Examination checklist

    Newborn examination

    A head-to-toe routine examination of the newborn — gestational features, birth injuries, red reflex, heart, hips, spine and reflexes — and the findings that must not be missed before discharge.

    Pediatrics
    Neonatology
    All colleges

    Mark sheet

    19 steps · 19 marks

    #StepWellPartlyNot
    1. 1Greets the mother, explains, gets consent, washes hands and examines the baby undressed under a warmer1½0
    2. 2Reviews the maternal, birth and feeding history and the birth weight1½0
    3. 3Observes colour, posture, activity, cry and breathing pattern1½0
    4. 4Measures weight, length and head circumference and plots them for gestational age1½0
    5. 5Counts respiratory rate and heart rate, takes temperature, and checks pre- and post-ductal saturation1½0
    6. 6Examines the head: fontanelles, sutures, moulding, caput, cephalhaematoma1½0
    7. 7Examines the face, eyes and red reflex, ears, nose patency and the palate by sight and touch1½0
    8. 8Examines the neck and both clavicles for swelling, crepitus or asymmetry1½0
    9. 9Examines the chest: recession, breath sounds, nipples1½0
    10. 10Palpates the apex and brachial and femoral pulses, and listens for murmurs1½0
    11. 11Examines the abdomen, liver, spleen and kidneys, and the umbilical stump and its vessels1½0
    12. 12Examines the genitalia, testes and anus for patency and position1½0
    13. 13Examines the limbs: digits, palmar creases, talipes, brachial plexus palsy1½0
    14. 14Performs the Barlow and Ortolani tests on each hip1½0
    15. 15Turns the baby prone and examines the spine for dimples, hair tufts or swelling1½0
    16. 16Examines the skin: jaundice, pallor, plethora, birthmarks, rashes1½0
    17. 17Assesses tone with pull-to-sit and ventral suspension1½0
    18. 18Elicits the Moro, grasp, rooting and sucking reflexes1½0
    19. 19Explains findings to the mother, gives advice on feeding, cord care and warning signs, and documents1½0

    Summary of findings

    I examined Baby Okafor, a 1-day-old boy born at term by vaginal delivery with a birth weight of 3.2 kg, which is appropriate for gestational age. He is pink, active, with a lusty cry and normal tone. Temperature 36.8 °C, respiratory rate 48, heart rate 136, saturation 98% in the right hand and the foot. There is a 3 cm fluctuant swelling over the right parietal bone that does not cross the suture line — a cephalhaematoma. The red reflex is present in both eyes, the palate is intact and the femoral pulses are palpable. The hips are stable, the spine is normal and the primitive reflexes are symmetrical. The rest of the examination is normal.

    Differential diagnoses

    FindingWhat it means
    Caput succedaneumSoft oedema that crosses sutures; resolves in days
    CephalhaematomaSubperiosteal blood limited by sutures; can worsen jaundice
    Subgaleal haemorrhageBoggy swelling across sutures with pallor and shock — an emergency
    Absent red reflexCataract, retinoblastoma, glaucoma — same-week ophthalmology review
    Weak or absent femoral pulsesCoarctation or interrupted aortic arch — echocardiography now
    Pre- and post-ductal saturation difference above 3%Duct-dependent heart disease or persistent pulmonary hypertension
    Single umbilical arteryAssociated renal anomalies — consider renal ultrasound
    Sacral dimple above the natal cleft, or with a hair tuftPossible spinal dysraphism — ultrasound of the spine
    Limp arm held in internal rotation (waiter's tip)Erb palsy — also check the clavicle
    Positive Ortolani or BarlowDevelopmental dysplasia of the hip — ultrasound and orthopaedic referral

    Investigations

    • Blood glucose in babies at risk: small or large for gestational age, preterm, infant of a diabetic mother, hypothermic
    • Serum bilirubin if jaundiced in the first 24 hours
    • Hepatitis B and HIV exposure status and the related prophylaxis
    • Hearing screening by otoacoustic emissions
    • Hip ultrasound for breech presentation, family history or abnormal hip tests

    Treatment

    • BCG, oral polio and hepatitis B birth doses
    • Vitamin K 1 mg intramuscularly (0.5 mg below 1.5 kg)
    • Chlorhexidine 7.1% gel to the cord stump once daily for 7 days, as recommended in Nigeria
    • Tetracycline eye ointment
    • Early and exclusive breastfeeding, warmth and skin-to-skin contact

    Warning signs to teach the mother: poor feeding, yellow soles or jaundice in the first day, fever or cold body, fast or difficult breathing, convulsions, reduced movement, a red or smelly cord.

    Examiner questions

    References

    • Kliegman RM, St Geme JW, Blum NJ, Tasker RC, Wilson KM, et al., eds. Nelson Textbook of Pediatrics. 22nd ed. Philadelphia: Elsevier; 2025.

    Updated September 18, 2026