What happens at my newborn's first pediatric assessment?

When I first assess a baby, I lay her down, and I just look at them. How’s the coloring, how are they acting, are they moving all their limbs, are they awake, are they asleep, what is the overall look of the baby? Feel the anterior fontanelle, make sure that it’s flat. Look at the shape of the head - make sure there’s not any major flat spots or any lesions on the head or cuts or scrapes or anything. Look at the ears, looking for any tags or pits. Look at her chest, looking for rashes. Make sure that the spine is straight, also look down here for little dimples. If there’s a dimple here in the lower back or a tuft of hair, that can mean some problems with the spinal cord. Next listen to the heart for any murmurs and for her lung sounds. Some babies might have fluid in their lungs and some babies may have some type of murmur. Murmurs are not necessarily bad in this age because a lot of times the heart is changing - it changes from being inside Mom to being outside Mom - so you can hear a murmur, and it’s really not a problem. I usually listen to it while they’re in the hospital. If the murmur persists, we might get an echocardiogram and look at the heart but usually it’ll go away and it just needs some time - we just follow it.
If it sounds a bit more abnormal we’ll get a picture of the heart (an echocardiogram) and make sure it looks okay. With the lungs, just want to make sure she’s getting air in and out, there’s not any fluid, there’s not any decreased breath sounds. Sometimes as babies are being born, they can retain that fluid and have a hard time breathing. Most babies are going to be kind of spitty, they’ve swallowed the amniotic fluid, it comes up, they cough, they choke, they gag a bit, but a lot of babies want to protect their airway - that’s why they’re coughing, that’s why they’re choking. If you notice they’re having trouble, a lot of times you can put them on their side and use a little bulb syringe to suck it out, but that’s a very common thing for them to do. Once they’ve worked the amniotic fluid out - either they’ve puked or pooped it out - they’re usually fine when they come home. Then we move to the abdomen, so listen for sounds here to make sure that her intestines are moving and working. I also feel for any enlargement of the liver or if there’s any masses in the abdomen. Mash on their bellies - they don’t like that too much, sometimes they spit up with it, but make sure that there’s not any large, hard masses in there. Then we want to make sure that the hips are nice and stable, so I’m going to push down and push out to make sure we’re not having any dislocation. Some babies' hips do dislocate and you can feel it do that. A higher risk in a baby that’s breech is dislocation of the limbs, but every single baby gets this test. Every time we assess a baby, whether it’s here in the hospital or if it’s at the 2-week visit or the 2-month visit we always check the hips, because it can develop later. Then you look at the genital area, make sure that everything is where it’s supposed to be. Next I look at her neurologic tone. If I pull their legs down, they don’t like it at all, and they want to keep it up. I also look for the startle reflex, so I grab the baby’s hands and then I let it go. It also shows me that she’s got the grasp reflex right here and the rooting reflex. You also have the grasp reflex down here. And while you’re doing that, you just make sure that you’ve got five toes and there’s not any abnormalities here. You look for any club foot. A healthy baby will have a normal range of motion. Their feet will move back and forth, up and down. Once I’m done with that, then I want to look in the eyes for the red reflex, so I get a thumb scope and that’s showing me the retina, the back of the eye, and that there’s not any cataracts or any masses in the eye or anything like that. Then look in the mouth, make sure that there’s not any cleft palate or any abnormalities in her mouth or what we call tongue-tied. Tongue tying is a fairly common thing and that’s when the tongue is tethered a little bit closer down and they can’t really stick their tongue out. If that happens, they have a really hard time latching on and eating, so if ever a mom is feeling like they just don’t latch, they just don’t suck, we look for that, and if the baby is tongue tied, we’ll talk to an ear, nose, throat doc, and they can come in and clip it, then it’ll move easier and they’ll be able to eat better. It can also affect them as they get older with speech and sucking. Talking about clipping a part of the tongue sounds scary and painful, but it really is very simple. The babies take it just fine and it’s not a problem, especially if we catch it earlier in progression.
If you have any questions for me in the future, you can ask them on our Facebook page at facebook.com/IntermountainMoms.