The six-to-eight week baby check

Examinations should be performed by a trained and competent healthcare professional. By Dr Louise Newson

The six-to-eight week check could be the first time a heart murmur is heard (Photograph: SPL)
The six-to-eight week check could be the first time a heart murmur is heard (Photograph: SPL)

The six-to-eight week baby check is often now performed when a baby is aged eight weeks, when the first set of immunisations is due. The examination that is actually performed varies between doctors and guidelines to standardise this are in development.

1. Clinical guidelines
Currently, NICE clinical guidelines on postnatal care cover the core care that every healthy woman and healthy baby should be offered during the first six to eight weeks after the birth.1

In March 2008, national standards were launched by the UK National Screening Committee. These standards were based on best practice and designed to ensure consistency and timeliness in newborn and infant physical examinations, under the banner of the NHS newborn and infant physical examination (NIPE) programme.

Before being discharged from hospital a newborn infant is examined, with particular emphasis on the eyes, heart, hips (and testes if male), to exclude the possibility of physical abnormalities. This examination is repeated again at age six to eight weeks.

Current priorities for the NIPE programme include developing and defining standards and competencies for the six-to-eight week examination, as well as raising awareness of the programme and the importance of these standards and competencies among healthcare professionals.

2. Examination
NIPE states that 'examinations should be performed by a suitably trained and competent healthcare professional who has appropriate levels of ongoing clinical experience'.

In general practice, baby checks are usually done by a GP who has a particular interest in child development. In some areas it is performed by a community paediatrician or health visitor.

The main purpose of the physical examination is to detect congenital heart disease, developmental dysplasia of the hip, congenital cataract and undescended testes.

It is usually common practice to also include weight, head circumference measurement, assessment of tone, examination of the spine, palpation of femoral pulses and assessment for any hernias.

Examination of the heart is very important because this may be the first time that a murmur is audible. For example, if the baby has a ventricular septal defect (VSD), this may not have been apparent in the first 24 hours after birth.

Some doctors do not routinely measure weight at this examination because health visitors usually document weight at regular intervals. However, one study has shown that babies whose early weight gain is slow show more feeding problems than controls and also some developmental delay.2

It is therefore often prudent to record weight if it has not been documented recently.

The examination should also be used as an opportunity for the parents to raise any matters of concern. In addition, it should be recorded whether the baby is being breast or bottle fed.

3. Hip dysplasia
Although all babies should have a clinical examination of their hips, some who have specific risk factors (see box) for developmental dysplasia of the hip (DDH) are offered an ultrasound examination.

Other risk factors for DDH include congenital talipes calcaneovalgus, metatarsus adductus, torticollis, oligohydramnios and a high female birthweight. Some units also use these risk factors as indications for an ultrasound of the baby's hips.

Hip dysplasia risks
  • First-degree family history of hip problems in early life (that needed treatment with a splint, harness or operation).
  • A breech presentation at or after 36 completed weeks of pregnancy, irrespective of presentation at delivery or mode of delivery.
  • A breech presentation at delivery if this is earlier than 36 weeks.

4. Other points
There should be a review of the general progress of the baby. This appointment should be used as an opportunity to deliver key messages about parenting and a baby's health, including eating and activity, weaning and accident prevention. Information about play and appropriate activities can also be given at this time.

The baby's first vaccinations are usually given at the same time as this appointment.

These are DTaP-IPV-Hib (diphtheria, tetanus, pertussis, polio and Haemophilus influenzae type b) in one injection and the pneumococcal conjugate vaccine in a separate injection. In addition, if the hepatitis B vaccine has been given after birth, a third dose is given at eight weeks.

  • Dr Newson is a GP in the West Midlands 

Reflect on this article and add notes to your CPD Organiser on MIMS Learning

References
1. NICE. Routine postnatal care of women and their babies. CG37. London, NICE, 2006.

2. McDougall P, Drewett RF, Hungin AP et al. The detection of early weight faltering at the 6-8-week check and its association with family factors, feeding and behavioural development. Arch Dis Child 2009; 94: 549-52.

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