At the time of the examination, the pediatrician first assesses the child’s general condition and overall condition. She looks for birth defects by observing, palpating, listening, and testing her baby’s feet. The doctor observes the child’s alertness, symmetry of movements, plasticity and variability, as well as the child’s attitude to the treatment. The skin often has spots and discoloration. There are differences in thermoregulation: some are reddish; Bookbinding is called marbling. Yellowing is a concern, but it is not always easy to assess visually whether a child needs light therapy. If the baby’s skin is dark in pigmentation, yellowing can be seen in the whites of the eye. The skin may be dry or loose if the child has received too little fluid.
The doctor will note the size and symmetry of the blacks, the straightness of the nose, and any personal features of the face. Bright light is pointed at the child’s eyes while looking at the so-called. red reflection of the direction of light. This ensures that the light is transmitted through the eyes. The doctor’s fingers feel the seams and openings of the skull, the integrity of the clavicles, pulses from the upper arms and the groin. The size of the viscera is assessed by compressing a large stomach. The scrotum should have two small pieces. The doctor will also check that the genitals and anus are in place and that there are no extra holes. Small fingers wrap around the doctor’s fingers as the doctor tries to catch the reflex. The doctor flexes and stretches the limbs, gently lifts the child out of his hands, letting his head swing back a bit. This gives the doctor an idea of the child’s tension and early reflections. Accustomed hands snap the child onto their stomachs, and their fingers wander along the spine for abnormalities.
The heart sounds are listened to carefully. Less than 1% of children have congenital heart defects. Some defects may already be detected in ultrasound during pregnancy. Some occur as a child’s malaise immediately after birth. Some defects do not cause any symptoms in the neonatal period. They can only be found by listening carefully to the heart sounds. Some heart defects cause noisiness and symptoms only when the so-called. pulmonary resistance has fallen to its final level. It is happening gradually.
When examining a newborn, it is also essential to test whether the hips remain in place. acetabulum. In particular, long-term infants have a risk of developing a hip pelvis, which results in the hips slipping out of place. In this case, childcare is usually required for several weeks.
If parents have any concerns about a child’s health, the home check-up has the opportunity to ask the pediatrician for their opinion. Even before the examination, the doctor has looked at the birth report. She has paid particular attention to the weeks of pregnancy, the course of labor, the time of labor, the starting points given to the child, and possible recovery measures. It has been the task of the nanny to tell if there is anything alarming about the baby being seen by a professional. Although the pediatrician was not following the birth, based on the documentation and information provided by the medical staff, he is able to comment, for example, on whether there was anything in the childbirth that would later pose specific health risks.
The starting points, the so-called Apgar points, are the points given by the child’s ability to breath, pulse, tension, irritability and color, from zero to two points each. The first score is given one minute after the baby is born, the second five minutes and the third ten minutes later. Starting points play a role in communication between professionals: if a child receives less than seven to eight points, they need to be refreshed in one way or another. If the points given at the age of five or ten minutes are still too few, it is known that refreshment has to be continued for longer than usual. Especially one-minute points have nothing to do with a child’s long-term forecast.
If the family wants to get home soon, less than two days after delivery, the pediatrician will assess whether it is safe for the child’s health. Then a control visit is often scheduled for a later date, even if nothing abnormal occurs. The idea of a control visit is that the newborn will gradually adapt to the world anyway. At less than two days, the process is still ongoing. The child’s blood circulation stabilizes in a new way. Maternal milk secretion and infant digestion are triggered. Fetal red blood cells break down and are gradually replaced by different cells. The liver has to deal with waste disposal independently.
After birth, the baby will always lose some weight. Nature is prepared for the baby to be usually in a small liquid cargo. The baby pee, poop and evaporate fluids through the skin and breath, but the amounts eaten are still small. For details on weight monitoring, see “Child Growth” (see page 198). Too much weight loss is often due to the onset of breastfeeding. Staff will advise and support how to better start breastfeeding. If it is considered that the health of the child is at risk, additional milk is given. As a precaution, maternity hospitals use milk similar to that given to milk-allergic children as surrogate milk – the breast milk donated is saved for the sick.
If a new follow-up check is arranged, it is usually most important that the child be weighed, the yellowness assessed and the heart listened.