A pediatric newborn checkup is important to ensure the health of your new bundle of joy. A thorough checkup includes baby’s vital signs, growth, and development. Once the physical exam is complete and any important issues are discussed with parents, the parents can ask the pediatrician any questions about any concerns they had with the pregnancy, the delivery, and their child’s health, which is an excellent opportunity to have a long discussion with the pediatrician. As a result, the new parents will feel more comfortable going home with their newborn.

Pediatric Newborn Checkup

Prenatal Newborn Concerns 

The physician will first check the mother’s prenatal lab tests, pregnancy, and delivery history. Typically the mother will have had blood tests for Hepatitis B, HIV, Rubella, Syphilis, Gonococci, Chlamydia, Group B Streptococcus, and blood type. If any of these labs are of concern, the infant will get appropriate lab tests, treatment, or observation. 

Newborn Physical Examination 

  • The physical exam can be done in the parents’ room before the family or in the nursery.
  • The nurse will typically check the weight, length, and head circumference and plot these on a growth chart, determining the newborn’s size compared to other newborns. The nurse will look at the infant’s physical characteristics and plot them on a scale to calculate the gestational age.  
  • A small baby in weight or length can signify prematurity or growth retardation due to prenatal problems. A large baby can be a sign of an infant of a diabetic mother or obese parent.  
  • A head circumference smaller than expected (microcephaly) can signify growth retardation or congenital infection.  
  • A large head (macrocephaly) can be a sign of cephalohematoma (swelling over one bone of the skull), caput succedaneum (diffuse swelling under the scalp), or hydrocephalus (fluid in the brain).  
  • A temperature check is performed to ensure that it is not too low. This can happen in small babies without a lot of body fat — an elevated temperature can signify infection.

A physical examination will include a head-to-toe evaluation.

  • The growth chart will be checked to determine the child’s size. Abnormalities may include obesity, failure to thrive, microcephaly, or macrocephaly. 
  • The skin will be checked for rashes, moles, lesions, birthmarks, discolorations, or jaundice. 
  • The head will be examined for cephalohematoma, caput succedaneum, and molding (abnormal shaping). The fontanels, or soft spots, are expected to be open and of proper size. A closed fontanel can be a sign of craniosynostosis (fused bones of the skull), which would need to be corrected. 
  • Any bruising from a difficult birth, vacuum extraction, or forceps delivery will be noted. These will usually resolve spontaneously but can cause jaundice as they’re healing. 
  • The ears will be examined to be sure that they are equal in size, appropriately positioned on the head, and that the ear canals are open and lead to the eardrum. 
  • The eyes will be checked for a red reflex (when light reflects off the retina, as is seen sometimes in pictures). A lack of a red reflex can indicate a cataract or something obstructing vision. The eyes will be checked for strabismus (the eyes pointing in different directions). A blocked tear duct can cause watering, crusting, and discharge of the eye. 
  • The nose will be examined for patency. Choanal atresia (closed nares) can cause breathing difficulties in infants. 
  • The mouth is checked for cleft lip and palate, natal teeth (a tooth present at birth), and tongue tie. 
  • The neck is checked for thyroid enlargement, masses, tumors, torticollis, or cysts. 
  • The clavicle is checked for any fractures that can occur during a difficult delivery. 
  • The heart is checked for the rate, rhythm, and abnormal murmurs. 
  • The chest is checked for symmetry of the ribs and abnormal rib structures such as pectus excavatum (funnel chest). 
  • The lungs are checked for normal breath sounds, respiratory rate, and retractions. Any abnormalities of these can signify respiratory distress needing immediate treatment. 
  • The abdomen is checked for bowel sounds and is palpated deeply to check for any enlarged organs (kidney, liver, or spleen) or any masses that can suggest a tumor. The baby is also checked for hernia. This can happen at the umbilical cord (umbilical hernia) or in the inguinal area (inguinal hernia). 
  • The hips are checked for instability or any dislocation. If there is hip instability, an x-ray or ultrasound can be performed to look for hip dysplasia. 
  • The genitals are checked. In a male, they’re checked to ensure that both testes are in the scrotal sac, that the penis is of normal size, and that the urethra comes out of the very tip of the penis. If the urethra comes out of the side of the penis (hypospadias), this will need surgical repair. On a female, the genitals are checked to be sure there is no imperforate hymen. A bloody, blood-tinged, or milky white discharge from the vagina is normal in the newborn female. 
  • All extremities are checked for symmetry and movement. A difficult delivery can cause Erb’s Palsy or Klempke’s Palsy (temporary floppiness of one arm due to nerve compression during birth). These will resolve spontaneously. 
  • The pulses are checked to ensure normal blood flow. 
  • The fingers and toes are counted to look for extra or missing digits. 
  • The feet are checked for clubbing or abnormal shaping. 
  • The infant’s reflexes, strength, head control, and body tone are checked for overall neurological status. 
  • The back is checked to look for neural tube defects (openings along the spine). Prenatal folic acid supplements will usually prevent this. 
  • The anus is checked for patency and size. 

Normal Findings in Newborns

There are many normal findings in babies, which can concern parents. These include: 

  • Red patches between the eyes or behind the neck are normal. These salmon patches, also known as Angels’ Kiss or Stork Bite, respectively, will disappear with time. 
  • Puffy eyes or conjunctival hemorrhages (red streaks on the whites of the eyes) will clear on their own. 
  • Hard knots under the nipples are common. 
  • Blueness of the hands and feet (acrocyanosis) can last for a few days. 
  • Cephalohematoma, caput succedaneum, or molding of the head will disappear in days to weeks. 
  • The startling or Moro reflex is very common in infants. 
  • Chin quivering, white spots on the roof of the mouth (Epstein’s Pearls) or red spots with a white center on the body (erythema toxicum neonatorum) will dissipate with time. 
  • Black, tarry stools (meconium) are normal for the first few days after birth.

Preventing Illness for Newborns 

The importance of limiting exposure to illness needs to be emphasized. Suppose an infant under six weeks old gets a fever (defined in this age group as a rectal temperature of 100.4 degrees Fahrenheit or 38.0 degrees Celsius or greater). In that case, a physician may need to do rule-out sepsis work-up and admit the baby into the hospital. It is difficult to know by physical examination whether a febrile baby under six weeks old has a minor infection or a more severe illness. Because of this, most physicians will do this medical work-up and admission as a precaution for the baby. Walking outside with the baby is fine, but crowded places should be avoided until at least six weeks. Weather does not cause illness; exposure to illness causes illness. 

Infant Booklet 

Typically, a pediatrician will have an infant booklet covering topics such as breast or bottle-feeding, sleeping position (which should always be on the back), bathing, stools, safety concerns, crying patterns, and other newborn issues.

Having a newborn is definitely an adjustment, especially if this is your first child! Please do not be afraid to ask your pediatrician questions and voice any concerns you may have. Your pediatrician and pediatric staff are here to help and support you and your child.

Majority of this blog was written by Dr. Michael Bornstein, who has 30 years of experience as a pediatrician. 

Disclaimer: The contents of this article, including text and images, are for informational purposes only and do not constitute a medical service. Always seek the advice of a physician or other qualified health professional for medical advice, diagnosis, and treatment.