When your baby is born, they will go through a series of assessments that will check their health and measure any potential problems.
These assessments include Apgar scoring, physical measurements and physical exams. All of these exams have been designed so that nurses and physicians can keep a close eye on your baby’s well being during those important first few hours after birth.
The first tests a baby has are called Apgars, which enable your physician to estimate your baby’s general condition at birth. The exam is done at 1 minute and 5 minutes after birth, during which your physician checks for heart and respiratory rates, muscle tone, reflexes and color. For babies who need immediate attention directly after birth, the apgar score is taken later once immediate issues have been treatment.
Most newborns have Apgar scores greater than 7. Few have a perfect score of 10, due to the tendency for a newborn’s hands and feet to be blue from immature circulation. Babies who need extra assistance after birth or those who had a difficult delivery will often have lower Apgar scores, such as a 6 or lower.
Below are examples of how a physician measures an Apgar score:
0 Apgar Score
- Heart Rate: Absent
- Respiration: Absent
- Muscle Tone: Limp
- Reflex: Absent
- Color: Pale or blue
1 Apgar Score
- Heart Rate: Less than 100 beats per minute
- Respiration: Irregular, slow, weak cry
- Muscle Tone: Some flexing of arms and legs
- Reflex: Grimace
- Color: Pink body, blue hands and feet
2 Apgar Score
- Heart Rate: More than 100 beats per minute
- Respiration: Strong cry
- Muscle Tone: Active movements
- Reflex: Grimace and cough or sneeze or cry
- Color: Completely pink
The Apgar scores are not predictors of future health or development. Babies with low Apgar scores can still grow up healthy and develop normally, if given the treatment they need. Instead, low Apgar scores lets the healthcare team know your baby may need more assistance adapting to life outside the womb.
After birth the hospital staff will also take various measurements and check vital signs.
- Head circumference. This measures around your baby’s head.
- Length. This measures from top of your baby’s head to their heel.
- Abdominal circumference. This measures around your baby’s belly.
- Temperature. This is taken to see if your baby can maintain a stable body temperature.
- Pulse. A normal newborn pulse is 120 to 160 beats per minute.
- Breathing rate. A normal newborn breathing rate is 40 to 60 breaths per minute.
Birth weight helps measure health because very small or very large babies are at greater risk for other health problems. Full-term babies typically weigh around 7 pounds (3.2kg,). Newborns are weighed every day at the hospital to monitor a baby’s intake of fluid and nutrition.
It is common for newborns to lose 5% to 7% of their birth weight in the first few days. Sick or premature babies may not gain this weight back immediately and may need to be monitored more closely. Healthy babies will often gain this weight back by 2 weeks.
A physician or nurse will also perform a physical exam and check each body system for normal function. They will also be on the lookout for signs of birth defect or illness. The physical exam may include the following:
- General appearance. Monitoring muscle tone, physical activity, posture, and level of consciousness.
- Head and neck. Assessing the bones across the upper chest, the soft spots on your baby’s skull (fontanelles), and the shape of the head.
- Skin. Examining skin texture and color, and checks for any rashes.
- Face. Inspecting ears, nose, eyes, and cheeks.
- Mouth. Assessing the tongue, throat, and roof of the mouth (palate).
- Abdomen. Looking for any hernias or masses.
- Lungs. Checking the sounds your baby makes when he or she breathes.
- Heart sounds and pulses in the groin (femoral).
- Arms and legs. Inspecting your baby’s movements.
- Genitals and anus. Checking for open passages for stool and urine.
The Dubowitz/Ballard Examination estimates a baby’s gestational age by looking at your baby’s skin, movement, reflexes, and physical features. The physical maturity exam is done in the first 2 hours after birth, while the movement and reflexes exam is done within 24 hours after birth.
This exam measures gestational age, which is a way of checking how mature your baby is. It is especially helpful in cases where pregnancy dates are uncertain. For instance, your baby may be quite small, but if he or she was born premature, this smaller size is to be expected. As a result, checking maturity helps to put all of the other measurements of size and weight into perspective by offering a gestational age.
Babies’ physical features will look different at different stages of gestational age. These variations are what the Dubowitz/Ballard exam measures. Babies who are physically mature usually have higher scores on the Dubowitz/Ballard exam than premature babies.
A score of 4 or 5 means a baby is very mature (postmature) and a score of -1 or -2 means a baby is very immature (premature). The exam gives points for each area of assessment listed below:
Downy hair on the body (lanugo). This hair shows up on a mature infant, but disappears for a postmature infant. It is not found on immature babies.
- Skin textures. Is the skin peeling, sticky, or smooth?
- Breast. Checking the size and thickness of breast tissue and the darker ring around each nipple (areola).
- Plantar creases. These creases on the soles of the feet can be absent or cover the entire foot.
- Eyes and ears. Observing if eyes are open or fused, and checking the amount of cartilage in the ears.
- Genitals, female. Checking the size and appearance of the clitoris and labia.
- Genitals, male. Checking how smooth or wrinkled the scrotum and testes are.
Nerves and Muscles Maturity
Your healthcare provider will check your baby’s nerves and muscles 6 times and score each area. Normally, a higher score indicates a more mature baby. These areas are checked:
- “Square window.” This measures how far a baby can flex their hands toward their wrist.
- Arm Recoil. This checks how much a baby’s arms return to a flexed position.
- “Scarf Sign.” This measures how far a baby can move their elbow across their chest.
- Posture. This examines how a baby holds their legs and arms.
- Heel to ear. This looks at how close a baby can move his feet to his ears.
- Popliteal angle. This checks how far a baby can extend their knees.
The nerves and muscles score and physical assessment score are added together and produce an estimate of the baby’s gestational age. Scores are very high for postmature babies and very low for immature babies.
Low scores in any of these exams do not mean your baby won’t grow up healthy and develop normally. Instead, the exams provide important information so your healthcare team can plan the best possible care for your baby.