Chapter 19: Newborn and Infant Exams

INTRODUCTION

By definition an infant is a child under one year of age, while a newborn infant is a child 0-28 days of life. The newborn examination is a screening exam that occurs within 24 hours of birth. The goals include the following:

• Identify in utero growth issues.

• Recognize dysmorphic features.

• Note birth trauma.

• Normalize common variations.

• Educate parents about temperament, parent-newborn interaction, and development.

• Model how to hold, interact with, and comfort the baby.

• Provide anticipatory guidance focused on routine newborn care and any concerns that arise from the history.

A similar examination is performed during the first year of life at subsequent well-child checks with some minor variations based on age. A visit for an acute clinical concern would include a focused exam.

HISTORY

General Information

• Newborn: consists mostly of the mom’s^* pregnancy and delivery history, including:

  • Maternal laboratory results

  • In utero exposures

  • Prenatal ultrasound reports (including placental issues)

  • Birth information

  • Parental observations since the baby’s birth

  • You may need to ask visitors, including the partner, to leave the room in order to ask sensitive questions.

  • While speaking with the family, you will get a sense of their dynamics and maternal recovery.

• Infant

  • Feeding

  • Sleep

  • Development

  • Parental concerns and/or any acute issues

Family History

• Newborn

  • Focus on childhood conditions such as:

    • Hip dysplasia

    • Birth defects

    • Sudden infant death syndrome

    • Childhood hearing loss

  • Remember to ask about genetic relatives. The known family history of a donated egg or sperm may be quite limited.

• Infant

  • Ask about any updates.

  • Ask about conditions that are pertinent to the clinical encounter.

Social History

• Newborn

  • Who will be living at home?

  • Are there older siblings?

  • Does anyone smoke?

  • Are there pets that could harm an infant?

  • What are the childcare plans?

  • Does the family have needed supplies such as a safe sleeping space and car seat?

• Infant

  • Update the items above.

  • How is parental mental health?

  • Are there any family relationship issues?

  • Is food security a concern?

GENERAL COMMENTS ABOUT THE EXAM

Most newborns in the United States now room-in with their parents rather than going to a separate nursery, so the newborn examination will likely occur in the patient room. As with all patient encounters, the first thing you should do is introduce yourself and your role. Because newborns ...