical? Can you see the white part of both eyes? Are the pupils black and round? Can the pupils of the eye move in the correct direction regardless of the level of light? When light is shone into your baby’s eyes, do both pupils shrink? If a light is shone from the side, are the pupils still the same size? If your baby cries, can you find the direction of the sound? Can your baby focus on faces or black and white pictures? Is your baby’s neck flexible? If baby is able to lift their head, can they follow someone’s movements with their eyes?
6.1. Hearing Tests
Newborn checks are a series of assessments carried out in your baby’s first days of life to ensure that he/she is healthy. The person conducting this check could be the doctor, a registered nurse whether it is hospital-based or community-based, or your midwife. They are to assess your baby’s overall appearance and look for immediately obvious problems. They also can help you manage the initial care and help you keep your baby safe at home, so it is important to receive the leaflets in the discharge package that contain information about the gross and fine motor, vision, hearing, social/emotional, and speech and language development milestones. With the advent of universal newborn hearing tests, many parents are coming to expect that this test will be done at this check, even if they were not told about it. Yet there is considerable variation in the nature of newborn checks, and it is important to be well informed about this test in advance. The newborn checks are usually conducted when your baby is 2-3 days old, and you should be informed about the tests in advance. Remember! Your baby is unique, and not all newborn checks will apply in every case. It is important for the registered nurse to offer information that relates to your child specifically.
Regular weighing and examining of your baby helps to ensure that he/she is healthy and able to develop to their full potential. A baby’s newborn check is the only chance you will get to look for hidden problems that may not be immediately obvious in your new baby. Nearly all babies are born healthy, enjoy breastfeeding, gain weight at a good rate, and develop normally, but a small number will need a little extra help in the early days. These checks could just confirm that everything is going well for both of you, and they are another opportunity to ask important questions and get early advice and guidance in many areas such as feeding and development.
7. Immunizations and Vaccinations
In the very beginning, babies sometimes receive a vitamin K shot shortly after they are born. If your child is breastfeeding and has a specific condition that interferes with their body’s ability to absorb vitamins, then your baby’s healthcare provider may also prescribe vitamin D supplementation. If your baby is formula-fed, they will receive these vitamins through formula. Once your baby is over the age of six months, Canada’s recommendations will suggest giving your baby a supplemental vitamin D.
When parents and family members read about what to expect at a newborn check from a baby or parent booklet, immunizations or vaccinations tend to get a lot of attention and perhaps even a bit of a bad rap. This is understandable. In Canada, we are fortunate to have an immunization schedule that is monitored and updated so that children can be protected from many diseases. In the early years, there may need to be visits to different healthcare providers, such as doctors, for the immunizations. COVID-19 has also made getting your child’s vaccinations feel like a particular challenge, but it’s important to know that there are guidelines for safely doing this.
7.1. Recommended Schedule
1. All healthy babies should be protected from infections by breastfeeding and staying up-to-date with their immunizations. 2. Cord, skin, and eyes should be checked before discharge from hospital. 3. Cord and skin may be checked again at 3-5 days after birth if you are discharged from hospital early or live out of the area. When you and your baby leave the hospital, your baby should look like this. 4. There are certain things that it is better if you do not notice about your baby because you will not be able to do them normally. 5. Ask to have everything about your baby explained to you when it is first done to your baby. Ask what is being done and why. 6. Babies change rapidly in the first few weeks of life. Your baby’s next clinic visit will be at 6 weeks of age and each month after that until age one year.
Congratulations on the arrival of your new baby. This is a joyous but tiring time for you. Your baby is rapidly adapting to life on the outside and you are learning about your baby’s needs. Birth is a health risk for both you and your baby. You and your baby will need to have regular check-ups with a health professional. The routine newborn check is the first of these visits outside your home. First, there are a few issues that relate to these checks. They are the recommended schedule for these checks, who will do each check, and which problems your baby will be checked for. Monthly checks are conducted by a Well Baby Clinic nurse or by a doctor.
8. Skin and Hair
The lanugo hairs will fall out. It may worry a mother who finds lanugo hairs in her baby’s clothes. She could assume it was an infection of some sort or not remove lanugo. Generally, there will only be fine hairs like those on a peach’s skin after a few months. If one in a thousand has an abnormal amount of hair at the end of their first year, then it is usually caused by the roots responding more than the hairs. Just ask a doctor if the amount of hair worries you. Be especially cautious of protecting your baby’s skin and eyes from too much heat. Too much sun quickly makes baby’s skin red and sore. Babies lose heat very easily, so an infant can be sunburnt in as little as half an hour.
The skin may be greasy and peeling, sometimes with white lumps of cheese-like substance on the body. Most babies lose their initial covering of fine hair (lanugo) soon after birth. Have a closer look if you want. You may notice some downy hair on the back of the baby, especially near the shoulders. There are also fine downy hairs on their forehead and in and around their ears. If these observations worry you, ask a doctor. They will explain that the hair and greasiness are due to a slightly early birth. They won’t worry about it as the baby is using them to adjust to life outside mother.
8.1. Common Rashes
Other babies may have tiny white pimples on their face during the first month. This is particularly common around the eyes and looks a bit like whiteheads. Medical intervention is not usually required and again, in due course, the condition will resolve.
Erythema baby acne (pimple) on the face of a young child is relatively common. This often looks like a rash of larger pimples. Very often, having a good wash is enough as the condition will resolve on its own. However, you should not use acne treatments unless your healthcare provider has told you so. Some babies can briefly have pimples on the scalp. This is sometimes called “baby acne” and is believed to be due to changing hormone levels as the baby adjusts to life after childbirth. Apply hydrocortisone 1 percent cream, if necessary. There’s no sensation.
Milia, also called milk spots, is the term for a rash of small, pearly-white bumps on a newborn’s nose, chin or cheeks. Milia can also appear on the baby’s gums and the roof of the mouth. The shallower variety of milia occurs in about 40 percent of newborns and heals on its own after several weeks.
Erythema toxicum is a common rash and usually occurs in the first few days of life. The baby may have a raised red rash and, sometimes, little white spots in the middle. Any area can be affected. The rash may come and go and appear in another place. Many babies are not bothered by this rash. Medical intervention is not usually needed.
9.Umbilical Cord Care
When the baby is wearing a diaper, you can fold it below the umbilical cord, leaving the cord open to air. Many disposable diapers are designed with a cut-out area where they fold to keep the button exposed. If you choose to use cloth diapers, you can place one under the baby and tie it with gauze strips. This creates a silk-like cone-shaped sheath in which to cradle the stump and keep it exposed to air.
Keeping a newborn clean is vital. Mother Nature has equipped all mothers with the best natural soap: breast milk. For the best results, clean the umbilical cord area with breast milk. It is safe, natural, and works wonders. If you are still worried, gently clean the kernels (the little yellowish lumps), but please don’t use your own antiseptic, powder, or lotions. Despite what well-intentioned relatives may advise, it is not recommended to use alcohol or hydrogen peroxide. Scientific studies have found that applying these substances to the umbilical cord can actually delay healing. Just keep the area dry and open to air.
9.1. Signs of Infection
The most reliable measures of the baby’s temperature are the ear (tympanic membrane) or the bottom (rectal), which are the nearest to the core body temperature. Once you have a measurement, you should check the temperature on a temperature guide. Of course, if you believe that your baby is feverish or has an infection, it is best to contact your doctor immediately rather than spend time searching around the ‘Panic Guide’.
The idea of an infant with an infection is very distressing. It is, however, relatively easy to ascertain if there is an infection, and some minor infections such as conjunctivitis (sticky eyes) will not worry your doctor too much. Virtually all infections present themselves with a fever. In a small baby who appears unwell and seems to have a raised temperature, you should look in the nappy to check that the baby is not hot or cold, to see if they are comfortable. It is, however, also important to check the baby’s temperature. This is easy to do and is accurate with any of the new digital thermometers available.
10. Follow-Up Care
After what seems like the very long wait during labor and delivery, your newborn baby is finally born. Congratulations! You can now finally hold your precious little baby in your arms. After your baby is born, the medical personnel checking out your new addition to your family will complete a variety of tests and procedures known as the newborn check. These are tests to make sure your baby is healthy. They will also check to ensure your baby is developing just as they should. In most cases, this newborn check is the first of many important appointments for your newborn. Some are scheduled ahead of time, while others will come as needed. However, be sure to bring your new baby to all of the appointments or tests recommended by their pediatrician. This way they can get the best start in life possible. If you have a newborn check coming up, you may want to use this handy newborn checklist of items to have, ask about, and discuss with your baby’s pediatrician or relevant medical staff.
You may have follow-up care instructions, especially if your baby’s pediatrician has any concerns about his/her overall health after your baby’s newborn check. Make sure you understand any and all instructions given to you before heading home with your newborn. Ask questions if you have any, as your baby’s healthy growth and development is of utmost importance to you and medical staff alike.
10.1. Importance of Well-Baby Visits
This initial check is an opportunity to have your baby examined and tested while you are in the safe environment of the healthcare provider’s office. At this time, your baby’s health can be assessed in case further intervention or treatment is needed. Your baby’s provider will also be able to give you advice about taking care of your baby based on its specific health needs. This is a time of many new things and likely many new worries. Please don’t hesitate to ask a lot of questions. This information should also help answer some of them. Let’s get you off to a good start.
An important part of keeping your baby safe and healthy is taking your baby for regular check-ups. Soon after your baby is born, we encourage you to make an appointment for a baby assessment. Your birth hospital may have arranged for a doctor examination before you go home. If you are still pregnant and are looking for a pediatrician, it’s a good idea to start researching well baby doctors. Ask other parents, family, and those in the health and childcare industries who they are and who they recommend.
11. Parental Concerns and Questions
You know your baby better than anyone else in the world. When something is going on with your baby, you will recognize that. If you do not feel comfortable with the answer you were given or if you feel there is something else you should have been asked but were not, ask more questions. If a diagnosis is not being entertained for your baby’s condition, then get another opinion. This is the quickest way to make sure that a diagnosis is not being missed. Be honest and open with the baby’s doctor and the care your baby receives will be that much better.
If you have any concerns or questions, no matter how trivial or complex they may seem, ask your baby’s doctor. You should feel comfortable with the care your baby’s doctor provides for your baby and with the answers to your concerns or questions. If you feel that something is being overlooked in the management of your baby’s care, then you need to express this concern to the baby’s doctor before you leave the clinic. If the baby’s doctor is not listening, then a second opinion is often the next best option as long as it is done in a non-accusatory way. With complex questions and concerns, consultations with experts in the field involved are in order.
11.1. Creating a List of Questions
Today we focus on the actual baby work of finding a doctor accredited to provide medical care for your baby and your baby’s siblings. This means you and your family can stay at that practice. And on which day post birth you need to hear your voice confidently on the phone, or have someone else who knows the answer confidently phone to book your baby in for the first doctor’s appointment.
I know you can’t talk, but you can spread a message of hope – giving some “hope” or some comfort to my struggling new mum friends. What message of hope or comfort would you spread in your baby cuteness and gurgles? Get those questions ready – write them down. When you can ask, ask. How are you going?
When do they want you to come? The first newborn check can be between day 3-4, or 5-7 days post birth. Sometimes it might occur at the hospital before your baby is discharged. There is not a definitive correct timing, but the big thing is to have that appointment time booked in, confirmed, and that you know when it is.
Everything is very new and you may feel tired post birth, or simply so overwhelmed by all the new information and experiences along this new journey. Have your questions written down, and when can do so – or when you do remember, ask. We are there to help!
Interested in discovering more? Visit us for further insights!
References:
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