What should be included in a physical exam for babies?

Components of a Physical Examination for Babies

A comprehensive physical examination for babies should include assessment of general appearance, vital signs, growth parameters, and systematic evaluation of all body systems to identify potential abnormalities, developmental concerns, or signs of illness.

General Approach to Infant Physical Examination

Initial Assessment

• General appearance: Observe the baby's posture, alertness, responsiveness, color, and spontaneous movements 1
• Vital signs: Measure temperature, pulse, respiratory rate, blood pressure, and oxygen saturation 1
• Growth parameters: Measure and plot length, weight, and head circumference according to CDC or WHO growth curves 1

Key Components by Body System

Head and Neck

• Head: Assess head shape, size, fontanelles (fullness/depression), and check for craniosynostosis 1
• Face: Observe for symmetry, dysmorphic features, and facial expressions 1
• Eyes:
  • Perform red reflex test to detect cataracts, tumors, or other abnormalities 1
  • Check pupillary response, ocular alignment, and eye movements 1
  • Assess for conjunctival hemorrhage or other abnormalities 1
• Ears: Examine external ear structure and tympanic membranes 1
• Nose and mouth: Check for congestion, blood in nares, evidence of trauma, torn frenulum 1
• Neck: Assess mobility and check for masses (vascular malformations, abnormal lymphatic tissue, teratomas) 1, 2

Chest and Cardiovascular

• Chest: Observe shape, symmetry, and respiratory effort; auscultate for breath sounds 1
• Heart: Assess heart rate, rhythm, and auscultate for murmurs 1, 2
• Lungs: Evaluate respiratory rate, pattern, and auscultate for abnormal sounds 1

Abdomen

• Inspection: Look for distention, visible peristalsis, or abnormal appearance 1
• Palpation: Check for organomegaly, masses, or tenderness 1
• Genitalia: Assess for abnormalities appropriate to sex 1

Musculoskeletal and Neurological

• Extremities: Evaluate muscle tone, symmetry of movement, injuries, or deformities 1
• Spine: Check for abnormalities, dimpling, or tufts of hair 1
• Neurological assessment:
  • Evaluate alertness, responsiveness, tone, and reflexes 1
  • Assess symmetry of movement and strength 1
  • Check for primitive reflexes appropriate for age 1

Skin

• Color: Observe for pallor, cyanosis, jaundice, or other discoloration 1, 2
• Perfusion: Check capillary refill 1
• Lesions: Look for rashes, birthmarks, bruising, or other skin abnormalities 1, 2

Age-Specific Considerations

Newborns (0-28 days)

• Developmental dysplasia of the hip: Perform Ortolani and Barlow maneuvers 1
• Birth trauma assessment: Check for cephalohematoma, caput succedaneum, or fractures 2
• Umbilical cord: Examine for signs of infection or abnormal appearance 2

Infants (1-12 months)

• Motor development: Assess age-appropriate milestones (head control, rolling, sitting, etc.) 1
• Growth trajectory: Monitor growth parameters over time 1
• Hearing and vision screening: Perform age-appropriate assessments 1

Special Considerations

High-Risk Infants

• Premature infants: May have associated sequelae such as apnea of prematurity 1
• Infants with risk factors for developmental dysplasia of the hip (breech presentation, family history): Consider imaging evaluation 1
• Infants with suspected BRUE (Brief Resolved Unexplained Events): Perform detailed assessment of vital signs and physical examination features 1

Warning Signs Requiring Immediate Attention

• White pupil or absent red reflex (possible retinoblastoma) 1
• Persistent cyanosis (may indicate respiratory or cardiac issues) 2
• Bulging fontanelle (possible increased intracranial pressure) 1
• Signs of respiratory distress (grunting, retractions, nasal flaring) 1

Documentation

Document all findings systematically, including normal and abnormal findings, to establish a baseline for future evaluations and to track development over time 1.

Common Pitfalls to Avoid

• Failing to undress the infant completely for examination (may miss important findings)
• Not accounting for the infant's state (sleep, crying) which can affect examination findings
• Overlooking subtle signs of neurological dysfunction or developmental delays
• Performing painful procedures at the beginning of the examination (can make the rest of the exam difficult)
• Inadequate assessment of growth parameters or improper plotting on growth charts

Remember that physical examination findings must be interpreted in the context of the infant's age, gestational history, and overall clinical picture. Abnormal findings should prompt appropriate follow-up or referral to specialists.