18 August 2003

Well-baby developmental screening

The paediatrician usually gives the baby a thorough physical examination within its first 12 hours of life. A further six week test is normally done at a clinic, satellite or mobile clinic.

The paediatrician usually gives the baby a thorough physical examination within its first 12 hours of life.

A further six week test is normally done at a clinic, satellite or mobile clinic. The “Road-to-Health” card is first examined to identify any high risk factors such as the antenatal history or birth history.

In premature babies, for purposes of developmental assessment, correct for gestational age by subtracting the number of weeks born early from the actual age. Thus a baby of eight weeks old born six weeks premature will have an actual age of two weeks.

The following are the developmental guidelines published by the Western Cape Department of Health and Social Services for state employed doctors. These guidelines are regarded by paediatricians in South Africa as a viable and practical guide to identify developmental defects or growth problems in babies and children early.

Physical Examination:


Examinable item Shortly after Birth 6 Week check-up
Weight and length These measurements are taken to provide references for future growth charts.The average weight for a full-term newborn baby is between 3-3.5 kg and it is normally between 48 and 53cm in length. The weight should be plotted on a growth chart. The newborn baby loses weight during the first three days, but should begin to regain weight from the fourth or fifth day, completely regaining birth weight by the seventh to tenth day.
Head and face After a normal delivery the face may be slightly misshapen for several days. Some swelling and bruising of the scalp is common, particularly after forceps or a vacuum extraction have been used. Pressure caused by the movement down the birth canal in a vaginal delivery may also bruise or cause swelling on the face or may cause it to be a little asymmetrical. The ears may be crumpled but will straighten out after a few days. The head circumference and weight should follow centiles.
Fontanelle The fontanelle is a diamond shaped gap in the bones on the top of the skull. Newborn babies are born with a fontanelle, which disappears as the bones in the skull fuse; the fusion is complete at around 18 months of age.
Skin The skin should be reddish, though it may be tinged with blue due to poor circulation in the early hours of life. Newborns who are otherwise normal may become slightly jaundiced after the first day and this is not normally a cause for undue concern. If the baby is overdue, it may be born with dry, peeling skin as the vernix which covered it in the uterus may have started to dissolve. The baby’s entire skin is examined for any irregularities such as any signs of jaundice, anaemia, rashes or mottling.
Eyes If held upright, most babies will spontaneously open their eyes. A check is done to exclude any jaundice, conjunctivitis and conjunctivital pallor, which may be a sign of anaemia. The baby’s eyes are observed, whilst a brightly coloured object is moved across its gaze. By six weeks, the baby should follow it.
Hearing The examiner needs to determine if either of the baby’s parents were born deaf. If this is the case, there is a high chance of congenital deafness in the baby, even if the examination suggests the baby can hear. In this event, the baby should be referred to a specialist for a thorough hearing assessment.If a hearing impediment is suspected at any time, the baby must be formally tested by an audiometrist.
Mouth and palate The baby’s mouth is examined for a cleft lip and/or oral thrush or a submucosal cleft palate. Small submucosal clefts may not affect sucking.
General appearance The body shape, face, ears, hands and feet are checked for dysmorphic features. Dysmorphism means an abnormality of the physical structure of a single or multiple parts of the body. Characteristic patterns of malformations may be recognised as syndromes, for example Down Syndrome or Foetal Alcohol Syndrome.
Genitalia The genitals of a newborn are often swollen and pink in colour, caused by the mother’s hormones that have been passed to the baby during the pregnancy. In a boy, the testes should be present in the scrotum. Occasionally the testes do not descend into the scrotum until after birth and this will be rechecked at the six week check-up. In a girl, the labia should be prominent. If a male’s testes are not in the scrotum, the examiner checks for retractile testes. The examiner will check to see if your little one passes urine with a good stream. If he always dribbles, this could mean an obstruction and he should be referred.
Abdomen The general shape of the abdomen is studied as well as the size and shape and position of the internal organs such as the kidneys, liver and spleen.  
Heart and lungs The heart and lungs are listened to through a stethoscope to detect any abnormalities.  
Rooting reflex When either side of the baby’s mouth is touched, the newborn will turn its head towards that side and open its mouth. This is the reflex required to allow it to find the mother’s nipple.  
Moro reflex The Moro reflex - occurs when the newborn is startled. The baby is held supine, the head supported with the palm of the examiner’s hand. The head is lifted and then gently and quickly lowered for about 4 cm. The baby should extend its arms, open its hands and then flex its midline. The movements should not be excessive, decreased or asymmetrical.
Sucking reflex When an object (like the examiner’s finger) is placed in the newborn’s mouth, sucking begins immediately.  

Gross and fine motor examination – done at birth and the six week check-up

Limb movements The baby’s spontaneous movements are observed whilst it is placed on the examination surface and any asymmetry or decreased movements are excluded. The movements are usually jerky with the arms being more active than the legs.While held standing on a hard surface, the baby presses down its feet, straightens its body and usually makes a forward movement (stepping reflex). This reflex normally diminishes after one or two months.
Posture The baby’s posture is observed during the examination. A normal posture includes some flexion of the limbs.
Tone Pull to sit: the baby is held at the wrists and pulled to a sitting position and the extent of head lag observed.Ventral suspension: the baby is held in a prone position with the chest and abdomen supported, while the extension of the trunk and neck and flexion of the arms and legs are observed. At birth, when placed in a prone position, the baby promptly turns its head sidewards, the buttocks are humped up and the knees flex under the abdomen. At three months, when placed in a prone position, the baby will lift its head and upper chest well up in midline, using its forearms to support itself.Limb flexion: with the baby lying supine, the limbs are gently extended and flexed whilst the examiner observes for skin flexure cleanliness.

Psycho-social - done at six week check-up

Smiling The baby should smile by six weeks.
Interaction with caregiver The quality and type of the interaction of the caregiver and baby are observed to see if the caregiver is able to respond appropriately to the baby.


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