Ais carried out the first day of life and again just before discharge from hospital. The initial examination is to detect any obvious abnormality that might require early treatment. The second examination is done in more detail and gives you an opportunity to ask the paediatrician any questions that you may have about your baby’s progress. It is a good idea to ask the sister to let you know when the paediatrician is coming so that you can be present at the examination. Even at this early age a baby will probably feel more secure if he knows that you are there. What does the paediatrician do? He watches a baby’s activity and the different postures that are adopted. You will already have noticed how the activity varies at different times of the day and that, for most of the time, a baby sleeps with his arms and legs partially flexed. Sometimes, especially when being undressed, he gets very cross, in rage and shows you just how strong his arms and legs are. Allowances are made for a baby’s mood during the examination, so do not be disappointed if you think your baby has not performed at his best for the paediatrician!
Most mothers are very conscious of the appearance of their baby’s skin. A mild degree of, however, is very common between the third and fifth day and certain or are also very common. ‘Stork bites’ are small pink blemishes found on the eyelids and nape of the neck. Do not worry, they will soon fade. Many normal babies come out in red blotches during the first few days of life. These can affect any part of the baby’s skin, can be quite widespread and can cause mothers a lot of anxiety. We do not know why this , which is called Erythema toxicum, occurs but it never affects a baby’s health and it fades in a few days.
A ‘Mongolian blue spot’ is a harmless blue-grey discolouration in the buttock region. This occurs in most black and oriental babies and occasionally in white-skinned babies. It disappears during the first two years of life. You will probably have noticed lots of tiny white spots over the baby’s nose and, perhaps, cheeks and forehead. These are caused by a temporary blockage of glands in the skin and disappear in a few weeks. Ask the paediatrician about any blemishes that are causing you concern, then you can leave the maternity hospital reassured about your baby’s skin.
THE BABY’S HEAD
Having made his general observations, the paediatrician will examine the baby in some detail, perhaps starting with the head and face. A baby’s head is not as delicate as you might think. It is built to withstand the pressures of being squeezed through the birth canal and, after this, your gentle touches are light relief! The skull of a young baby is made up of eight bones which are not yet fused into one and, during birth, the bones overlap each other a little to allow the head to mould as it comes through the birth canal. If you run your finger gently across your baby’s head soon after birth you can often feel several ridges where the bones have overlapped.
The moulding may persist for a day or two after birth and that is why the shape of a newborn baby’s head is rarely perfectly round. You may wonder why the paediatrician runs a tape measure around the baby’s head. Before his first birthday the baby will probably have other routine medical check-ups. If the head size is measured again at these times, the paediatrician will know how well the head has grown from birth.
The fontanelle On the top of the head, towards the front, is a diamond shaped area which is called the anterior fontanell. It feels rather soft because four of the skull bones in this area have not yet fused together. It is quite normal to see or feel pulsations here. This so-called soft spot is not as soft as you might think because under the skin there is a tough membrane.
Bruising and swelling
A little bruising and swelling over the part of the baby’s head which presented itself at birth, is common. This will subside in a few days. A somewhat larger firm swelling, called a cephalhaematoma, however, often causes parents concern. It is caused by a little bleeding around one of the skull bones and is harmless, although it is usually several weeks before it subsides. Bruising of the face is quite common especially after a’ delivery, and the eye lids and cheeks often appear a little swollen at first. You may have noticed that the whites of the baby’s eyes are somewhat bloodshot, but this will clear completely in a week or two.
THE BABY’S MOUTH
The paediatrician will carefully inspect the baby’s mouth, usually shining a torch inside to get a better view. White blisters in the centre of the lips are caused by sucking and always clear up spontaneously. White patches on the tongue are usually caused by milk staining, but are sometimes confused with a fairly common mouth infection called ‘thrush’. If a baby has thrush his mouth is usually a little sore and the white patches are somewhat thicker and difficult to wipe off. The condition is not dangerous and soon clears with some medicine drops.
THE BABY’S BREASTS
Baby boys and girls often have slightly swollen breasts which discharge a little milk for several weeks after birth. Some mothers are tempted to get rid of the swelling by squeezing the milk out. This should never be done. It can cause the breasts to become infected.
HEART AND LUNGS
Before using the stethoscope, the paediatrician watches how the baby is breathing. Babies breathe more quickly than adults and you have probably noticed that, when a baby is falling asleep after a feed, his breathing becomes quite jerky and irregular. It soon settles down, however, when he is sound asleep. A baby usually gets very cross when the stethoscope is put on his chest, especially if the instrument feels cold. If you watch carefully, you may see him try to push it away with his hands, showing you that he has a mind of his own! it is helpful if you can pacify him, perhaps by letting him suck at your finger.
Heart murmurs are quite commonly heard in newborn babies and do not necessarily mean that there is something wrong with the heart. In fact, most newborn babies who have something seriously wrong with their heart are obviously ill. A paediatrician will suspect a heart problem long before he has listened with a stethoscope from the baby’s general appearance, his behaviour and response to his surroundings.
THE UMBILICAL CORD
It usually takes about a week for the stump of the umbilical cord to come off. If you notice any bleeding from it, or if the skin surrounding it becomes unduly red or inflamed, mention it to the nursing staff or to the paediatrician when he is making his routine check-ups.
A baby’s tummy usually looks rather large. When the paediatrician feels it he is making sure that there is no enlargement of the internal organs and that everything is present and is located in the right place.
THE BABY’S BOWELS
Most babies have their bowels open by the end of the first day. When this happens immediately after birth in the delivery room it can be easily overlooked. During the first few days a baby passes a greeny-black, sticky substance called meconium. If he has not presented you with a dirty nappy by the end of the second day, mention it to the nursing staff. After a few days the stools will gradually become yellow, but their colour is not all that important. You will notice that it varies a little from time to time, as does the consistency.
THE NAPPY AREA
During the check-up the baby’s nappy is taken off as there are a number of things to be checked in this area. The paediatrician will, for example, look at the baby’s groins for signs of a hernia and will feel for the pulse in the arteries that carry blood to the legs. In boys, the opening at the tip of the penis (urethral meatus) is usually tiny and sometimes cannot be seen at all as it is covered by the foreskin (prepuce).
Usually both testicles can be felt in the scrotum, but sometimes fluid accumulates there causing a swelling known as a hydrocele. This nearly always disappears as the baby gets older. There is often some bruising of the scrotum if the baby is born by the breech if the buttocks, and although this may look sore it does not seem to worry the baby. Baby girls often have a vaginal discharge and, between five and ten days old, there may also be a little bleeding caused by temporary hormonal changes. This is quite normal and should not cause any anxiety.
SPINE, HIPS AND FEET
The paediatrician is especially interested in the baby’s spine, hips and feet. A skin dimple or tiny pit at the base of the spine, just where the buttocks begin, is common and quite harmless. Many years ago, it was not a rare sight to see older children walking with a limp because of dislocated hip. Things are different now because the hips are examined most carefully after birth to spot early signs of dislocation and, if necessary, treatment ;e commenced right away.
Sometimes a baby’s feet tend to turn in or turn out a little after birth. This usually becomes less noticeable as the baby gets older but, occasionally, it is necessary to put some strapping around the ankles until the position of the feet improves.
MOST BABIES ARE NORMAL
It is natural for a mother to compare her baby with others in the maternity ward, but remember that no two babies are quite the same. Nearly all babies are normal, so the paediatrician is most unlikely to find anything wrong. If you have any worries about your baby’s health, do ask. But most problems will be uncovered by the.