New Parents : He Looks Like a Pixie Is my baby ok (part 3) - Newborn tests and checks Top-to-toe examinations

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Newborn tests and checks Top-to-toe examinations

Between 6 and 72 hours after the birth, your baby will receive a detailed examination from a doctor or pediatric nurse practitioner. The aim of this is to detect any abnormalities that may not have been picked up by the prenatal ultrasounds during pregnancy. If you need to see a specialist as a result of these tests, an appointment will be made at a later date. Other tests are done in the couple of weeks following the birth, at the two-week well-baby checkup.

The first examination

During this initial examination, your baby will be weighed and measured and his heart and lungs will be listened to using a stethoscope. The roof of his mouth will be checked to make sure that there is no cleft, or split, in his palate and his eyes will also be examined. His limbs will be checked to ensure that they match in length, and that his feet are properly aligned with no sign of clubfoot. Your baby's tummy will be felt to check that the internal organs are the right size and in the right place, and the pulses in the groin will also be checked. The genitals will be examined, and the spine will be checked to make sure that all of the vertebrae are in place. His hip joints will also be looked at to ensure that these are not dislocated and not “clicky,” which could lead to instability later on. Your baby's reflexes will also be checked (see Newborn reflexes).

The heel stick test

Just before you go home, at 24–48 hours of age, after your baby has been fed, the heel stick test is done. Also known as the PKU test, it detects phenylketonuria, a rare but serious condition that can be treated if diagnosed early in your baby's life. Blood is taken from a heel or ear lobe stick and dried onto a paper spot. In general it screens for over 50 genetic and metabolic illnesses.

Conditions that are identified

Most states include the following categories in the spot screening: disorders of hemoglobin (e.g. sickle cell) and the endocrine system (e.g. thyroid), amino acid disorders (e.g. phenylketonuria), fatty acid oxidation disorders, and organic acid disorders. Phenylketonuria is an inherited condition in which babies are unable to process a substance in their food called phenylalanine. Early treatment involves a special diet which can prevent severe disability. Congenital hypothyroidism is one of the most common conditions detected by newborn screening, with an incidence of 1 in 4,000 births. Cystic fibrosis screening is also included in most state programs.

How the blood test is done

The blood test involves the side of your baby's heel being pricked and several drops of blood being carefully placed on a special card. The test can be done while your baby is feeding, since this makes it less painful or alarming for your baby. You can get the results from your doctor, although you will be contacted if anything is detected. Sometimes more testing is needed. Most babies screened will not have any of these conditions, but, for those who do, early treatment can be vital to ensure long-term health.

Your baby's hearing test

Two to three of every 1,000 children in the US are born deaf or hard-of-hearing, and more lose their hearing later during childhood. Newborn hearing screening is common practice in most hospitals and maternity centers. Testing is noninvasive and quick. Some states mandate such testing (with the right of parental refusal) while others strongly encourage it prior to discharge. Still other states require only that information on hearing screening be available to parents before they leave the hospital. Babies who exhibit evidence of hearing loss should have an audiologic assessment by three months of age and early intervention services by six months of age. It is important that any hearing loss is picked up within the first six months of life so that special support can be given to ensure normal language development.

How your baby is checked
Heart and lungs:

A stethoscope will be used to listen to your baby's heart beat and his lungs and check that both of these sound normal.

Head examination:

The shape of your baby's head will be checked and the soft spots on the skull, known as the fontanelles, will be examined.

Mouth and palate:

The midwife or doctor will check that there is no split in the roof of your baby's mouth that could indicate a cleft, or split, palate.

Feet and hands:

Each hand and foot is checked and the number of digits counted, and the feet are looked at to check that they align properly.


The legs are bent gently upward and then the hips are rotated to check that there is no sign that the hips are dislocated, or “clicky.”


Your baby will be turned over and his spine will be examined to check that it is straight and that there are no other abnormalities present.

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