What is it about ?
After birth, each child undergoes several careful examinations by a doctor. The first exam is done right after birth in the delivery room. It is above all about checking that the baby is adapting well to life outside the womb. When the baby is about 1 day old, a pediatrician performs the first head-to-toe examination. This complete examination is then repeated when the baby is 7 days old. It can be performed by the pediatrician, if the mother is still hospitalized, or by the pediatrician or general practitioner if the mother has already left the hospital.
It is preferable that the parents (or at least one of the two) are present during the examination. The baby is first stripped naked so that the doctor can examine the whole body. To avoid cooling, the examination is performed in a sufficiently heated room.
The doctor will also ask a few questions about the progress of pregnancy and childbirth in order to get a good idea of the general health of the newborn baby.
First examination
Childbirth is a very intense time for the baby: once born, it needs a few minutes to recover. The Apgar test helps determine how the baby is adjusting to life outside the womb. About one minute after birth, respiration, skin color, muscle tone, heart rate, and responsiveness to stimulation are assessed. Each of these parameters is evaluated on a scale of 0 to 2. 0 means “absent parameter” and 2, “optimal parameter”.
A total score is then calculated on 10 points.
- A score below 4 confirms the presence of potentially serious problems. In this case, the baby is immediately put on oxygen.
- A score of 4 to 6 is common. It means that the baby is reacting correctly, but not yet optimally. In this case, the examination is repeated after 5 and 10 minutes.
- A score above 7 means the baby is reacting normally.
Shortly after birth, weight, height and head circumference are also measured.
Head-to-toe examination
During this examination, the baby’s body is thoroughly and thoroughly checked.
Skin
The doctor carefully examines the baby’s skin. The following observations are common:
- Lanugo : at birth, the baby’s skin is often covered with a fine down. These little hairs are perfectly normal, they keep the baby warm. They disappear in the first days after birth.
- Sebum : it is a fatty layer, white in color, which is observed on the skin of the newborn, mainly in the skin folds. The sebum disappears spontaneously after a few days.
- Jaundice : about 1 in 3 children develop jaundice during their first week of life. The skin may then take on a slight yellowish color. Jaundice usually goes away on its own, without treatment. If the doctor suspects abnormal jaundice, a blood test will be taken. Phototherapy is sometimes necessary: the baby is put under a UV lamp.
- Spotted rash with small pimples : This is a harmless rash, which appears in babies with dry skin. The baby does not have it and the rash will go away on its own after a few days or weeks.
- Strawberry (hemangioma) : it is a large number of small blood vessels, in or on the skin, taking the form of flat or slightly raised red spots. These spots may be present at birth or appear in the first few months after birth. Infant hemangiomas are harmless, and 95% of them go away on their own. Treatment is usually not necessary.
Nutritional status and water balance
- A baby that is too small, who has too low a birth weight, can be a sign of growth disorder in the womb.
- The elasticity of the skin gives an indication of the water balance.
Sequelae due to birth
During childbirth, the baby must pass through the birth canal, the narrowness of which can lead to a series of benign abnormalities:
- Newborn bump : It is a soft lump on the baby’s head, filled with fluid and elastic to the touch. Temporary, it usually disappears on its own 1 to 3 days after birth.
- Cephalhematoma : it is a lump on the baby’s head, due to an effusion of blood between the skull and the skin covering the bone of the skull (the periosteum). Temporary, it does not generally require treatment: the body evacuates the blood in a few weeks or months.
- Blood effusion on the white of the eye : the white of the eye is bright red in color. The blood effusion is not painful and goes away automatically after 1 to 3 weeks.
- Clavicle fracture Arm movements can sometimes be somewhat limited by a broken collarbone, but it heals spontaneously within a few days, or even two weeks at most.
Blood circulation
The doctor checks the proper functioning of the heart and blood circulation.
- Skin coloring : the skin should be dewy. A bluish coloration of the lips or tongue indicates a lack of oxygen.
- Pulse : In a healthy child, the heart rate is 100-160 / min, but it can increase to 200 / min when the child cries.
- The heart murmur: the doctor listens to the baby’s heart using the stethoscope. If he hears a murmur in the heart, additional tests should be done to identify a possible cardiac abnormality.
- Pulsations in the crease of the groin : the doctor checks that the heartbeats are well felt in the femoral arteries of both groins.
Respiratory
The doctor listens to the baby’s lungs using the stethoscope. Normally, the newborn breathes between 40 and 60 times per minute. Breathing difficulties can be due to a disease of the lungs, but also of the heart, to infections or to a metabolic disorder.
Nervous system and sense organs
The doctor will check the different functions of the nervous system and the sense organs.
- Skull : as the skull has not finished growing, the different bones are not yet fully united. The newborn normally has two fontanels: one large and one small. A fontanel is an opening between the bones of the skull. The size of the fontanelles is systematically controlled. The anterior fontanel closes completely between the ages of 8 and 24 months. The posterior fontanel closes a little earlier, around the age of 2 to 6 months.
- Movement : the doctor examines whether the baby spontaneously moves the 4 limbs in the same proportions.
- Reflexes : the doctor checks, among other things, the sucking, gripping, jumping and walking reflexes.
- Eyes : the doctor checks for any abnormalities in the eyes. He can possibly also test the pupillary reflex.
Ears : the doctor checks for any abnormalities in the ears. A hearing test is done later by ONE, when the baby is between 2 and 4 weeks old.
Digestive
The doctor checks the different parts of the digestive system.
- Mouth : the doctor feels the palate to check that it is completely closed.
- Stomach : the doctor palpates the stomach and auscultates it with a stethoscope. The liver can often be palpated in a newborn baby, unlike the spleen. If the doctor palpates other masses, the baby will need to have additional tests. The doctor also checks the umbilical cord and checks that it heals well. An umbilical hernia is common in newborns, it usually heals without treatment after a few years.
- Anus : the doctor systematically checks the anus and asks if the child has already produced stools.
Genitals
The genitals are also checked.
- At the little boys, the doctor palpates to check that both testicles are present in the scrotum and that the penis is formed normally. The length between the pubis and the end of the penis should be at least 2.8 cm.
- At the young girls, the doctor checks that the labia majora, labia minora and clitoris appear normal. White discharge is normal in babies.
Skeleton and hips
The doctor assesses the proportion between the body and the limbs.
- Arms and hands : the doctor checks the number of fingers and looks at the position of the folds in the palm of the hand.
- Legs and feet : The doctor checks the number of toes and examines whether the baby has clubfoot.
- Hips : the doctor systematically checks the mobility of the hips and checks that both thighs are the same size. A difference may be due to abnormal development of the hip. Sometimes an ultrasound is needed to rule out the presence of abnormalities.
Weight
The first few days, the weight is checked every day. It is normal for a newborn to lose 10% of their birth weight in the first 5 days. Indeed, the baby has been accustomed to being fed continuously via the umbilical cord.
Screening for congenital anomalies
All children born in Belgium have a blood test from the heel 72 hours after birth. This blood test is usually taken at the maternity ward, at the midwife or at the doctor’s office. The blood sample is then analyzed for a series of serious congenital diseases, which allows treatment to be started as soon as possible in order to prevent or limit damage to health.