The basics - Doing a mother and baby check

GPs should take advantage of the six-week check to reassure the mother, writes Dr Chris Barry.

With so much work being carried out by midwives and health visitors, GPs have little contact with mothers and new babies. The six to eight week check provides a unique opportunity for GPs to detect problems, discuss contraception and build a rapport with the family.

The six-week check is a good time to answer any parental concerns (photograph:SPL)

The mother's well-being
This visit is the time to consider the physical, psychological and social aspects of the mother's situation.

Mothers often welcome the opportunity to discuss the birth - how it was, any lessons that could be learned (by her or the health professionals) and how the experience has affected her outlook.

With increasing evidence on the short- and long-term benefits of breastfeeding, now is the time to encourage her if she is doing so and to support her if she 'failed'. If she bottle-fed from the outset, she might consider breastfeeding her next baby.

Postnatal depression is common, and is a significant cause of morbidity and family upheaval. Some women do not realise they are depressed, and some try to conceal it. It is important to explore this area sensitively.

Regardless of depression, this is a good opportunity to make the mother aware of any local peer support groups.

Physical examination
As far as physical examination is concerned, ask about vaginal loss, any perineal discomfort and whether sexual activity has resumed. It is not necessary to do a vaginal examination unless there is an identified problem.

It is necessary to check the woman's BP, whether or not she is planning to start oral contraception. Ensure that contraception has been discussed and preferably acted on.

Examining the baby
The examination is the same as for a newborn (see box below) with added questions of whether the baby is smiling, and fixing and following with its eyes. The questions in the parent-held record are a useful addition.

The newborn examination
  • Appearance: behaviour, colour, activity, breathing.
  • Head shape, facial features, ears, palate.
  • Measure and plot head circumference.
  • Eyes for squint and red reflex.
  • Neck, clavicles, hands (palmar creases), feet.
  • Heart: position, sounds, murmurs; pulses.
  • Lungs: effort, rate, sounds.
  • Abdomen for organomegaly; umbilicus.
  • Genitalia: check boys' testes.
  • Spine and overlying skin.
  • Skin: birthmarks, rashes.
  • CNS: tone, posture - reflexes only if concerned.
  • Hips: symmetry, Barlow and Ortolani manoeuvres.
  • Cry.

In most surgeries, the health visitor will have weighed the baby, measured its length and head circumference, and plotted the child on the growth charts in the parent-held record.

This information is essential for a properly informed discussion with the mother.

The six to eight week check is often combined with the first immunisation; this is the ideal time to discuss and address any parental concerns about this.

If abnormalities are suspected, refer the baby to an appropriately qualified professional.

Empower the parent
Lastly, many parents are uncertain as to how to recognise signs of severe illness in the baby.

What you say must be tailored to the parents' level of knowledge and confidence, but it may be useful to give one or two basic pointers on 'red flag' symptoms, such as features of the meningococcal rash; unduly rapid breathing; the quiet or lethargic baby.

The context is important i.e. a rash in an otherwise well baby is unlikely to matter; in an unwell baby it may matter a great deal.

  • Dr Barry is a semi-retired GP in Swindon, and provost of the RCGP Wessex Faculty
Learning points
Mother
  • Address physical, psychological and social needs.
  • Support/promote breastfeeding.
  • Encourage peer group support.
  • Offer contraceptive advice.

Baby

  • Refer if abnormal, reassure if normal.
  • Discuss and offer immunisation.
  • Inform parents of signs of serious illness.

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