Physical Examination of a Newborn

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.

(See also Birth Defects of the Face, Bones, Joints, and Muscles Introduction to Birth Defects of the Face, Bones, Joints, and Muscles Birth defects, also called congenital anomalies, are physical abnormalities that occur before a baby is born. "Congenital" means "present at birth." Birth defects of the face and limbs are fairly... read more .)

The newborn's head, face, and neck are examined by a health care professional for any abnormalities. Some abnormalities occur during delivery Birth Injuries in Newborns Birth injury is damage that occurs as a result of physical pressure during the birthing process, usually during transit through the birth canal. Many newborns have minor injuries during birth... read more . Other abnormalities may be caused by a birth defect Introduction to Birth Defects of the Face, Bones, Joints, and Muscles Birth defects, also called congenital anomalies, are physical abnormalities that occur before a baby is born. "Congenital" means "present at birth." Birth defects of the face and limbs are fairly... read more .

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 Position refers to whether the fetus is facing rearward (toward the woman’s back—that is, face down when the woman lies on her back) or forward (face up). It’s important to check the baby’s... 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 Position refers to whether the fetus is facing rearward (toward the woman’s back—that is, face down when the woman lies on her back) or forward (face up). It’s important to check the baby’s... 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 (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.

Doctors examine the ears and note whether they are properly formed and in the correct place. For example, low-set or incorrectly formed ears may mean the newborn has a genetic disorder Overview of Chromosome and Gene Disorders Chromosomes are structures within cells that contain a person's genes. Genes are segments of deoxyribonucleic acid ( DNA) and contain the code for a specific protein that functions in one or... read more and/or hearing loss Hearing Impairment in Children Hearing impairment refers to any degree of hearing loss, mild to severe, and can occur when there is a problem with a part of the ear, including the inner, middle, and outer ears, or the nerves... read more .

Doctors also examine the mouth for problems. Rarely, newborns are born with teeth, which may need to be removed, or a cleft lip Cleft Lip and Cleft Palate A cleft is an opening that can form in the lip (cleft lip), roof of the mouth (cleft palate), or both if the tissue does not join together completely during pregnancy. Cleft lip and cleft palate... read more or cleft palate Cleft Lip and Cleft Palate A cleft is an opening that can form in the lip (cleft lip), roof of the mouth (cleft palate), or both if the tissue does not join together completely during pregnancy. Cleft lip and cleft palate... read more . Doctors check to see whether newborns have an epulis (a noncancerous growth on the gums) because these growths can cause feeding problems and may block the airways.

The neck is examined for swelling, growths, and twisting or spasms.

(See also Birth Defects of the Heart Overview of Heart Defects About one in 100 babies is born with a heart defect. Some are severe, but many are not. Defects may involve abnormal formation of the heart's walls or valves or of the blood vessels that enter... read more .)

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.

(See also Birth Defects of the Digestive Tract Overview of Digestive Tract Birth Defects A birth defect can occur anywhere along the digestive tract—in the esophagus, stomach, small intestine, large intestine, rectum, or anus. The digestive organs may be incompletely developed or... read more and Birth Defects of the Urinary Tract and Genitals Overview of Kidney and Urinary Tract Birth Defects Birth defects are more common in the kidney and urinary system (urinary tract) than in any other system of the body. Defects can develop in the Kidneys—the two organs that filter waste from... read more .)

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.

(See also Birth Defects of the Brain and Spinal Cord Overview of Brain and Spinal Cord Birth Defects Birth defects of the brain or spinal cord cause a spectrum of neurologic problems; some may be barely noticeable, others may be fatal. Birth defects of the brain and spinal cord can occur in... read more .)

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.

(See also Birth Defects of the Face, Bones, Joints, and Muscles Introduction to Birth Defects of the Face, Bones, Joints, and Muscles Birth defects, also called congenital anomalies, are physical abnormalities that occur before a baby is born. "Congenital" means "present at birth." Birth defects of the face and limbs are fairly... read more .)

The newborn's flexibility and mobility of the arms, legs, and hips are examined to see whether the newborn has dislocated a hip or broken any bones during delivery (the collar bone is the most common bone that may break during delivery and usually heals completely within a few weeks). All limbs and joints are checked for unformed or missing limbs Missing or Incompletely Formed Limbs Limbs can be missing, deformed, or incompletely developed at birth. Birth defects, also called congenital anomalies, are physical abnormalities that occur before a baby is born. "Congenital"... read more .

The spine is examined for defects or deformities (such as spina bifida Neural Tube Defects and Spina Bifida Neural tube defects are a certain type of birth defect of the brain, spine, and/or spinal cord. Neural tube defects can result in nerve damage, learning disabilities, paralysis, and death. The... read more ).