A newborn sees many complex physiological changes from birth to the first four weeks of life. This is because the newborn interacts with its new world. Common health problems during this time include colds, coughs, fevers, and vomiting. Most of these problems are not serious. If you see any warning signs and are unsure of how to deal with the sickness, call your pediatrician right away.
Babies need continuous and effective care, and this is not only when the baby is sick. Your pediatrician will be aware of the best practices required for adequate care of your newborn. This consists of a complete physical exam and administration of vaccines. Your pediatrician will also be able to talk to you about adequate feedings, safe sleep, hygiene of the newborn, and other important areas for baby wellbeing.
Initial Examination
The doctor will assess growth parameters and behavior as soon as your baby is born. In case of a normal spontaneous vaginal delivery or a Caesarean section with no complications, it is imperative to establish skin-to-skin contact with the mother and start breastfeeding. A pediatrician or nurse practitioner will monitor the newborn in the first twenty-four hours of life. The initial examination is to specifically watch out if the baby needs any resuscitation.
Physical Examination
The weight, length, head circumference, and abdominal and chest circumference are taken at the time of birth. The values of each of these parameters will vary depending on sex, socioeconomic status, and race. Boys tend to be heavier than girls, but the average weight is around 3500 grams or 3.5 kilos. The length of the baby is an average of 20 inches. The head circumference will be around 14 inches (+/- 2 inches). The doctor or medical practitioner will note the measurements on a growth chart.
Patient results fall into three categories based on weight and gestational age:
| Category | Boys (Weight in kilograms) | Girls (Weight in kilograms) | Percentile |
| Small for gestational age | Less than 3 | Less than 2.8 | < 10 |
| Adequate for gestational age | 3- 4.2 | 2.8-4 | – |
| Large for gestational age | More than 4.2 | More than 4 | > 90 |
*Data derived from www.msdmanuals.com
The doctor also does a full physical examination to ascertain any abnormalities with your baby. A head-to-toe approach is the most recommended method. A physician usually examines different aspects and reflexes in the eyes, nose, mouth, and ears starting with the head. The chest, abdomen, and limbs are also thoroughly examined. Palpation is a method of feeling with fingers. The doctor will touch and feel the baby’s body to examine various parameters of body parts. This is mostly the method followed for the newborn baby. The doctor usually checks the following:
Head: Subcutaneous swelling, hematomas, overriding of sutures, and subcutaneous swelling
Eyes: Symmetry, size, any subconjunctival hemorrhage
Nose: Patency and balance of nares
Mouth: Rule out the cleft palate and check for sucking reflex
Ears: Size, patency of ear canals, malformations, skin tags or pits
Neck: Masses and range of motion checks
Clavicles: palpation to assure continuity and to rule out fractures
Chest: Symmetry and location of nipples in relationship to the clavicular midline
Heart: Auscultation identifies rhythm and the presence of murmurs, if any
Lungs: Auscultated for identification of adventitious sounds and air entry
Abdomen: Evaluation for asymmetry or malformations, auscultation to assess peristalsis, and palpation for the presence of masses or organomegaly. Examination of the umbilical stump for normal vessels and hernias.
Hips: Palpation of the femoral pulses for intensity and symmetry and examination of the hips using the Ortolani and Barlow maneuvers to assess for the presence of clicks suggesting developmental dysplasia of the hip.
Back: Assessment of spine centralization, sacral dimples, or hair tuff
Skin: Checks for color, macules, spots, birthmarks. Trauma that may have occurred at birth or caused by medical equipment
Evaluation of neurologic development of the baby by eliciting reflexes and assessing them.
If anything is found, the doctor will document it for future reference. The following are usually done to ensure the baby stays healthy post-examination:
Medication: The doctor will administer a dose of intramuscular Vitamin K within the first hour of birth. Doctors recommend prophylaxis with erythromycin ointment to both eyes and Hepatitis B vaccine at this time.
The following are common conditions that are common in babies that the mother has to be aware of:
Abdominal distension
After a large feeding, most babies’ bellies normally stick out. The belly should feel soft between feedings. Call your pediatrician if
- Your baby’s abdomen feels swollen and hard
- Your baby has not had a bowel movement for more than one or two days
- Your baby is vomiting
There might be no cause for worry. It might only be gas or constipation. But it could also signal a more serious intestinal issue.
Birth injuries
Injuries can occur during birth, especially if labor is long or difficult. Injuries can also occur when babies are huge. Newborn babies tend to recover quickly from some of these injuries. An example of this may be a broken collarbone, which will heal quickly. A small lump may form at the site after a few weeks. This is a sign of formation of the new bone, and it will soon be as good as new.
Another common birth injury during labor is muscle weakness. This is caused by pressure or stretching of the nerves that are attached to the muscles. If this occurs, they return to normal after a few weeks. Your pediatrician will tell you how to hold the baby to promote healing when this occurs.
Blue baby
Usually, babies will have mildly blue or purple hands and feet. Hands and feet can turn blue from cold, and they will return to being pink as soon as the baby is warm. When the newborn is crying hard, the face, tongue, or lips may turn a little blue. The color returns to normal as soon as the baby stops crying. If it persists, it may indicate that the heart or lungs is not functioning properly and the baby is not receiving enough oxygen. Please get your baby’s medical attention as soon as possible.
Unusual bowel movements
After birth, medical personnel will watch your baby’s first urination and bowel movement. This may be a little delayed and is nothing to worry about. One or two bowel movements will be black or dark green and very slimy. This is meconium, which fills the infant’s intestines before birth. If the baby does not pass out the meconium in the first 48 hours, further evaluation is called for.
Blood in stool
Sometimes, there might be a little blood in the baby’s bowel movements. If it occurs during the first few days, it indicates that the infant has a little crack in the anus from stooling. While considered harmless, let your doctor know about it.
Coughing
Babies are not used to drinking milk, and fast drinking may lead to coughs. As soon as the baby is used to feeding, this cough should stop. If the cough persists, consult your pediatrician. It may signal underlying problems in the digestive tract or lungs.
Excessive crying
Babies cry seemingly for no apparent reason, and mothers may feel exasperated by this. If your baby is well-fed, warm, and snug, it should stop crying in a bit. If the crying goes on for too long or if it sounds like there are shrieks of pain in between the crying, this could indicate a medical condition that gives the baby pain. Talk to your pediatrician about going in for a consultation.
Forceps marks
Forceps used during delivery can leave red marks on a baby’s face and head. The red marks or scrapes will disappear within a few days. Like bone damage, tissue damage could lead to the formation of a lump at the injury site. This lump will also go away within two months.
Jaundice
Babies are generally screened for jaundice around 24 hours after birth. A build-up of bilirubin in the baby’s blood can cause the skin to look yellowish. This is known as jaundice. Mild jaundice is normal and nothing to be worried about. If the bilirubin level continues to rise and is not treated, it can lead to brain injury. Breastfeeding mothers should aim to feed their babies at least eight to twelve times per day, producing enough milk and keeping bilirubin levels low. If you notice the jaundice is getting worse, call your doctor.
Lethargy & sleepiness
Newborn babies spend most of their day sleeping, staying awake only for feedings and a bit of play. If your baby sleeps too much and does not wake up on its own for feedings or seems a bit less alert, call your pediatrician. Too much lethargy can indicate an underlying illness.
Respiratory problems
Your baby will start to breathe normally only a few hours after birth and establish a pattern. If your baby seems to be breathing unusually, it could be due to a blocked nasal passage. This can be fixed with saline nasal drops. You can also suction the mucus from the nose with a bulb syringe. If the problem persists, call your doctor.
Babies adjust to their life outside the womb quickly. They are fragile. They need constant care in the first few years of their birth. If they are born with an illness or a defect, you can detect and treat it early. Watch out for the following signs-
- Rashes
- Swelling
- Change in color of skin
- Breathing patterns
- Change in sleep patterns
- Difficulty in feeding
- Change in the color of a motion
- Continuous crying
There is no need to panic when you see these signs most of the time. They usually go away in a day or two. But, if they persist, plan a trip to your pediatrician.