How’s My Baby?

Learn about the physical examinations your tiny one will undergo immediately after birth.

By the time your baby is born, you will likely have become accustomed to your body being the focus of a lot of medical attention. But it could feel strange at first when your baby has medical testing. It might help you to have an idea of what the pediatricians in the hospital will be doing to their newest patient, your little one.

First Physical
From the moment of birth, the doctors and nurses attending to the delivery will be assessing your baby. They will assign an Apgar score when she is one minute and five minutes old based on criteria such as how well she is breathing and how good and balanced her body muscle tone appears to be. (Don’t be disappointed when she doesn’t have a perfect score of ten — most babies don’t.) Sometime during the first hours of your baby’s life, a pediatrician at the hospital will give her a first complete physical exam, either at your bedside or in the nursery. The exam includes listening closely for a heart murmur, looking at the eyes with an opthalmoscope to check for congenital cataracts, and manipulating your baby’s legs for any sign of a problem with her hip joints.

Hearing Check
About one to three children in a thousand have hearing loss. If not identified early enough, hearing loss can result in serious delays in communication skills. But when hearing loss is identified early, an infant as young as three months can wear and benefit from a hearing aid. The American Academy of Pediatrics recommends universal hearing screening of newborns at birth. In many states testing is mandatory, but laws vary widely across states (for details see www.infanthearing.org/index.html). There are two main types of hearing tests on newborns: OAE (otoacoustic emissions) and ABR (automated auditory brainstem response). Hospitals use one or the other, but both are safe and each takes about five minutes. The OAE measures the response that a baby’s own inner ear structures (cochlea) make when a clicking noise is made by a small microphone placed in the ear. The ABR also makes clicking noises, but measures the electroencephalographic (EEG) waves (or brain waves) generated when the baby listens to these sounds.

Newborn Screen
This important panel of tests for rare diseases requires only a few drops of blood from your baby’s heel. The test has been done since the 1960s, when doctors started to screen for phenylketonuria (PKU), a condition where individuals can avoid medical consequences such as mental retardation as long as they are on a special diet. Because of the tremendous benefit that comes from early recognition, other diseases have been included over the years. Newborn screening is done in all states, but the specific diseases that your baby will be screened for vary from state to state (for more details, see www.genes-r-us.uthscsa.edu/). Commonly included are:

• Metabolic diseases like phenylketonuria and galactosemia, where the baby can’t metabolize certain foods and needs to avoid them.
• Endocrine diseases where the baby can’t make thyroid hormones (hypothyroidism) or natural steroids that are necessary to live (congenital adrenal hyperplasia).
• Disorders of red blood cells such as sickle cell anemia and thalassemia.
• Cystic fibrosis, a disease affecting the lungs and digestive system.

One last note about newborn screening: Testing is done no earlier than 24 hours of life, and ideally as close as possible to discharge. If done too early, some tests may be falsely negative.

June Tester, M.D., M.P.H., is a pediatrician and researcher in Oakland, CA.