Articles - Your Well Child

Physical Examination

Height, weight and head circumference should be plotted on the growth chart and development should be checked.

The weight is checked to be sure that the baby is gaining weight properly. Typically a baby will lose 10% of their birth weight between four to five days of age, regain birth weight by two weeks of age and then gain a pound every two weeks after that.

If the baby is losing too much weight or not gaining properly this is called failure to thrive. The reasons for this can be discussed. These reasons include not eating enough food, not mixing the formula properly if the baby is formula-fed, or difficulty with breast-feeding, including improper technique or poor supply of breast milk. Gastroesophageal reflux can cause poor weight gain, and pyloric stenosis can still be a possibility although this is the outer age limit.

If the baby is gaining too much weight then feeding history can be reviewed to determine if feeding is being done every time the baby simply needs to have their suck reflex satisfied with either a thumb or pacifier.

The head circumference is reviewed to be sure that it is not too large (macrocephaly) or too small (microcephaly). Remaining cephalohematoma (swelling over one bone of the skull) can cause macrocephaly at this age. Caput succedaneum (diffuse swelling under the scalp) and any molding should be nearly resolved. A hydrocephalus (water in the brain) can also cause an enlarged head. Microcephaly can happen from a congenital infection, a small baby, or can be a sign that the skull is not growing properly due to craniosynostosis (premature fusion of the bones of the brain).

Flattening of the occiput (the back of the head), or shaping of the skull happens frequently due to sleeping position.

The temperature is checked to be sure that it is not too high, which can be a sign of infection or over bundling of the baby or too low which can be a sign of poor temperature instability from low body fat or a sign of infection.

The examination will include a head-to-toe evaluation.

The skin is checked for rashes, moles, lesions, or birthmarks.

The head is checked to be sure that there are not any abnormal lumps or bumps and that the head is growing properly and of proper size.

The ears are checked to make sure that there is normal positioning on the head, that the ear canals are open and lead to the eardrum and that the eardrum or tympanic membrane is of normal shape, color and movement.

The ears are checked to make sure that there is normal positioning on the head, that the ear canals are open and lead to the eardrum and that the eardrum or tympanic membrane is of normal shape, color and movement.

A blocked tear duct can cause watering, crusting, or discharge. Message techniques can be taught.

The nose is checked to be sure that the nasal canals are open. Most babies at this age are breathing through their nostrils and any difficult breathing patterns can be a sign of a closed nares or choanal atresia.

The throat is checked to look for cleft lip and palate, natal teeth (a tooth present at birth) or tongue-tie.

The neck is checked for enlargement of the thyroid, any masses, cysts or torticollis.

The clavicles are checked to be sure that any fractures from birth are healed.

The heart is checked for rate, rhythm, and for murmurs.

The chest is checked for symmetry of the ribs, and any abnormal rib structures such as pectus excavatum (funnel chest).

The abdomen is checked for bowel sounds and is palpated deeply to check for enlarged organs such as kidney, liver or spleen or any masses that can signify a tumor. The abdomen is also checked for an umbilical hernia or inguinal hernia.

The hips are checked for instability or dislocatability. If there is a hip instability either an x-ray or ultrasound can be performed to look for developmental hip dysplasia.

The genitals are checked to look for any abnormalities. In a male both testes will be palpated to be sure that they are in the scrotum and the penis will be checked for normal size. The urethra should come out of the tip of the penis. If it doesn't this is called a hypospadius, which will need surgical repair. The scrotum is checked for a hydrocele (fluid in the scrotum). In a female, the vagina is checked for any labial adhesions or imperforate hymen. A milky white or blood-tinged discharge is normal.

All extremities are checked for symmetry and movement. Any difficulty such as Erb's Palsy or Klempke's Palsy, which are floppiness of one arm due to birth trauma, should be resolved at this point. If not a visit to the physical therapist may be indicated.

The pulses are checked to look for normal blood flow.

The fingers and toes are checked for proper blood flow, shape and size.

The feet are checked for clubbing or abnormal shaping.

The infant's reflexes, strength, head control and tone of the body are checked to look at the overall neurological status.

The back is checked to look for neural tube defects, which are openings along the spine.

The anal canal is checked for patency and size.

Any questions, parents, can be answered at this time.