Malady Wise

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Newborn Check

Maladywise

Reference

Birth History

  • Pregnancy

  • Birth

  • Early neonatal period

  • Check if the mother had 6/52 check

Screen for Adverse Childhood Experience (ACE)

  • Physical, emotional, or sexual abuse

  • Neglect

  • Parent or carer substance abuse or mental health

  • One or no parents

  • Parental incarceration

  • Intimate partner violence

  • Housing instability

  • Foster care

  • For refugees consider trauma

Look for protective families

  • Parenting training programs

  • Family and community support

  • Support programs for teenage pregnancy

  • Mental health support

Family medical history

  • Who the baby lives with

  • Health issues in siblings, parents

    • Congenital cardiac

    • Hearing

    • Kidney

    • Hip

  • Social support and psychosocial risk factors including D+A

Ask about

  • Feeding

    • Breast or bottle

    • Timing, frequency and tolerance

    • Volume and concentration of formula

    • Plans for introduction of solid

  • Nappies

    • Concerns about urine or stools

    • Can vary from one per nappy to once per week

  • Vomit and posset

    • Possets

      • Effortless

      • Common and peak at 67% at 4 months

      • 50% of <3 months have at least 1 per day

      • 5% have at 12 months

      • In isolation, possets are not GORD

    • GORD

      • Pronounced irritability

      • REfusal to feed

      • Weight loss

      • Haematemesis

      • Chronic cough and wheeze

      • Apnoea

  • Sleep

    • Sleep-wake cycle develops over 3 months, at first babies do not recognise night from day

    • Short sleep cycles and need time to learn how to transition between sleep and self settle

    • Newborns aged up to about 2 months wake for feed every 3 to 4 hour overnight

  • Crying or settling

    • Most infants go through a stage of increased crying

    • Starts to increase at age 2 weeks, peaks at 2 months, then reduces at about 4 to 5 months

    • Usually worse in the afternoon or evening

    • An infant may draw up their legs as if in pain but there is no evidence that excessive crying is causes by intestinal problems or wind

    • The Period of Purple Crying

  • Development

    • Age 4 weeks babies fix on faces and begin to startle at noise

    • AGe 4 to 8 weeks babies learn to smile, start to vocalise, fix and follow with their eyes and raise their head briefly when prone

Examination

  • Assess infant - carer relationship

    • How carer describes their child

    • Tone of voice, affect, and facial exprssions

    • How satisfied with their role as carer

    • Observe interactions

    • Eye contact, touch

    • Ask how the carer interprets their babies unsettledness

  • Observe

    • Looking at faces, smiliing, tracking faces

    • Syndromes

    • Tone of limbs, moving and symmetrical

    • Jaundice

  • Measure

    • Length, Weight, BMI and HC

  • Head

    • Common

      • Moulding (over riding of cranial bones is noth at birth and resolves day 5)

      • Scalp swelling

    • Normal

      • Caput succedaneum (resolves 48 hours)

      • Cephalhaematoma

        • Swelling limited by suture lines

        • Often associated with difficult births with forceps or vacuum

        • Can worsen over 48 hours and takes months to resolve

        • Increases risk of neonatal jaundice

    • Abnormal

      • Subgalael haemorrhage

        • Less common, requires careful monitoring and treatment post-birth, resolves over 2 t o3 weeks

        • Associated with difficult births and coagulopathy

        • Deep haematoma that crosses the midline

      • Encaephalocoele

        • Midline swelling

        • Increases in size and crying

        • May disrupt hair growth

      • Plagiocephaly

  • Fontanelle

    • Size and position

    • Palpate - should be soft and pulsatile

    • Bulging can occur with crying or raised ICP

    • Anterioe closes around 18 months and generally not before 10 months

    • Posterior can close by 2 months and not alwasy felt

  • Ears

    • Low Set

      • Pinna below medial canthus can be Trisomy 21

    • Microtia (small)

      • CHARGE syndrome

      • Hearing loss

    • Pre-auricular tags

      • May be linked to hearing loss and syndromes

  • Nose

    • Check patency with stethoscope

  • Mouth

    • Cleft lip and palate

    • Micrognathia

    • Bifid uvula

    • Tongue tie

    • Neonatal teeth

    • Suck blisters

    • Thrush

  • Eyes

    • Discharge

    • Blocked tear ducts, sticky yellow non-purulent secretions form the nasolacrimal duct, common

    • Conjunctivitis, less common and can be chlamydia / gonorrhoea

    • Corneal light reflexes

    • White pupils (cataract)

    • Fiation and tracking

    • Cover response

    • Nystagmus

  • Neck

    • Congenital torticollis

    • Webbed neck in Turner’s

    • Neck lumps

      • Cystica hygroma

      • Thyroglossal duct

      • Crachial cyst

      • SCM tumours

  • Cardiovascular

    • Cyanosois

    • Consider puloximetry

    • Murmurs

    • Femoral pulses

  • Skin

    • Jaundice

    • Rashes

    • Haemangiomas

    • Birthmarks

  • Abdomen, umbilicus, anus

    • Observe shape of abdomen

    • Masses

    • Hernia

    • Patent anus

    • Umbilicus clean

  • Genitalia

    • Ambiguous genitalia

    • Inguinal hernia

    • Testes

    • Hydrocele

    • Hypospadius

  • MSK

    • Digits

    • Palms

    • Distal upper limb

    • Feet

    • Hips

  • Neuro

    • Moro

    • Grasp

    • Suck

    • Rooting

    • Placing and stepping

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