Every baby should have a thorough physical examination soon after birth, and again within the first days (in many countries within 72 hours, e.g. the UK’s newborn and infant physical examination, NIPE). The examination can detect congenital conditions such as heart defects, cataracts, developmental dysplasia of the hip and undescended testes, where early treatment improves outcomes. It’s also a chance to reassure parents and teach them about newborn care.
Before you start
- Review the pregnancy and birth history: antenatal scans, maternal infections, prolonged rupture of membranes, family history (e.g. hip problems, heart defects, hearing loss), mode of birth.
- Warm, well-lit room; baby undressed but kept warm; parents present.
- Hand hygiene.
Head-to-toe check
- General: colour (pink, pale, jaundiced, cyanosed), tone, posture, cry, alertness. Weight, length and head circumference.
- Head: fontanelles (soft and flat), sutures, swelling (caput, cephalhaematoma).
- Face: symmetry, features suggestive of genetic conditions.
- Eyes: red reflex with an ophthalmoscope. An absent or white reflex may indicate cataract or retinoblastoma and needs urgent referral.
- Ears: position, shape, pits or tags. Newborn hearing screening where available.
- Mouth: palate (look and feel for cleft), tongue tie.
- Neck and clavicles: swellings, clavicle fracture after difficult birth.
- Chest: breathing rate and effort, breath sounds.
- Heart: heart rate, murmurs, femoral pulses (weak or absent may indicate coarctation of the aorta). Pulse oximetry screening can detect critical congenital heart disease.
- Abdomen: shape, masses, umbilical cord (bleeding, signs of infection).
- Genitalia: in boys, both testes descended, position of urethral opening; in girls, normal appearance. Ambiguous genitalia needs urgent specialist review.
- Anus: patent and normally positioned; passage of meconium (usually within 24–48 hours).
- Hips: Barlow and Ortolani manoeuvres to check for developmental dysplasia of the hip, by trained practitioners; risk factors (breech, family history) may prompt ultrasound.
- Spine: straight, intact skin, no dimples, hair tufts or swellings (possible spinal defects).
- Limbs: movement, digits, feet (talipes).
- Skin: birthmarks, rashes, jaundice. See neonatal jaundice.
- Reflexes: Moro, grasp, suck.
Routine newborn care
- Vitamin K to prevent vitamin K deficiency bleeding, with parental consent.
- Eye prophylaxis where national policy recommends.
- Vaccinations: hepatitis B birth dose, BCG and oral polio as per national schedule. See hepatitis B birth dose.
- Newborn blood spot screening where available (for conditions such as sickle cell disease, hypothyroidism and metabolic disorders). See sickle cell in children.
Talking to parents
Explain what you’re checking and share normal findings as well as concerns. Teach feeding cues, cord care, safe sleep, keeping baby warm, and danger signs. See neonatal sepsis danger signs.
Based on WHO postnatal care recommendations (2022), UK NHS Newborn and Infant Physical Examination (NIPE) screening programme standards, and NICE guidance. Educational content: examinations should be performed by trained practitioners following local protocols.