Head, Shoulders, Knees, and Toes
During each visit, your pediatrician will perform a physical exam. Although your baby's schedule of checkups may vary depending on his doctor, this is when they usually happen:
- 1 to 2 weeks
- 1, 2, 4, 6, 9, and 12 months
- 15 and/or 18 months
- 2 years
- Yearly thereafter
Generally, here's what you can expect:
- Head: We inspect the newborn's head to check for any residual swelling following the delivery. From then on, we check the shape of his head, paying particular attention to the soft spots, as well as making sure that his head isn't misshapen from sleeping on his back to prevent SIDS.
- Eyes: We use our ophthalmoscope -- an instrument with a magnifying lens and a light -- to make sure baby's pupils, cornea, and vision are normal, and that the eyes are aligned.
- Ears, nose, and throat: We check for any eardrum abnormalities, such as redness or fluid, any irregular narrowing of the nostrils, and the appearance of structures, such as gums, teeth, and tonsils.
- Neck: Baby's immune system is growing rapidly, so pediatricians check the lymph nodes to make sure they're not unusually swollen, which may indicate an underlying infection. We also look for abnormal swellings, such as rare congenital cysts.
- Chest: We listen to the heart for any murmurs and to the lungs for any wheezing or congestion noises.
- Tummy: We feel for any masses or swollen organs. Although they're rare, the most common cause of a mass is a swollen kidney.
- Groin: We feel both sides of the groin for equal and regular pulses, indicating that the major blood vessels are properly working.
- Genitals: We check boys and girls to see that they have normal external genital structures. In boys, we feel the scrotum to make sure both testicles are inside, and we inspect the foreskin or circumcised penis.
- Hips: We will push and pull your baby's legs up and out toward his tummy, checking for any congenital hip dislocations. They occur in 1.5 per 1,000 births and are 8 times more common in girls than boys. Undiagnosed hip dislocations can cause permanent deformities of the hip joint, which can lead to unequal leg lengths, difficulty crawling and walking, and chronic pain.
- Back: We feel to make sure the spine is straight and that there are no deep dimples, which can signify an abnormal spinal cord. This can occur with a certain form of spina bifida and when the spinal cord isn't properly attached to the back, known as a tethered cord. In these cases, babies will usually also have decreased movement in their legs, but sometimes, if the defect is mild, the back's external appearance may be the only indication of the malformation early on.
- Skin: We'll inspect the scalp for cradle cap and the face and chest for baby acne. We also look for other conditions, such as diaper rashes and eczema, which most often appears as dry, red patches on the cheeks or in the creases of the arms and legs. For some babies, eczema is triggered by a food allergy. If this is the case, your pediatrician will suggest dietary changes.
- Nervous system: We'll pull your baby's arms up toward us and then let them go to check for a startle reflex. His arms should extend outward quickly. A normal reflex shows us that the child's brain is developing normally. We will also move your baby's arms and legs around individually to check his muscle tone.