HealthPhone™: Newborn Physical Exam - Newborn Care Series
The baby’s exam is best done on the first day of life. The health worker carefully examines the baby's body systems for signs of health and normal function, as well as signs of illness or birth defects.
This video will demonstrate the exam in 3 parts: observation, vital signs and the head to toe exam.
Ask the mother if she had any problems during her pregnancy or birth. Ask what she has observed about the baby.
Explain to her that you are going to examine the baby to be sure he’s healthy. Tell the mother what you are looking for and give positive feedback as you come across normal findings.
First wash your hands; then clean the thermometer and stethoscope with antiseptic.
Keep the baby warm during the exam -- in a warm room, under a lamp, or in the mothers lap.
Observe the baby: Look at his color: his tongue and lips are pink.
Inspect his skin. A bluish area on the trunk is normal. Check for jaundice by pressing the skin on the forehead or nose; look for a yellow discoloration, best seen in natural light.
Check for pallor, a sign of anemia, by comparing whiteness on the baby’s palm with your palm.
The baby’s arms and legs are flexed and moving showing that his muscle tone and activity are normal. Check the hands and feet for extra digits. If there is no bone inside, tying the tag will eventually allow it to fall off.
Next check his temperature, breathing and heart rate:
Feel the baby’s trunk with the back of your hand, comparing it to your forehead. Or place a thermometer deep under the arm. The normal range is between 36.5° and 37.5° C.
Count the baby’s breaths for a full minute when she is calm. Breathing is normally irregular. The rate should be between 30 and 60 breaths per minute. Here is an example of a baby breathing too fast, with chest indrawing. Nasal flaring can be seen in some babies with breathing problems.
Count his heart rate for a full minute with a stethoscope if you have one. The rate should be between 100-160 beats per minute.
Now examine the baby from head to toe: Check the fontanels on the baby’s head. The anterior is here and the posterior is back here. They are normally flat but may swell a little when the baby cries.
It’s normal to have an uneven shape of the head due to molding from pressure of the birth canal. It usually goes away by 2 or 3 days after birth.
Check the baby’s eyes for discharge and abnormalities. This baby’s eyes are clear. Occasionally we see a spot of blood on the white of the eye due to the trauma of birth. This will go away without treatment. If the pupils are white the baby will need to be seen by an eye specialist.
With a gloved hand insert your fingertip into the baby’s mouth to check his sucking. Ask the mother if the baby has breastfed and whether he sucked well. A baby born with a cleft lip and palate won’t be able to suck and will need an alternative feeding method.
It’s normal for both girls and boys to have swollen breasts at birth from the mothers' hormones.
Gently press his abdomen to feel for softness. A swollen belly can be a sign of obstruction or infection. Notice that the cord is tied well.
Some baby’s are born with an umbilical hernia. As abdominal muscles mature, the hernia usually goes away by itself.
Turn him gently over and run your finger down the spine to check for openings or defects. This baby has a large spinal defect and will need surgery.
The anus is checked by the passage of the first stool. If no stool is passed within 24 hours the baby may have a blockage and will need referral. This baby was born with a closed anus that will require surgery.
Look at the genitals. In males we look for the urethra to open at the end of the penis. Feel gently for the 2 testes in the scrotum. Sometimes they have not yet dropped into the sac.
Females can have a white vaginal discharge and even a slight bloody discharge several days after birth.
Normal birth weight is 2.5 to 4 kg. Babies often lose a little weight in the first few days but by 2 weeks they should be back to their birth weight.
Reassure the mother that she has a perfectly healthy baby.
A thorough head to toe check is important in the baby’s first day
Keep the baby warm
Involve the mother and family by giving positive feedback as you check the baby.
This film demonstrates a newborn physical exam. It shows 3 parts: observation, vital signs, and the head to toe exam. It also shows normal variations and abnormal findings. The primary audience are frontline health workers in primary and district level facilities. This video was filmed in Nigeria and the Dominican Republic and produced by Global Health Media Project with support from USAID/MCHIP. visit us on-line at http://healthphone.org
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