By the age of 6 weeks, your baby will be beginning to smile, look at you when you talk and generally respond positively to any form of contact.
Your GP will want to know about his general health, and will review any problems there may have been with your pregnancy, the delivery and in the time since then.
You may be asked about family health issues that might affect your baby, such as congenital hearing loss, thalassaemia (an inherited form of anaemia), or genetic disorders.
The results of any blood tests your baby had shortly after the birth will be recorded. These will include the result of the Guthrie test (the heel prick test which checks thyroid function and for the genetic disorder phenylketonuria), and sickle cell and thalassaemia, if taken.
Reflexes are automatic, involuntary movements. Testing the presence of the reflexes helps determine the health of your baby’s central nervous system. The GP may hold your baby to assess muscle tone, movement and responses.
Boys are examined to ensure there’s no evidence of hypospadias, (where the urethra opens on the underside of the penis). Both testes should be descended. If they’re not completely down, they’ll be checked again between 6 and 9 months.
Girls are checked to ensure that the labia aren’t fused, and there’s no other anatomical abnormality.
Both sexes will have their anus checked.
Your baby’s arms and legs should appear symmetrical and have good muscle tone.
Your baby’s hips are examined to detect a condition called developmental dysplasia of the hip (DDH). This is more likely to occur where there’s a family history of the disorder or if your baby was breech.
Your baby’s height, weight and head circumference will be measured and plotted on a chart in the red book (Personal Child Health Record) to show his or her growth pattern.
The shape and position of your baby’s ears will be checked – some genetic disorders have characteristic appearances, such as the low-set ears associated with Down’s syndrome. She’ll ask you whether your baby seems to respond to noises and check the ear canal looks normal.
Chest, heart and lungs
By listening to your baby’s heart rate and observing her breathing, any heart and lung problems can be identified. If you have any worries about your baby’s breathing, respiratory rate or colour while resting, sleeping or feeding, discuss this with your doctor.
The size and position of vital organs (liver, kidneys, etc) are examined. Your baby’s umbilical stump should have fallen off and healed by now. Occasionally, it may still be moist or have a lump, called a granuloma, that your GP will advise you about. Some babies have small hernias that usually reduce by themselves given time.
The elasticity, colour and texture of your baby’s skin are checked and a note is made of any birthmarks, including Mongolian spots (blue/grey birthmarks found near the bottom of the back). Sometimes a strawberry birthmark is present, which grows rapidly as your baby gets bigger. These marks are not usually a problem unless they happen to be close to your baby’s eye, and they usually disappear completely without treatment.
Your baby’s mouth should be pink and moist inside. The doctor will look for any evidence of a cleft palate or lip. She’ll also check for white patches on the tongue and gums, which may indicate thrush. If your baby has any teeth, your doctor will make a note in your baby’s records.
Your doctor will check your baby’s nostrils for any abnormal swellings or cysts.
Your doctor will ask you whether your baby turns to shiny, bright objects or lights and if his eyes follow your face when you move in front of his line of sight. She’ll also check your baby’s tear ducts and look for signs of cataracts or other abnormalities.
The size and shape of babies’ heads vary enormously, but very large or small heads may, along with other signs, be a cause for concern. Plagiocephaly (flattening of one side of the skull) is a common finding and usually not significant. There are two fontanelles (soft spots). The posterior fontanelle closes by 6 weeks and the anterior fontanelle (towards the front) is generally closed by 18 months.
Occasionally a harmless swelling called a sternomastoid tumour may be found in the neck muscle. It can restrict movement and may need physiotherapy.
How to prepare for your visit to the doctor:
- Your health visitor or midwife should have given you a Personal Child Health Record (or ‘red book’) for your baby, which will chart his health checks and developmental progress. Bring this with you.
- Make a note of any questions you have so that you can discuss them with your doctor.
- If possible, try to plan things so that your baby isn’t too hungry or tired for the appointment. You can talk more comfortably if your baby’s not miserable and crying.
- Dress him in clothes you can take off and put back on with the minimum of fuss.