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Physical Examination of the Newborn

By

Deborah M. Consolini

, MD, Sidney Kimmel Medical College of Thomas Jefferson University

Last full review/revision Sep 2021
CLICK HERE FOR THE PROFESSONAL VERSION
Topic Resources

The doctor usually gives the newborn a thorough physical examination within the first 24 hours of life. The examination begins with a series of measurements, including weight Weight Physical growth refers to an increase in body size (length or height and weight) and in the size of organs. From birth to about age 1 or 2 years, children grow rapidly. After this rapid infant... read more , length Length and Height Physical growth refers to an increase in body size (length or height and weight) and in the size of organs. From birth to about age 1 or 2 years, children grow rapidly. After this rapid infant... read more , and head circumference Head Circumference Physical growth refers to an increase in body size (length or height and weight) and in the size of organs. From birth to about age 1 or 2 years, children grow rapidly. After this rapid infant... read more . 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 (see Newborn Screening Tests Newborn Screening Tests Many serious disorders that are not apparent at birth can nonetheless be detected by various screening tests. Early diagnosis and prompt treatment can reduce or prevent many disorders that may... read more ).

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

A normal head-first delivery leaves the head slightly misshapen for several days. 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 Breech presentation Position refers to whether the fetus is facing rearward (toward the woman’s back—that is, face down when the woman lies on her back) or forward (face up). Presentation refers to the part of... read more ), the head is usually not misshapen. However, the buttocks, genitals, or feet may be swollen and bruised. Delivery of a baby in the breech position is now usually avoided. When the baby is in the breech position, doctors usually recommend a cesarean delivery Breech presentation Position refers to whether the fetus is facing rearward (toward the woman’s back—that is, face down when the woman lies on her back) or forward (face up). Presentation refers to the part of... read more or C section (the surgical delivery of a baby by incision through a woman's abdomen and uterus), which minimizes danger to the baby.

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. This asymmetry sometimes 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 Subconjunctival Hemorrhage Subconjunctival hemorrhages are small accumulations of blood beneath the conjunctiva (the membrane that lines the eyelid and covers the front of the eye). Sometimes the whole eye appears red... read more Subconjunctival Hemorrhage (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.

The neck is examined for swelling, growths, and twisting or spasms.

Heart and lungs

The doctor listens to the heart and lungs through a stethoscope to detect any abnormality. Doctors are able to hear abnormal sounds such as a heart murmur or lung congestion. The doctor inspects the newborn's skin color. 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. Doctors watch the newborn breathe and count the number of breaths in a minute. Grunting and/or flaring nostrils with breathing and breathing too fast or too slow can be signs of problems.

Abdomen and genitals

The doctor examines the general shape of the abdomen and also checks the size, shape, and position of internal organs, such as the kidneys, liver, and spleen. Enlarged kidneys may indicate a blockage to the outflow of urine.

The doctor examines the genitals to ensure the urethra is open and in the proper location. The doctor also checks to make sure the genitals 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. The doctor examines the anus to make sure the opening is normally placed and not sealed shut.

Nervous system

The doctor looks at the newborn's level of alertness, muscle tone, and ability to move arms and legs equally. Unequal movement could be a sign of an abnormality of the nerves (such as a nerve palsy).

Doctors test the newborn's reflexes using various maneuvers. A newborn's most important reflexes are the Moro, rooting, and sucking reflexes.

Three Common Reflexes of Newborns

In the Moro reflex, when newborns are startled, they cry and fling their arms wide with fingers outstretched and draw up their legs.

In the rooting reflex, when either side of their mouth or lip is stroked, newborns turn their head toward that side and open their mouth. This reflex enables newborns to find the nipple.

In the sucking reflex, when an object (such as a pacifier) is placed in their mouth, newborns begin sucking immediately.

Muscles and bones

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Separation Anxiety and Stranger Anxiety
An important part of normal development is an infant’s growing attachment to its parents. As this bond strengthens, the infant may express fear or anxiety when the parents leave. This “separation anxiety” typically begins at around 8 months of age and resolves at around 24 months of age. Which of the following is the normal and expected infant behavior in reaction to a parent leaving the room during the time period of separation anxiety?
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