6 week baby check GP Obstetric Shared Care Accreditation Seminar Program 16 th Feb 2013 Dr Sanjay Sinhal MBBS MD FRACP CCPU Neonatologist, NICU, Flinders Medical Centre Paediatrician, Flinders Private Hospital Paediatrician, Ashford Hospital Acknowledgements - Dr V Ellison, Dr R Seth, Dr V Dasireddy

Aims of examination Detect congenital anomalies, developmental issues Identify common postnatal problems Follow-up on antenatally detected problems Opportunity for parents to ask questions Psychosocial wellbeing of infant and family

Examination Warm quiet environment Infant in a quiet, alert state Wash hands While undressing infant observe activity, tone, lethargy Colour, Respiratory rate

Before examination Maternal/ perinatal history how certain is the GA? maternal illness especially inherited disorders maternal drug use prescribed or not Fetal growth obstetric history and liveborn infants neonatal / postnatal deaths Results of antenatal USS Delivery & resuscitation history Concerns from nursing or medical staff in postnatal period Bedside chart, urine, stools, feeding, weight, length

Order of examination Observe – interaction with parents and infant Red Reflex Murmur, femoral pulses Thorax Abdomen, umbilicus Genital area, anus Legs, hips Oral cavity Roll infant over, ventral suspension, back Reflexes Hands, Arms Head, neck, mouth

Observation Dysmorphism Tone, posture, equal use of limbs Cyanosis, central & acrocyanosis Cutaneous lesions e.g milia, petechiae, erythema toxicum

Order of examination Interaction between infant and examiner –Fixing following, postural corrections when handling –Quality of cry –Symmetry of startle, limb movements during exam –Parental concerns Red Reflex, light reflex (asian babies – pale retina) Squint – when to refer, ptosis, eye discharge Murmur, femoral pulses Thorax – shape, respiratory system, engorged nipples, accessory nipples Abdomen – distension, liver, spleen, masses Umbilicus – granuloma, hernia, innie/outie, cleaning

Order of examination Genital area – undescended testes, chordae, hypospadias, hydrocele, discharge from vagina, skin tags Anus – rashes, anteriorly placed, tone Inguinal hernia Legs – bowing, rashes, hemangiomas Hips Oral cavity – natal tooth, thrush, ebstein pearls, cleft Ventral suspension Back – mongolian spot, spina bifida, pilonidal sinus, paraspinal reflex, skin lesions

Order of examination Reflexes – Moros, head control, grasp Hands, Arms – paronychia, bowing, Vit D deficiency Head – plagiocephaly, sutures, AF, head circumfernce Neck, mouth – sternomastoid muscles Developmental milestones in first few months Jaundice Weight gain – normal, variants, slow or fast, what to do

Common questions Irritable infant – differential diagnosis, investigations, management, follow up Routines! Feeding and sleep issues, noisy breathing GORD URTI from siblings Vaccination Weaning Long term follow up

Thank you