Six week baby check

By Catherine Locke
GPST1
 Aims
• Background
• Physical examination – important diagnoses
and referral options
• Review of development – growth charts
• Health promotion
• Supporting parents
 Background
• NHS Newborn and infant physical
examination Programme.
• Offers an examination within 72 hours of
birth and again 6-8 weeks later1.
• Purpose is to screen for abnormalities,
monitor development and provide support
for often worried parents.
 Systematic approach
• Top to toe
• Quiet, warm room with all equipment to hand.
• Parents can be anxious so explain what you are
about to do & reassure during the procedure.
• Examine exposed parts first e.g. fontanelle.
• Undress baby so that you can do a thorough
examination.
• Do heart/eye examination first and leave hip
examination to last.
 Common skin complaints
Erythema toxicum – blotchy
red rash with associated
yellowish pustules. Settles
with no treatment.

Milia – benign keratin filled

cysts.
 Birthmarks
• Mongolian blue spots – particularly
over the sacrum / buttocks are
extremely common.

• Small port wine naevi and Strawberry

naevi generally require no treatment.
They grow for 6-12 months before
gradually fading within 5-8 years2.

Large unilateral port wine stains can be associated with intracranial

vascular anomalies2 and further imaging/review may be required.

Large disfiguring birthmarks need reviewing by a senior paediatrician

to discuss further management options
 Neurological
• Inspect spine for sacral dimples / hairy
patches. If unable to identify base of dimple
refer for spinal USS2.
• Tone – when pulling babies to sit from supine,
babies should be able to attempt to raise their
head.
• Social smile / normal cry
• Hearing – startles to noise
 Facial features
• Measure head circumference. Is it a normal
shape?
• Eyes – check for bilateral red reflex
(retinoblastoma)
• Cleft lip/palate – refer cleft coordinator LGI2
• Ears – pre auricular skin tags – plastic
surgeons2
• Neonatal tooth – orthodontist2
Cardiovascular/Respiratory system
• Rule out congenital heart
disease.
• Inspect for cyanosis or
respiratory distress.
• Palpate apex for
displacement.
• Listen for murmurs & check
for equal air entry.
• Palpate for femorals –
diagnose coarctation of the
aorta
 Hands
• Polydactyly – if bilateral can
be associated with renal
abnormalities so a renal US
should be arranged2.

• Syndactyly – if there is
fusion of the bone refer to
a hand specialist / if not
refer to the plastic
surgeons2
 Abdomen / hernias
• Umbilical hernia – common and usually
resolves by 18/122.

• Inguinal hernias are rare in term, newborn

infants2. If diagnosed they need early
surgical intervention as they are at
increased risk of incarceration .
 Developmental dysplasia of the hip
Risk factors: breech presentation, FHx of DDH require USS of
the hips2.

Barlows – flex and adduct

each hip then push the hip
posteriorly keeping your
fingertips on the greater
trochanter. Feel for the
femoral head slipping out of
socket.

Ortolani’s – gently abduct the

hip fully – feel for the femoral
head slipping back into joint.
 Genitalia
• Ambiguous genitalia – don’t guess! Refer to a
consultant paediatrician.
• Undescended testes – most will descend in the
first few weeks post delivery. If undescended by
1 year old referral to surgeons is needed2.
• Hypospadias – urethral meatus opens in an
abnormal position. Ensure that baby can pass a
good stream of urine2. Need referral to
paediatric urologist.
 Development /health promotion
• Review feeding and weight gain.
• Plot on growth chart length, weight and HC.
• Note centiles.
• Take the opportunity to discuss
- Immunisations
- Reducing risk of sudden infant death
- Dangers of passive smoking
- Car safety
- Dental health
 Parental support
• Take the opportunity to ask if there are any
specific concerns about baby.
• Consider maternal health e.g. evidence of
postnatal depression.
• If any referrals are warranted then explain to
the parents clearly why they are being
referred and what will happen next.
 Summary
• Important screening tool if conducted in a
systematic and thorough way.
• Act confident and establish good rapport with
parents.
• Explain reasons for referrals and what the next
steps will be.
• Take the opportunity to discuss health
promotion.
Any questions?
 References
• 1) NHS Newborn and infant physical
examination programme. Frequently asked
questions.
http://newbornphysical.screening.nhs.uk/faqs
#fileid10637 (Accessed 24/10/12)
• 2) ANNP Office. Common problems in the
healthy neonate.Calderdale and Huddersfield
NHS foundation trust, 2011.