ibabydoc.com - Newborn Well Checkup

NEWBORN CHECKUP

Physical Examination

The physical exam can be done either in the parents' room in front of the family or in the nursery. �
The nurse will typically check the weight, length and head circumference and plot these on a growth chart. This will determine the newborn's size compared to other newborns. The nurse will look at the physical characteristics of the infant and plot them on a scale to calculate the gestational age. �
A small baby in weight or length can be a sign of prematurity or growth retardation due to prenatal problems. A large baby can be a sign of an infant of a diabetic mother or obese parent. �
A head circumference smaller than expected, microcephaly, can be a sign of growth retardation or a congenital infection. �
A large head, macrocephaly, can be a sign of cephalohematoma (swelling over one bone of the skull), caput succedaneum (diffuse swelling under the scalp), or hydrocephalus (fluid in the brain). �
The temperature is checked to make sure it is not too low which can happen in small babies without a lot of body fat or too high which can signify infection.

A physical examination will include a head-to-toe evaluation.

The growth chart will be checked to determine the child's size. Abnormalities may include obesity, failure to thrive, microcephaly or macrocephaly.
The skin will be checked for any rashes, moles, lesions, birthmarks, discolorations, or jaundice.
The head will be examined to look for cephalohematoma, caput succedaneum, molding (abnormal shaping), and to be sure the fontanels, or soft spots, are open and of proper size. A closed fontanel can be a sign of craniosynostosis (fused bones of the skull), which would need to be corrected.
Any bruising from a difficult birth, vacuum extraction or forceps delivery will be noted. These will mostly resolve spontaneously but can cause jaundice as they're healing.
The ears will be examined to be sure they are equal in size, positioned properly on the head and that the ear canals are open and lead to the eardrum.
The eyes will be checked for a red reflex. This happens when light reflects off the retina as is seen sometimes in pictures. A lack of a red reflex can be a sign of a cataract or something obstructing vision. Also the eyes will be checked for strabismus (the eyes pointing in different directions). A blocked tear duct can cause watering, crusting, and discharge of the eye.
The nose will be examined for patency. Choanal atresia (a closed nares) can cause breathing difficulties in infants.
The throat is checked to look for cleft lip and palate, natal teeth (a tooth present at birth) and tongue-tie.
The neck is checked for thyroid enlargement, masses, tumors, torticollis, or cysts.
The clavicle is checked for any fractures, which can occur during a difficulty delivery.
The heart is check for rate, rhythm and abnormal murmurs.
The chest is checked for symmetry of the ribs any abnormal rib structures such as pectus excavatum (funnel chest).
The lungs are checked for normal breath sounds, respiratory rate and retractions. Any abnormalities of these can signify respiratory distress needing immediate treatment.
The abdomen is checked for bowel sounds and is palpated deeply to check for any enlarged organs such as kidney, liver or spleen or any masses that can signify tumor. The baby is also checked for hernia, which can happen at the umbilical cord (umbilical hernia) or in the inguinal area (inguinal hernia).
The hips are checked for instability or dislocatability. If there is hip instability either an x-ray or ultrasound can be performed to look for hip dysplasia.
The genitals are checked. In a male, they're checked to make sure that both testes are in the scrotal sac, that the penis is of normal size, and that the urethra comes out of the very tip of the penis. If the urethra comes out of the side of the penis this is called a hypospadius and will need surgical repair. On a female the genitals are checked to be sure there is no imperforate hymen. A bloody, blood-tinged or milky white discharge from the vagina is normal in the newborn female.
All extremities are checked for symmetry and movement. A difficult delivery can cause Erb�s Palsy or Klempke�s Palsy, which are a temporary floppiness of one arm due to nerve compression during birth. These will resolve spontaneously.
The pulses are checked to ensure normal blood flow.
The fingers and toes are counted to look for extra or missing digits.
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. Prenatal folic acid supplements will usually prevent this.
The anus is checked for patency and size.

Click Here
For More Info

Dr. Bornstein's book is here. You can now purchase all of the information from ibabydoc.com plus more in book form. Understanding Children's Health is over 400 pages long and includes illness, well checks, vaccines, safety, growth and development, and more. To purchase Dr. Bornstein's book, please click on the link.

design by iwebsight.com solutions