Six week baby check

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Six week baby check

• By Catherine Locke
• GPST1

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Aims

• Background
• Physical examination important diagnoses and
  referral options
• Review of development growth charts
• Health promotion
• Supporting parents

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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.

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Little Red book
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Recording your findings
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Physical examination
Eyes
Hearing
Heart
Social smile
Tone
Spine
Hips
Behaviour
Testes/genitalia
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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.

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Common skin complaints

• Erythema toxicum blotchy red rash with
  associated yellowish pustules. Settles with no
  treatment.
• Milia benign keratin filled cysts.

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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
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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

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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

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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

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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

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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 .

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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. Ortolanis gently
abduct the hip fully feel for the femoral head
slipping back into joint.
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Genitalia

• Ambiguous genitalia dont 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.

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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

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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.

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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.

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Any questions?
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References

• 1) NHS Newborn and infant physical examination
  programme. Frequently asked questions.
  http//newbornphysical.screening.nhs.uk/faqsfilei
  d10637 (Accessed 24/10/12)
• 2) ANNP Office. Common problems in the healthy
  neonate.Calderdale and Huddersfield NHS
  foundation trust, 2011.