Your newborn's general health check-up - Apgar test
When’s the test done? One minute after birth and five minutes later.
Who does it? Your midwife
What happens? Straight after your baby’s born, he’ll have a check called the Apgar.
This is totally painless and looks at five things:
- Heart rate
- Breathing
- Muscle tone
- Skin colour
- Reflex response
A score of 0, 1 or 2 is given for each test, with a total of 10. A normal score is 7 or over, but if your baby has a low first score, but a normal second score, this is counted as normal.
Your midwife will also weigh and measure your baby and check him over, inside his mouth, his temperature and that he has all his fingers and toes.
Head
When’s the test done? Within an hour or two of the birth.
Who does it? Your midwife.
What happens? The circumference of your baby’s head will be taken along with his other measurements. Together, these measurements provide the starting point for plotting your baby’s growth on his charts. The shape of your baby’s head and the fontanelle (the ‘soft spot’ at the top of your baby’s head that allows the skull to grow and fills in over time) will also be checked, and he’ll be examined for any bruising from assisted delivery by ventouse or forceps, and for any birthmarks.
Genitals and bottom
When’s the test done? Soon after the birth while still in hospital and checked again six-week postnatal check.
Who does it? Usually a trained midwife or doctor.
What happens? Your baby’s genitals will be examined to check they appear normal and that he’ll be able to wee normally. Boys can sometimes have the opening on the underside of the penis instead of at the end. If this is the case, it’ll need to be corrected. With a baby boy, the top of his testicles will be checked too, to see if his testes have descended. You’ll also be asked if your baby has passed meconium, his first black, sticky poo.
Mouth
When’s the test done? Within 24 hours of the birth, while still in hospital.
Who does it? Your midwife in your initial examination, straight after the birth.
What happens? Your baby’s mouth will be checked to make sure he does not have a cleft palate or a tongue tie (where the tongue is attached too close to the front of the lower jaw). At the same time his ears will be checked for any abnormal discharge.
Reflexes
When’s the test done? Within 72 hours of birth.
Who does it? The doctor or specially trained midwife.
What happens? Your baby’s born with certain reflexes that help him survive the first couple of weeks. Your doctor will check that your baby can:
- Suck on a finger that’s put in his mouth (the sucking reflex)
- Turn his head and open his mouth ready to feed when his cheek is stroked
(the rooting reflex)
- Tightly grasp a finger that’s put into his hand (the grasping reflex)
- Shoot out his arms and legs if something startles him (the startle or ‘Moro’ reflex)
- Make walking movements with his legs when he’s held under his arms in an upright position with his feet on a firm surface (the stepping reflex)
Back and hips
When’s the test done? Within 72 hours of the birth and again at the six-week postnatal check.
Who does it? A doctor or a specially trained midwife.
What happens? Your baby’s spine will be checked to make sure it’s straight and his legs will be moved around to see whether his hips make a click noise. Clicky hips occur where the hip joint is too loose and the thighbone dislocates itself.
Heart and lungs
When’s the test done? Within 72 hours of birth.
Who does it? A doctor or a specially trained midwife.
What happens? A stethoscope will be used to check your baby’s heart for heart murmurs, and to listen to his lungs to make sure they’re clear of fluid and working correctly. Many babies have a heart murmur at birth that will disappear of its own accord.
Eyes
When’s the test done? Soon after birth, while still in hospital.
Who does it? The doctor or specially trained midwife.
What happens? The appearance and position of your baby’s eyes will be examined and a light shone into them to check for a red reflex. This red reflection – the same as ‘red eye’ seen in photos – shows that there are no cataracts and that all is normal.
Ears
When’s the test done? Either before you leave the hospital or you’ll be invited back again for an outpatient appointment, depending on how your hospital operates.
Who does it? Specially trained health screener or your health visitor.
What happens? Your newborn is given a hearing test to pick up early defects. A small earpiece is inserted into the outer part of your baby’s ear. This sends clicking sounds into his ear and screening equipment listens for the echo normally produced by the inner ear when it receives the sound. The test isn’t uncomfortable for your baby and is usually done while he’s settled or asleep.
Heel prick test
When’s the test done? Day 5-8 after the birth. Usually at home.
Who does it? Your midwife.
What happens? The heel prick test (or Neonatal Screening Test) checks for certain rare diseases, including:
- Cystic fibrosis
- Sickle cell disease
- Phenylketonuria (PKU – an enzyme deficiency that prevents the normal breakdown of protein foods)
- Medium Chain Acyl-CoA Dehydrogenase Deficiency (MCADD – babies with this inherited condition have problems breaking down fats to make energy for the body)
- Hypothyroidism
For the test, your baby’s foot is pricked once with a small needle. His foot is then squeezed gently and a sample of his blood is placed directly onto a card, which is then sent to the lab for testing.