Newborn Baby Examination

This examination is performed on all newborn babies,

ideally within 48 hours of birth. It is also rechecked by the
babys general practitioner at the 8 week check. It is
basically a top-to-toe examination of a baby and therefore
has many parts to it.
It is not often examined in OSCEs as you would not be able
to use real babies as patients, however some medical
schools do have dummy babies to practice these skills on.
Every medical student will however have a paediatric
placement and it is here that you can practice these skills. In
addition, helping the doctors with their baby checks on the
post-natal wards will also gain you brownie points! All of the
following steps have to be performed but its up to you which
order you do them, this is the order I [Laura] personally
developed during my paediatric placement as part of GP
training.

Subject steps
1. Equipment required for this station:
o Neonatal stethoscope
o Opthalmoscope
o Oxygen saturation monitor/pulse oximeter
Introduce yourself to mum and clarify her, and
babys identity. Explain what you would like to
do, i.e. full examination of her new baby(s) and
gain her consent. Congratulate her on the birth

as this will put her at ease and help gain

your trust. New mums are protective of their
babies so trust and rapport is essential.
Whilst washing your hands you could ask mum
to strip her baby down to its nappy. Ensure you
have a changing mat to do the examination on.
Start by asking mum a few questions:
How was the birth?
Good to know as forcep deliveries can cause facial
bruising, c-sections can occasionally cut the babys
skin. Babys born by c-section are usually more
mucusy too.
Did your baby need any help after birth with
breathing?
i.e. did the midwives or paediatric doctors have to
give oxygen/rescue breaths.
How are you feeding your baby? Breast or
bottle?
If breast feeding ask her
How is it going/baby latching ok, etc?
If bottle feeding ask
Which milk are you giving your baby/is baby
taking bottles ok, etc?
Dont criticise if mum has not opted to breast feed,
this is an individual decision.
Are there any conditions that run in you or dads
family e.g. congenital heart problems?

Has anyone in your family (especially females)

had problems with their hips at birth?
Female babies are more likely to have clicky or
dislocated hips due to the hormones that are in mums
body during pregnancy, these are the hormones
which help to open up mums pelvis prior to and
during birth.
Has your baby passed its sticky black stool yet?
Parents often dont know the term meconium
Start by observing the baby. Does it look and
behave normally, i.e. colour e.g. jaundice,
activity and posture. Is there any obvious
bruising or marks from birth. Are there any other
marks such as strawberry naevus, stork marks
or Mongolian blue spot. Remember to turn the
baby over and inspect its back too.
With the baby lying on its back feel
the fontanelle gently with your hand. It should
be nice and soft, a tense/bulging or
sunken fontanelle can suggest the baby is
unwell.
Using both your hands gently feel the
babys bones checking they are symmetrical on
both sides. Face, around ears, clavicles (these
can be injured during birth if shoulder
dystocia occurs), both arms (e.g. Erbs palsy)
down to legs and feet. Open up the babys hand
and look at the palm for normal palmar creases,
count the fingers on each hand. Look at the

feet, is there any signs of a sandal

gap or talipes and count the toes on each foot.
If the baby has its eyes open at this point check
for the red reflex using your opthalmoscope. An
absent reflex could suggest congenital
cataracts.
Auscultate the babys heart using a
neonatal/paediatric stethoscope. The normal
rate is 120-150 so you will have to listen much
more carefully for any murmurs as there is less
time between heartbeats to hear them. If you do
pick up any murmurs assess whether it radiates
anywhere.
Ausculate the lung fields. The normal
respiratory rate is 30-60 in newborns. Are there
any extra sounds e.g. grunting or stridor.
Palpate the abdomen and check the umbilical
stump/clamp to ensure no signs of infection.
Turn the baby over and check down its spine
and between buttock cheeks for the sacral
dimple.
At this point undo the babys nappy. Look for
any obvious genital abnormalities. If its a male
infant you should check the scrotum to see if
the testicles have descended. If not you may be
able to palpate them in the spermatic cord and
gently bring them down yourself. Check the
patency of the anus at this point too.

 Test the babys hips. This is done by two

techniques, Ortolani and Barlow tests.
Essentially cup the babys hips in the palm of
your hand and gently abduct the hips, this
should be smooth with no clicks. Next move
your hands to the front of the baby and with
their knees flexed push gently downwards into
the bed, again this should be smooth with no
clunks.
At this point redo the nappy and again wash
your hands. With your hands freshly washed
you now want to assess inside the babys
mouth. Use your little finger to feel the palate of
the mouth. Look to see if there is a tongue tie.
Again wash your hands. Attach the
pulse/oxygen monitor to the babys foot.
Remember if a baby is sleeping or crying the
heartrate may be higher or lower than the
normal range.
There are a number of primitive
reflexes present in newborns which you should
elicit. Moro, grasp and sucking.
Thank mum, offer to dress the baby, although
she will usually wish to do this herself. Answer
any questions she may have.
Again wash your hands and report your
findings, if any, to the examiner, or doctor if on a
ward. Should you notice any abnormalities you

may wish to suggest how to investigate these

further.
- See more at: http://www.osceskills.com/elearning/subjects/newborn-babyexamination/#sthash.eQVjnagI.dpuf

1. Andrew Bold came to your office concerning his six month old
Jimmy. He has some questions about vaccinations. Talk to him
in the next ten minutes. (Immunization).
2. Rochelle Davidson came to your office and want to talk to you
about her one year old son Tom. Her sister noticed that Tom is
so small. Address her concerns in the next 5/10/15 minutes.
(Failure to thrive /or Child abuse /or Single mother/
Feeding).
3. Eric George is 16 year old came to your office asking for a
letter to the transportation authority. Talk to him in the next
5/10/15 minutes. (Epilepsy).
4. John Smitherman came to your office worried about his three
and half year old daughter, Julie, speech. Talk to him in the
next 5/10/15 minutes. (Speech delay).

5. Leanne Goldson brought her two year old daughter, Lisa, to the
emergency because of diarrhea for three days. The ER team
managed Lisa is in the next room and she is stable now. Mrs
Goldson is waiting in this room. You are the physician on duty
now. In the next 5/10/15 minutes enter the room an take a
focused history from the mother. (Diarrhea).
6. Sandra Levis brought her two month old son, Leo, to the
emergency because of vomiting for two weeks. The ER team
managed Leo and he is stable now in the next room. Mrs Levis
is waiting in this room worried and crying. You are the
physician on duty now. In the next 5/10/15 minutes enter the
room an talk to her. (Infant colic /or Single mother /or
spousal abuse).
7. Luisa Huang brought her three day old son, Kim, to the
emergency because he turned yellow. The ER team managed
Kim is in the next room and he is stable now. Mrs Huang is
waiting in this room worried. You are the physician on duty
now. In the next 10/15 minutes enter the room and talk to her.
In the last two minutes the examiner will ask you few
questions. (Neonatal Jaundice).

8. Mary Hansfield brought her two and a half year old son, Tony,
to the emergency because he just had a fit. The ER team
managed Tony is in the next room and he is stable now. Mrs
Hansfield is waiting in this room. You are the physician on duty
now. In the next 5/10/15 minutes enter the room an talk to her.
(Febrile convulsion).
9. Martin Simon came to your office concerned about his 18
month old son, Patrick. He thinks he looks pale. In the next ten
minutes address his concerns. (Anemia).
10.Barbara Hancocks is the mother of a six month old baby, Jim,
who brings her child to your office because of fever. Jim is in
another room with your nurse. Please enter this room and talk
to the mother in the next 5/10/15 minutes. (Fever).
11. Mary Levis is the mother of a 4 week old baby, Nick. She
brought him to the emergency because of vomiting for two
weeks. The ER team managed Nick and he is stable now in the
next room.. Mrs Levis is waiting in this room. You are the
physician on duty now. In the next 5/10/15 minutes enter the
room an talk to her. (Vomiting / Pyloric).

12.Erin Mayer came to your office concerned about her four year
old daughter, Emmy, who has cough for quiet some time. In
the next 5/10/15 minutes take a focused history and initiate
counseling. (Cough).
13.Nicole Bennet came to your office because she thinks her 18
month old daughter, Jane, is not growing well. Please address
her concerns in the next 5/10/15 minutes. (Failure to
thrive /or Child abuse /or Single mother/ Feeding).
14.Wanda Hung came to your office because she thinks her six
year old son, Kim, is short. Please address her concerns in the
next 5/10/15 minutes. (Short stature).
15.Catherine Wellman is in your office to talk about her five year
old Eric who wet his bed at night. Please address her concerns
in the next 5/10/15 minutes. (Enuresis / UTI).
16.Lesia Malanchuk come to your office because her seven year
old daughter, Cathy, is complaining for abdominal pain. Please
address her concerns in the next 5/10/15 minutes. (Recurrent
abdominal pain).

17.Elizabeth Hartman came to your office because she received a

letter from her son's elementary school principle asking her to
consult with a physician about his condition. Please address
her concerns in the next 5/10/15 minutes. (Hyperactive
child).
18.Jennifer Black asked you to see her 15 year old daughter,
Tracy, because she refuses to eat and lost over twenty pounds
of her weight. Tracy is now here in your office. Please talk to
Tracy in the next 5/10/15 minutes. (Anorexia).
19.Jeffery Hamilton brings his two year old son, Martin, to the
emergency for a hand injury. When you took X-rays, you found
a spiral fracture of the humerus. You also noticed old fractures
of both the forearm bones. Please talk to Mr. Hamilton in the
next 5/10/15 minutes. (Child abuse).
20.Ellen Anderson came to your office complaining that her two
year old son, Tim, cannot sit with the family during dinner and
finish his plate. Please talk to her in the next 5/10/15 minutes.
(Feeding /or Hyperactive child ).

21.Jane Dave is calling concerning her 18 month son, John, who

has swallowed his aunt's blood pressure medications. In the
next 5/10/15 minutes enter the room and pick up the
telephone and talk to her about John and advice her.
(Poisoning).
22.Julie Copper is calling concerning her 7 year old daughter,
Jessica, who has swallowed 10 birth control pills. She is worried
if that will initiate early puberty. In the next 5/10/15 minutes
enter the room and pick up the telephone and talk to her about
Jessica and advice her. (Poisoning).
23.Andrea Jackson came to the emergency bringing her 18 month
old son, Roy, who has been crying for the last ten hours. Please
talk to her in the next 5/10/15 minutes. (Acute
abdomen/ Intussusception).
24.Yee Man Lee came to your office because her 4 year old son,
Kim, has rash. Please talk to her in the next 5/10/15 minutes.
(Rash).

25.Susan Coupland came to your office because her 4 year old

daughter, Julie, has recurrent urinary tract infections. Please
talk to her in the next 5/10/15 minutes. (UTI).