A newborn is usually given a thorough physical examination by a health care professional within the first 24 hours of life.
The examination begins with a series of measurements, including weight, length, and head circumference. The average weight at birth is 7 pounds (3.2 kilograms), and the average length is 20 inches (51 centimeters), although there is a wide range that is considered normal. Then the doctor examines the newborn’s skin, head and neck, heart and lungs, and abdomen and genitals and assesses the newborn’s nervous system and reflexes. Doctors also routinely do screening tests to detect problems they cannot see during the physical examination.
Skin
Doctors examine the skin and note its color. The skin is usually reddish, but the fingers and toes commonly have a bluish tinge because of poor blood circulation during the first few hours. Sometimes, there are tiny reddish-purple spots (called petechiae) on parts of the body that were pressed hard during delivery. However, petechiae on all parts of the body could be a sign of a disorder and need to be evaluated by the doctor. Dryness and peeling of the skin often develop within days, especially at wrist and ankle creases.
Many newborns develop a rash about 24 hours after birth. This rash, called erythema toxicum, consists of flat, red splotches and usually a white, pimple-like bump in the middle. It is harmless and disappears in 7 to 14 days.
Head and Neck
The newborn’s head, face, and neck are examined by a health care professional for any abnormalities. Some abnormalities occur during delivery. Other abnormalities may be caused by a birth defect.
After a normal head-first delivery, the baby’s head may be misshapen for several days (it may appear cone-shaped or flat on some sides). The bones that form the skull overlap, which allows the head to become compressed for delivery. Some swelling and bruising of the scalp is typical. Sometimes bleeding from one of the bones of the skull and its outer covering causes a small bump on the head that disappears in a few months (called a cephalhematoma).
When the baby is delivered buttocks, genitals, or feet first (breech delivery), the head is usually not misshapen. However, the buttocks, genitals, or feet may be swollen and bruised. When the baby is in the breech position, doctors usually recommend a cesarean delivery, or C section (the surgical delivery of a baby by incision through a woman’s abdomen and uterus), instead of a vaginal delivery to minimize risk of injury to the baby during birth.
Pressure during a vaginal delivery may bruise the newborn’s face. In addition, compression through the birth canal may make the face initially appear asymmetrical. Rarely, this asymmetry results when one of the nerves supplying the face muscles is damaged during delivery. Recovery is gradual over the next few weeks.
The delivery process might also cause subconjunctival hemorrhages (broken blood vessels on the surface of the eye) to form in the newborn’s eyes. These hemorrhages are common, do not need treatment, and typically go away within 2 weeks.
Doctors examine the ears and note whether they are properly formed and in the correct place. For example, low-set or incorrectly formed ears may mean the newborn has a genetic disorder and/or hearing loss.
Doctors also examine the mouth for problems. Rarely, newborns are born with teeth, which may need to be removed, or a cleft lip or cleft palate. Doctors check to see whether newborns have an epulis (a noncancerous growth on the gums) because these growths can cause feeding problems and may block the airways.
The neck is examined for swelling, growths, and twisting or spasms.
Heart and Lungs
A stethoscope is used to listen to the heart and lungs to detect any abnormality. Abnormal heart or lung sounds may be a heart murmur or lung congestion.
The newborn’s skin color is examined. A blue color of the face and torso may be a sign of congenital heart or lung disease.
The rate and strength of the pulse is checked. The newborn’s breathing is observed, and the number of breaths in a minute is counted. Grunting and/or flaring nostrils with breathing and breathing too fast or too slow can be signs of problems.
Abdomen and Genitals
The general shape of the abdomen is examined and the size, shape, and position of internal organs, such as the kidneys, liver, and spleen are checked. Enlarged kidneys may indicate a blockage to the outflow of urine.
The genitals are examined to ensure the urethra (the tube through which urine passes from the bladder during urination) is open and in the proper location. The genitals are checked to see if they are clearly male or female. In a boy, the testes should be present in the scrotum. In a girl, the labia are prominent because of exposure to the mother’s hormones, and they remain swollen for the first few weeks. Secretions from the baby’s vagina that contain blood and mucus are normal. Rarely, a newborn has genitals that are not clearly male or female (ambiguous genitalia) and further evaluation is needed.
The anus is examined to make sure the opening is normally placed and not sealed shut.
Nervous System
The newborn’s level of alertness, muscle tone, and ability to move arms and legs equally are observed. Unequal movement could be a sign of an abnormality of the nerves (such as a nerve palsy).
A newborn’s reflexes are tested using various maneuvers. A newborn’s most important reflexes are the Moro, rooting, and sucking reflexes.
Muscles and Bones
The newborn’s flexibility and mobility of the arms, legs, and hips are examined to see whether the newborn has dislocated a hip or broken any bones during delivery (the collar bone is the most common bone that may break during delivery and usually heals completely within a few weeks). All limbs and joints are checked for unformed or missing limbs.
The spine is examined for defects or deformities (such as spina bifida).
Newborn Screening Tests
Screening tests are done to detect health conditions that are not yet causing symptoms. Many serious disorders that are not apparent at birth can be detected by various screening tests. Early diagnosis and prompt treatment can reduce or prevent many disorders that may interfere with an infant’s healthy development. In the United States, some tests are done routinely and some are required by the state. When screening tests are positive, further testing is often done.
Typical screening tests include
- Blood tests
- Tests of oxygen level
- Hearing tests
All newborns are evaluated for jaundice (a yellow color of the skin caused by elevated levels of bilirubin in the blood) by looking at the skin and whites of the eyes, using a skin sensor, doing a blood test, or a combination.
Many government organizations require a number of blood tests in newborns to detect certain inherited metabolic disorders that are treatable. Common tests include those for phenylketonuria, maple syrup urine disease, galactosemia, congenital adrenal hyperplasia, sickle cell disease, and hypothyroidism. Some organizations also require testing for cystic fibrosis and severe combined immunodeficiency. However, in the United States, different states require different tests. For a list of routine newborn screening tests by state, see Conditions Screened By State.
Doctors place an oxygen sensor (pulse oximetry) on the newborn’s right hand and right foot to measure oxygen levels. Low oxygen levels or significant differences between the hand and foot suggest the possibility of congenital heart disease.
Hearing tests are done to detect hearing loss, which may accompany certain birth defects or infections. Doctors use a handheld device that produces soft clicks and measures the echoes off the newborn’s eardrum (called evoked otoacoustic emissions testing).
