Check It Out

From the moment that your baby is born, she will be routinely checked and examined to ensure that she is developing well. Modern Mum gives you the comprehensive guide to all the checks that your baby will undergo.

The first tests that your baby has to undergo are performed both straight after birth and within the first 36 hours.

The Agpar Test

As soon as your baby is born, the midwife will assess her overall health at one minute and then at five or ten minutes after birth. This test – the Agpar Test, as it is known, has five categories, which are assessed:

Skin colour: A newborn baby’s skin is tinged with blue, but it will become pink quickly after the birth, especially after they’ve had a good cry! In non-white babies, the inside of the mouth, whites of the eyes, soles of the feet and palms are also checked.

Heart rate: Newborns should have a heart rate of over 100 beats per minute.

Breathing: This should be strong and regular.

Muscle tone: Your baby should be able to actively move her arms and legs.

Response/reflex: When stimulated, baby should respond.

Each category is given a score from nought to two, giving a total score of between zero and ten. A healthy baby will have a score of seven or higher, while a baby with a lower score may need time to recover from the birth. A baby, who registers a very low score, many need medical attention.

Scores below seven are relatively rare, and usually happen if your baby has had a traumatic birth. Even if your baby does score low, she may just need careful monitoring immediately after birth. Often babies with low scores will experience no further problems.

You may not even be aware that any tests are taking place, as experienced midwives can often carry out the Agpar Test just by assessing your baby while she’s in your arms.

Weight and size

Your baby’s weight, length and head circumference will be recorded. These details are important, as the measurements provide the basis to monitor how she’s doing in the following months – steady growth and weight gain are indicators that all is well.

As babies acclimatise to life outside the womb, most will lose some weight in the first few days after birth. After the first week or so, however, this should level out and you can then expect your baby to gain weight steadily.

Further tests

Within 36 hours of the birth a midwife or paediatrician will carry out further checks.

Your baby’s head and neck: the skull and fontanelle (soft spot) will be checked, as well as the roof of your baby’s mouth, to ensure her palate is properly formed. The eyes, ears and nose will also be examined.

Heart sounds and breathing: Your baby’s heartbeat should be around 120 beats per minute. It’s fairly common for the doctor to pick up an innocent heart murmur as a baby’s circulatory system adjusts. Nearly half of all newborns have a heart murmur, but most are harmless and disappear within weeks.

Hands, feet, arms and legs: The doctor will examine your baby’s feet to see if there is any sign that they turn in excessively. The tone and strength of baby’s limbs will also be observed.

Hips: The doctor will very gently rotate baby’s hips to check joints for dislocation or clicking. Hip dislocation affects about one in 500 babies and partial dislocation (or ‘clicky hips’ as they’re known) affect slightly more babies. Treatment usually involves wearing a special plaster splint for six to twelve weeks.

Genitals: At birth boys’ testes should have descended, but in four per cent of cases they remain in the abdomen. They will, however, descend naturally by around the six-month mark. It’s common for baby girls to have swollen genitals after birth and some may have a little vaginal discharge within the first few days. The doctor will examine the genitals to check that they are properly formed.

Bowel movements: The doctor will ask you if your baby has opened her bowels (ie, ‘done a poo’). This will indicate that baby’s back passage is open. The first poo will be sticky and of a greenish black colour, so don’t panic! It’s called meconium and is perfectly normal.

Spine: The doctor will run his hands down the bones in baby’s back to check for any obvious abnormalities.

Hearing: This is checked by the insertion of a special instrument into your baby’s ear.

Six to eight-week check

After the postnatal checks, the next big check-up focuses on all areas of development. These include alertness, feeding and sleeping patterns, with particular emphasis placed on the following:

Sight

At this age your baby can see up to a distance of about 35-38 cm, which is the distance between your faces when you’re holding her in your arms. You can help her with her sight by moving a toy slowly in front of her face to encourage her to track moving objects.

Smile

Smiling is a clear indication that baby is beginning to respond to and interact with others. During baby’s first few weeks you’ll see the first signs of a smile, but, by six to eight weeks, your baby’s smile will light up any room.

Arms and legs

During this check your health visitor or midwife will also check that your baby can move both arms freely and kick both legs. Ability to do both of these actions indicates normal development and mobility.

Sounds

Baby’s coos are lovely to listen to, but they’re actually the sounds of her experimenting with the different sounds that she can make with her throat, mouth and tongue. This is the first attempt at speech and you’ll soon notice that she is directing her cooing at both you and others.

Don’t worry!

Developmental milestones are put in place to give healthcare professionals some general benchmarks for babies at different stages, but don’t worry if your baby doesn’t reach some of these milestones during her checks! In addition to the fact that babies are renowned for not performing when they’re asked to, you also have to bear in mind that some babies will simply reach milestones a little later than others.

Follow the tips to help your baby’s development, but try and make it fun and don’t force her into doing anything that she doesn’t want to and that is making her upset.

If you are concerned about anything in particular, your GP or health visitor can reassure you, or refer you to a specialist to rule out any possible underlying problems. Many potential problems can be easily sorted out if they’re picked up early.