From the Guidelines
The approach to a physical examination on a 1-month-old infant should include a hip examination to screen for Developmental Dysplasia of the Hip (DDH) as part of the well-baby visit.
Key Components of the Physical Examination
- The Ortolani and Barlow tests should be performed to assess for hip instability, as these tests are most sensitive in the first few months of life 1.
- The physical examination should also include an assessment of hip abduction, as limited abduction can be a sign of DDH.
- Other findings that may be relevant include asymmetric buttock creases and leg length discrepancy.
Importance of Early Screening
- Early detection of DDH is crucial, as late presentation is associated with a higher risk of complex treatment and long-term complications 1.
- The American Academy of Pediatrics (AAP) recommends selective screening for DDH, with a focus on infants with risk factors such as female gender, breech positioning, and positive family history 1.
Role of Imaging
- Imaging, such as ultrasound, may be considered in infants with an equivocal physical examination or risk factors for DDH, but is not typically recommended until after 4 weeks of age 1.
- The AAP recommends selective use of ultrasound in high-risk infants, such as girls with breech presentation at birth, and suggests it as an option in girls with a positive family history or boys with breech presentation 1.
From the Research
Approach to Physical Examination
The approach to a physical examination on a 1-month-old infant should be tailored to the child's age and developmental level.
- A thorough history and physical examination are essential for diagnosis and management 2, 3.
- The examination should be modified to correspond to the age of the infant, taking into account the expected developmental skills achieved at various ages 2.
- The pediatrician should have a firm foundation in normal development, neuroembryology, and changes in the expression of diseases at various stages of maturation of the nervous system 2.
Key Components of the Examination
- A head-to-toe examination should be performed, including a review of growth 4.
- The examination should include an assessment of general movements, which can be a useful method for follow-up of high-risk infants 5.
- The pediatrician should also assess for any emergency signs or priority signs that require prompt attention and management 3.
Considerations for the Infant's Age
- At 1 month of age, the infant's physical examination should focus on assessing normal development and detecting any potential abnormalities or risks 4.
- The examination should be performed in a comfortable and pleasant environment, with playful behavior to yield maximum information from the examination 3.
- The pediatrician should be aware of the normal parameters and expectations for a 1-month-old infant, including the presence of "primitive" reflexes and the expected developmental milestones 2, 6.