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Key takeaways

• Your baby will have a full physical examination within 72 hours of birth.
• Newborn screening tests check for hearing loss and rare health conditions.
• Monitoring your baby's weight and growth helps ensure they are healthy.
• Always contact a health professional if you have any concerns.

The newborn physical examination

A specially trained midwife, nurse, or doctor will offer your baby a thorough physical examination. This usually happens within 72 hours of your baby being born. It may take place before you leave the hospital, at a local clinic, or at home.

Before starting, they will ask general questions about your baby. These questions might be about how your baby is feeding or any family history of illness. You will be asked to undress your baby for the examination.

The aim of this check is to spot any problems early. This means that treatment can start as soon as possible if needed. Some parts of the examination may be a little uncomfortable for your baby, but they will not cause pain.

What the examination checks

The health professional will do an overall examination of your baby's body. They will check for any general problems. They will also specifically look for issues with your baby's:

• Eyes – The health professional checks the appearance and movement of your baby's eyes for childhood cataracts, a condition where clouding of the lens can affect sight. If needed, your baby can be referred to ophthalmology for further tests.
• Heart – They will check your baby's heart by looking, feeling their pulse, and listening with a stethoscope. This checks for conditions like congenital heart disease that can affect how the heart works.
• Hips – The health professional will check that your baby's hips have grown properly and move as expected, helping to detect developmental dysplasia of the hip (DDH). This condition, where the hip joint has not grown properly, can cause pain and problems with movement.
• Testicles – If your baby is a boy, they will check if his testicles have moved down into the scrotum to find conditions like undescended testicles. This condition, where the testicles have not moved into their usual place, can cause problems later in life.

The health professional will also check your baby's temperature, weight, and reflexes. You may notice a diamond-shaped patch on the top of your baby's head, and another smaller soft spot towards the back. These soft spots (fontanelles) are where the skull bones have not yet joined together and are covered by a tough protective membrane.

Newborn screening tests

Two main screening tests are offered to your baby. These are the newborn hearing screen and the newborn blood spot (heel prick) test. These tests help to identify certain conditions early.

Newborn hearing screen

The newborn hearing screening test helps to identify babies who have permanent hearing loss as early as possible. This means you can get support and advice straight away.

About 1 to 2 babies in every 1,000 are born with permanent hearing loss in one or both ears. This number increases for babies who have spent more than 48 hours in intensive care.

Finding out early can give babies a better chance of developing language, speech, and communication skills. It can also help them make the most of relationships with their family or carers.

A small, soft-tipped earpiece is placed in your baby's ear. Gentle clicking sounds are played to check how the ear responds (this is the automated otoacoustic emission, or AOAE, test). The test only takes a few minutes.

If the screening test results do not show a clear response from one or both of your baby's ears, an appointment will be made with a hearing specialist. This appointment will be at an audiology clinic.

This does not necessarily mean your baby has permanent hearing loss. It is important to attend this appointment.

The tests give more detailed information about your baby's hearing. They will not hurt or be uncomfortable for your baby. You will be able to stay with them during the tests.

Newborn blood spot (heel prick) test

The newborn blood spot test screens for 10 rare but serious health conditions. Finding them early is important.

Knowing early if a baby might have or get these conditions means they can start to be monitored and treated sooner. This can improve their long-term health and development, and help prevent them from developing more serious problems.

The test is not compulsory, but it is recommended. It could be life-saving. It is important to tell your midwife or doctor if you or anyone else related to your baby has any of the conditions being checked for.

The test looks for 10 conditions, which include:

• Cystic fibrosis – This causes problems with breathing, digestion, and growth. It also makes it more likely for a person to get infections.
• Sickle cell disease – This is a group of conditions that affect red blood cells. It mainly affects people from an African or Caribbean background.
• Congenital hypothyroidism (CHT) – This is when a baby does not make enough of the thyroid hormone.
• Inherited metabolic diseases – These are rare, familial conditions that cause problems with how the body breaks down substances in food, such as proteins. They include conditions such as phenylketonuria (PKU) and medium-chain acyl-CoA dehydrogenase deficiency (MCADD).

The blood sample is usually collected when your baby is 5 days old. This is usually done at home by a community midwife or health visitor.

They will prick your baby's heel using a device with a tiny needle and collect a few drops of blood onto a special card. This card is then sent away to be tested.

The test is very quick. Your baby may cry or be uncomfortable during the test. You can help soothe your baby by cuddling and feeding them, and by making sure they are warm and comfortable.

Monitoring your baby's weight and growth

It is normal for babies to lose some weight in the first few days after birth. Putting on weight steadily after this is a sign your baby is healthy and feeding well.

Your baby will be weighed during their first 2 weeks to ensure they are regaining their birthweight. Most babies are at, or above, the birthweight by 3 weeks.

Using centile charts

Your baby's growth will be recorded on centile charts. These charts are found in their personal child health record (PCHR), also known as the "red book". You will be given this book for your baby.

Take this book with you every time you visit the baby clinic, health visitor, or GP. They will use it to record your baby's weight, length, and immunisations, as well as other important information.

These charts show the pattern of growth healthy children usually follow. This is true whether they are breastfed, formula-fed, or having a mixture of both. Boys and girls have different charts because boys tend to be a little heavier and taller, and their growth pattern is slightly different.

The curved lines on the charts are called centile lines. These show the average weight and height gain for babies of different ages. Your baby's weight and height may not follow a centile line exactly.

What to do if you have concerns

Around this time, your baby's care will move from a midwife to a health visitor. A health visitor is a registered nurse or midwife who has done further study in public health nursing.

They will check your baby's growth and development at regular appointments, recording this in your baby's red book. Your health visitor will get to know you and your baby, ensuring you get all the help and support you need as your baby grows.

It is important to trust your instincts if you think something is wrong. If you notice anything about your baby that worries you, do not hesitate to contact a health professional.

You can contact your midwife, health visitor, or GP. You can also see your local pharmacist. For advice at any time, you can call NHS 111.

Life-threatening illnesses in babies are very rare. If you think your baby is seriously ill, you can call 999 for emergency support.