6 week baby check

1. 6 week baby check GP Obstetric Shared Care Accreditation Seminar Program 16th Feb 2013 Dr Sanjay Sinhal MBBS MD FRACP CCPU Neonatologist, NICU, Flinders Medical Centre Paediatrician, Flinders Private Hospital Paediatrician, Ashford Hospital www.drsinhal.com Acknowledgements - Dr V Ellison, Dr R Seth, Dr V Dasireddy

2. Aims of examination • Detect congenital anomalies, developmental issues • Identify common postnatal problems • Follow-up on antenatally detected problems • Opportunity for parents to ask questions • Psychosocial wellbeing of infant and family

3. Examination • Warm quiet environment • Infant in a quiet, alert state • Wash hands • While undressing infant observe activity, tone, lethargy • Colour, Respiratory rate

4. Before examination • Maternal/ perinatal history how certain is the GA? maternal illness especially inherited disorders maternal drug use prescribed or not Fetal growth obstetric history and liveborn infants neonatal / postnatal deaths • Results of antenatal USS • Delivery & resuscitation history • Concerns from nursing or medical staff in postnatal period • Bedside chart, urine, stools, feeding, weight, length

5. Order of examination • Observe – interaction with parents and infant • Red Reflex • Murmur, femoral pulses • Thorax • Abdomen, umbilicus • Genital area, anus • Legs, hips • Oral cavity • Roll infant over, ventral suspension, back • Reflexes • Hands, Arms • Head, neck, mouth

6. Observation • Dysmorphism • Tone, posture, equal use of limbs • Cyanosis, central & acrocyanosis • Cutaneous lesions e.g milia, petechiae, erythema toxicum

7. Order of examination • Interaction between infant and examiner • Fixing following, postural corrections when handling • Quality of cry • Symmetry of startle, limb movements during exam • Parental concerns • Red Reflex, light reflex (asian babies – pale retina) • Squint – when to refer, ptosis, eye discharge • Murmur, femoral pulses • Thorax – shape, respiratory system, engorged nipples, accessory nipples • Abdomen – distension, liver, spleen, masses • Umbilicus – granuloma, hernia, innie/outie, cleaning

8. Order of examination • Genital area – undescended testes, chordae, hypospadias, hydrocele, discharge from vagina, skin tags • Anus – rashes, anteriorly placed, tone • Inguinal hernia • Legs – bowing, rashes, hemangiomas • Hips • Oral cavity – natal tooth, thrush, ebstein pearls, cleft • Ventral suspension • Back – mongolian spot, spina bifida, pilonidal sinus, paraspinal reflex, skin lesions

9. Order of examination • Reflexes – Moros, head control, grasp • Hands, Arms – paronychia, bowing, Vit D deficiency • Head – plagiocephaly, sutures, AF, head circumfernce • Neck, mouth – sternomastoid muscles • Developmental milestones in first few months • Jaundice • Weight gain – normal, variants, slow or fast, what to do

10. Common questions • Irritable infant – differential diagnosis, investigations, management, follow up • Routines! • Feeding and sleep issues, noisy breathing • GORD • URTI from siblings • Vaccination • Weaning • Long term follow up

11. Thank you www.drsinhal.com