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Physical Examination of a Newborn

By

Deborah M. Consolini

, MD, Thomas Jefferson University Hospital

Reviewed/Revised Sep 2023
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A newborn is usually given a thorough physical examination by a health care professional within the first 24 hours of life.

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

After a normal head-first delivery, the baby's head may be misshapen for several days (it may appear cone-shaped or flat on some sides). 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 During pregnancy, the fetus can be positioned in many different ways inside the mother's uterus. The fetus may be head up or down or facing the mother's back or front. At first, the fetus can... read more ), the head is usually not misshapen. However, the buttocks, genitals, or feet may be swollen and bruised. When the baby is in the breech position, doctors usually recommend a cesarean delivery Breech presentation During pregnancy, the fetus can be positioned in many different ways inside the mother's uterus. The fetus may be head up or down or facing the mother's back or front. At first, the fetus can... read more , or C section (the surgical delivery of a baby by incision through a woman's abdomen and uterus), instead of a vaginal delivery to minimize risk of injury to the baby during birth.

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. Rarely, this asymmetry 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

A stethoscope is used to listen to the heart and lungs to detect any abnormality. Abnormal heart or lung sounds may be a heart murmur or lung congestion.

The newborn's skin color is examined. 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. The newborn's breathing is observed, and the number of breaths in a minute is counted. Grunting and/or flaring nostrils with breathing and breathing too fast or too slow can be signs of problems.

Abdomen and Genitals

The general shape of the abdomen is examined and the size, shape, and position of internal organs, such as the kidneys, liver, and spleen are checked. Enlarged kidneys may indicate a blockage to the outflow of urine.

The genitals are examined to ensure the urethra (the tube through which urine passes from the bladder during urination) is open and in the proper location. The genitals are checked to see if they 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. Rarely, a newborn has genitals that are not clearly male or female (ambiguous genitalia) and further evaluation is needed.

The anus is examined to make sure the opening is normally placed and not sealed shut.

Nervous System

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

A newborn's reflexes are tested 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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