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Newborn Six Week Check

Introduction

Greetings
Hand wash
Verify the patient's identity using at least two or three details
Explanation of the examination
Obtain consent from parents

History

Pregnancy and delivery details
Feeding pattern and concerns
Sleep pattern
Bowel and bladder habits
Relevant family history

General Observation

Overall appearance and behavior
Skin color and jaundice assessment
Respiratory rate and effort

Normal newborn rate: 40-60 breaths/min. Look for signs of respiratory distress: nasal flaring, grunting, chest retractions.

Posture and spontaneous movements

asymmetry or abnormal posturing

Measurements

Weight measurement and plotting on growth chart
Length measurement and plotting on growth chart
Head circumference measurement and plotting on growth chart

Rapid increase may indicate hydrocephalus

Head and Neck Examination

Head shape, fontanelles, and sutures

Bulging fontanelle may indicate increased intracranial pressure

Palpate clavicles for fractures
Eye examination
General inspection (conjunctiva, sclera, position)
Fundal (red) reflex assessment

Use ophthalmoscope at 30cm. Look for symmetrical, red-orange reflection. White reflex requires urgent referral

Ear position and structure

Low-set ears associated with chromosomal abnormalities

Mouth examination including palate and tongue-tie

Check for cleft palate, high arched palate, and tongue-tie. Tongue-tie: restricted tongue movement due to short frenulum.

Cardiovascular and Respiratory System

Auscultate heart sounds and murmurs

Normal newborn HR: 120-160 bpm

Palpate femoral pulses

Weak/absent femoral pulses may indicate coarctation of aorta

Auscultate lung sounds
Check pre- and post-ductal oxygen saturations (if indicated)

Both should be ≥95% and within 3% of each other

Abdominal Examination

Inspect abdomen for distension or visible peristalsis
Palpate for organomegaly (liver, spleen, kidneys)

Liver edge may be palpable 1-2cm below costal margin

Check umbilicus for hernias or infection

Genitourinary Examination

Male: inspect penis, urethral opening, and scrotum

Check for hypospadias and chordee

Female: inspect labia and clitoris

Clitoral hypertrophy may indicate congenital adrenal hyperplasia

Check for descended testes in males

Musculoskeletal Examination

Inspect spine for scoliosis, sacral dimples, or hair tufts

Sacral dimples >2.5cm from anus or >5mm wide require further investigation

Examine limbs for symmetry and movement
Hip examination
Perform Barlow's test

Positive if hip dislocates

Perform Ortolani's test

Positive if clunk felt as hip relocates

Check for talipes (club foot)

Neurodevelopmental Assessment

Assess tone (normal, hypertonia, hypotonia)
Check primitive reflexes
Moro reflex

Suddenly lower infant's head while supporting body

Rooting reflex

Stroke cheek near corner of mouth

Sucking reflex

Place clean finger in infant's mouth

Palmar grasp

Place finger in infant's palm

Plantar grasp

Stroke sole of foot from heel to toe

Assess 6-week developmental milestones (for 6-week check)

Should smile responsively, fix and follow to midline, lift head briefly when prone

Conclusion

Summarize findings
Arrange follow-up or referrals if needed

Exam Progress

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