In the days and weeks after birth, NHS screening tests and routine check-ups help monitor your baby’s development and identify any health problems which require treatment.
Most babies in the UK are born healthy, but some babies do have problems or conditions that can only be diagnosed after birth. To pick up on any potential issues as soon as possible, the NHS will offer to screen your baby for the most common detectable conditions through a series of examinations and tests.
- Apgar score and measurements
- Newborn physical examination
- Hearing test and heel prick test
- 6 to 8 week baby check
- Your baby’s red book
First checks and Apgar score
As soon as your baby’s born, whether vaginally or via c-section, the midwife or doctor will check them over quickly, and record results known as your baby’s Apgar score. This is a way to check that your baby’s handling the transition from your womb to the outside world as expected.
Your baby will be given a score of either 0, 1 or 2 for their:
- Muscle tone
- Skin colour
The maximum total score is 10, and a normal score is anything of 7 or over. The check takes place twice: one minute after the birth, and again five minutes after the birth.
This may all sound complicated, but you really don’t need to worry about it. In fact, you may not even notice that the examination takes place as it will probably be done while you’re baby’s lying on your chest skin-to-skin and you’re enjoying a first cuddle.
Rarely, your baby have to be moved to the special care unit at the hospital after birth, either for observation or treatment.
Weight, length and head measurements
On the same day that your baby’s born, often within an hour of the birth, your midwife or doctor will record their:
- Head circumference
Finding out how much your baby weighs and how long they are is a really exciting moment as you prepare to make a birth announcement to family and friends. But the measurements are also an important way for health professionals to check that your baby is growing as expected in the weeks and months to come.
In the early days especially, it’s important to keep an eye on how much your baby weighs, to make sure they’re not losing too much weight and that they regain it as quickly as they should.
Newborn physical examination
Your baby’s first thorough physical examination will take place within 72 hours of the birth and can be carried out by either a doctor, midwife or nurse who is trained in doing newborn examinations.
- If you’re staying on the postnatal ward, the examination usually takes place before you get discharged.
- If you have a home birth or go home immediately from the birth centre or labour ward, your baby’s examination may take place in your home instead.
At this first check, the health professional will give your baby a complete check over, and in particular look at four different parts of their body where newborn babies are most likely to have a problem that needs treatment or monitoring.
Your health professional will look into your baby’s eyes with a special torch to make sure that they look as expected and can move around. It’s important to remember that while this examination can pick up on cataracts and other problems that need to be treated, it can’t tell you how well your baby will be able to see as a child or adult.
By checking your baby’s pulse and listening to their heart with a stethoscope, your health professional can detect if your baby has heart murmurs. This is very common in babies and almost never a problem, but around 1 in 200 babies have a heart problem that will need treatment, so it’s important that any heart murmur is detected and checked out.
Your health professional will check your baby’s hips. Some newborns’ hips aren’t properly formed, which is known as developmental dysplasia of the hip (DDH). With early detection and treatment, babies with this condition recover fully, but if it’s not treated it can cause a limp or joint problems. Your baby is more like to have DDH if they were in the breech presentation before the birth.
If you have a baby boy, your health professional will check that the testicles have descended. It’s fairly common for the testicles to not have dropped down into the scrotum before the birth, and for most babies the testicles descend within the first few months. However, around 1 in 1000 baby boys have undescended testicles that need treatment to avoid problems like reduced fertility later in life.
Newborn hearing test
Your baby’s hearing will usually be checked before you leave the hospital, if you give birth there, but it can be carried out up until three months after the birth.
During the hearing test, a small earpiece is placed in your baby’s ear and gentle clicking sounds are played.
Sometimes, it’s not possible to get a clear result from the first test, for example if your baby was unsettled or there was background noise. This doesn’t mean that your baby has hearing loss, and as a first step you’ll be invited to do the hearing test again.
Around 1-2 in 1,000 babies are born with permanent hearing loss, but it’s as many as 1 in 100 babies who spent at least two days in the NICU.
Heel prick test
When your baby’s around five days old, you’ll be offered the newborn blood spot screening. At the test, your health professional will prick your baby’s heel and collect little spots of blood on a card. The card is then taken away to be screened for rare but serious conditions:
- Sickle cell disease
- Cystic fibrosis
- Congenital hypothyroidism
- Six inherited metabolic diseases.
It might seem scary to have your baby’s heel pricked, but the test is done very quickly and you can cuddle or breastfeed your baby to keep them as calm as possible.
You should get the results of the test either through a letter or from your health professional before your baby is eight weeks old. You’ll be contacted sooner if your baby has tested positive for any of the conditions.
Screening isn’t 100% certain – a baby with a negative screening result may later turn out to have the disease screened for, and babies with a positive result sometimes turn out not to have the disease.
6- to 8-week baby check
Your baby’s next major review happens when they’re between six and eight weeks old. Often, but not always, it’s combined with the mother’s six-week postnatal check-up, or when your baby has their first immunisations eight weeks after the birth.
At this check, the doctor will check your baby over thoroughly and redo the tests on eyes, hips, heart and testes from the newborn physical screening. They may also check that your baby can smile socially, follow a finger with their eyes and ‘walk’ if being held up under the armpits.
If you have any concerns about your baby’s health or the results of any of the screening tests so far, this is a good time to bring it up.
Your baby’s red book
You’ll be given a health record book for your baby soon after the birth. This is used from birth until your baby is five years old and lets any new health professional you come into contact with quickly learn about your baby’s past and present health.
It’s a good idea to bring the book with you whenever you take your child to see your midwife, GP, practice nurse or health visitor.
This is some of what’s recorded in the book:
- Results from newborn baby checks
- Weight, height and head measurements
- Date of vaccinations
- Records of health visitor appointments.
You can also add things like illnesses, accidents, medications that your child has taken and developmental milestones to the book yourself, to be able to keep track of your child’s health and progress in the first few years.
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