1. Six week baby check By Catherine Locke GPST1

2. Aims Background Physical examination – important diagnoses and referral options Review of development – growth charts Health promotion Supporting parents

3. Background NHS Newborn and infant physical examination Programme. Offers an examination within 72 hours of birth and again 6-8 weeks later 1. Purpose is to screen for abnormalities, monitor development and provide support for often worried parents.

4. Systematic approach Top to toe Quiet, warm room with all equipment to hand. Parents can be anxious so explain what you are about to do & reassure during the procedure. Examine exposed parts first e.g. fontanelle. Undress baby so that you can do a thorough examination. Do heart/eye examination first and leave hip examination to last.

5. Common skin complaints Erythema toxicum – blotchy red rash with associated yellowish pustules. Settles with no treatment. Milia – benign keratin filled cysts.

6. Birthmarks Mongolian blue spots – particularly over the sacrum / buttocks are extremely common. Small port wine naevi and Strawberry naevi generally require no treatment. They grow for 6-12 months before gradually fading within 5-8 years 2. Large unilateral port wine stains can be associated with intracranial vascular anomalies 2 and further imaging/review may be required. Large disfiguring birthmarks need reviewing by a senior paediatrician to discuss further management options

7. Neurological Inspect spine for sacral dimples / hairy patches. If unable to identify base of dimple refer for spinal USS 2. Tone – when pulling babies to sit from supine, babies should be able to attempt to raise their head. Social smile / normal cry Hearing – startles to noise

8. Facial features Measure head circumference. Is it a normal shape? Eyes – check for bilateral red reflex (retinoblastoma) Cleft lip/palate – refer cleft coordinator LGI 2 Ears – pre auricular skin tags – plastic surgeons 2 Neonatal tooth – orthodontist 2

9. Cardiovascular/Respiratory system Rule out congenital heart disease. Inspect for cyanosis or respiratory distress. Palpate apex for displacement. Listen for murmurs & check for equal air entry. Palpate for femorals – diagnose coarctation of the aorta

10. Hands Polydactyly – if bilateral can be associated with renal abnormalities so a renal US should be arranged 2. Syndactyly – if there is fusion of the bone refer to a hand specialist / if not refer to the plastic surgeons 2

11. Abdomen / hernias Umbilical hernia – common and usually resolves by 18/12 2. Inguinal hernias are rare in term, newborn infants 2. If diagnosed they need early surgical intervention as they are at increased risk of incarceration.

12. Developmental dysplasia of the hip Risk factors: breech presentation, FHx of DDH require USS of the hips 2. Barlows – flex and adduct each hip then push the hip posteriorly keeping your fingertips on the greater trochanter. Feel for the femoral head slipping out of socket. Ortolani’s – gently abduct the hip fully – feel for the femoral head slipping back into joint.

13. Genitalia Ambiguous genitalia – don’t guess! Refer to a consultant paediatrician. Undescended testes – most will descend in the first few weeks post delivery. If undescended by 1 year old referral to surgeons is needed 2. Hypospadias – urethral meatus opens in an abnormal position. Ensure that baby can pass a good stream of urine 2. Need referral to paediatric urologist.

14. Development /health promotion Review feeding and weight gain. Plot on growth chart length, weight and HC. Note centiles. Take the opportunity to discuss -Immunisations -Reducing risk of sudden infant death -Dangers of passive smoking -Car safety -Dental health

15. Parental support Take the opportunity to ask if there are any specific concerns about baby. Consider maternal health e.g. evidence of postnatal depression. If any referrals are warranted then explain to the parents clearly why they are being referred and what will happen next.

16. Summary Important screening tool if conducted in a systematic and thorough way. Act confident and establish good rapport with parents. Explain reasons for referrals and what the next steps will be. Take the opportunity to discuss health promotion.

17. Any questions?

18. References 1) NHS Newborn and infant physical examination programme. Frequently asked questions. http://newbornphysical.screening.nhs.uk/faqs #fileid10637 (Accessed 24/10/12) 2) ANNP Office. Common problems in the healthy neonate.Calderdale and Huddersfield NHS foundation trust, 2011.