Systematic examination

Systematic examination may proceed as follows:

• look at both hands; look at the palms
• feel both brachial pulses
• feel the anterior and posterior fontanelles
• look at the ears
• look in the eyes with an opthalmoscope. Assess the red reflex and check that the iris is complete.
• double check for cyanosis by looking at the lips and tongue
• look in the mouth. After asking permission from the parents, gently feel the top of the mouth for a membranous cleft.
• look at the praecordium; count the heart rate and then auscultate
• listen to the chest; count the respiratory rate
• palpate the abdomen
• feel for the femoral pulses
• check hip stability with Barlow's and Ortalani's tests
• examine the genitalia. Check that the testes are descended in boys; also check for hypospadias. Enquire whether the baby has passed urine.
• look at the anus; assess patency. Enquire whether meconium has been passed - often this is all too obvious
• check the legs for any abnormality
• replace the nappy and ventrally suspend the baby, assessing the tone
• whilst in ventral suspension inspect and run a hand down the length of the spine as far as the sacrum. Note any dimples.
• suspend the baby facing you, with held by your thumbs under the arms. Babies with decreased tone tend to slip through the hands
• check for a moro reflex