Tiny, brand-new, perfect in your eyes — yet from the minute your baby is born they are being tested.
“Babies go through several checks throughout their first 18 months,” says Mr Afif El-Khuffash, consultant neonatologist and paediatrician at the Rotunda Hospital, Dublin.
It all starts straightaway.
“There’s the immediate check by the midwife to ensure no major issues can be identified. And babies are usually weighed shortly after birth.”
Before the baby is discharged from hospital, a paediatric doctor does a full head-to-toe examination.
“It’s usually done after the baby’s first 24 hours — some heart conditions may not be apparent before then,” says El-Khuffash.
As part of this clinical examination, a light is shone into the baby’s eyes to check for cataracts, their legs and hips are gently bent to detect dislocated hips, their hearing is screened and, if the baby is a boy, there’s a check to ensure testicles are in the right place.
Your baby’s pulse and oxygen levels are also checked.
El-Khuffash says Ireland is one of the leading countries to have introduced the newborn oxygen test. Using infrared technology, it is quick and painless.
“In the UK, some question the benefit of universal rollout — it’s a resource issue. We’ve had it in Ireland for 10 years. It has been proven to detect heart and lung conditions that we mightn’t find otherwise.”
He explains that the oxygen test is a one-off check.
“If baby’s well, there’s no need to check it again.”
The pre-discharge examination includes a weight check to ensure the baby hasn’t lost too much of their birth weight.
“All babies lose seven to 10% of their birth weight in the first few days,” explains El-Khuffash, adding that 75% regain it after a week, and by two weeks, 95% have put that weight back on.
Newborn bloodspot screening – heel prick test – is done within the first 72-120 hours of life and currently screens for nine conditions.
The test was developed by American microbiologist Dr Robert Guthrie in 1960 after seeing his niece with phenylketonuria (PKU).
One of the conditions screened for in the Irish programme, PKU causes build-up of an amino acid in the blood and brain, which can lead to brain damage.
El-Khuffash explains that the baby needs to be established on feeds for the heel prick test to be accurate.
“It tests for these rare but serious conditions that affect different chemical processes in the body. If identified early, they can be treated and managed well, and complications avoided.
“They’re all lifelong conditions but people can live with them.”
The test can sting, he says.
Along with PKU, the conditions tested for are: classical galactosaemia, congenital hypothyroidism, cystic fibrosis, glutaric aciduria type 1, homocystinuria, maple syrup urine disease, medium-chain acyl-CoA dehydrogenase deficiency and adenosine deaminase deficiency (ADA-SCID).
ADA-SCID was added to the Irish programme only last year. A rare and potentially very serious inherited disease, it causes a lack of a chemical that breaks down toxins in the body’s cells.
HIQA is currently examining adding spinal muscular atrophy to the newborn screening programme.
A rare, genetic condition, this causes irreversible damage to nerves that control movement and leads to muscle-wasting and weakness.
Its severity – and age at which symptoms present – varies, with some forms historically resulting in death in early childhood.
In recent years, new treatments have become available – with potential to significantly improve outcomes.
Once the baby is home, the public health nurse (PHN) visits within the first three days.
The nurse usually weighs and examines the baby, assesses mum’s health and gives information and support on parenting and local resources.
Any parental questions about feeding, sleeping, child safety, can also be addressed.
At two weeks of age, and again at six weeks, the baby is seen by the GP to ensure no issues are emerging.
The six-week visit is a full head-to-toe examination.
“Everything’s being checked for,” says El-Khuffash.
“Their movement, their heart and lungs. Are they pooing regularly, gaining weight, are there any issues with feeding?”
At three months, the PHN organises a developmental assessment, which takes place in the health centre.
- Head-to-toe physical examination looks at eyes, ears, genitalia, limbs, breathing, and fontanelles (soft spot on baby’s head).
- Weight and measurement.
- If a boy, testicles — to ensure they have moved down into the scrotum.
- Baby’s responses, their alertness, if they smile and other facial interactions.
- Posture and gross motor skills, e.g. arms and legs co-ordination, how baby holds their body. Can they hold their head erect for several seconds?
- How your baby uses their hands —do they respond to finger play? Do they watch hands — their own and the nurse’s.
- Fine motor skills — use of small muscles such as those in hands/fingers: e.g. Will baby hold a rattle?
“The PHN also looks at the shape of the baby’s head. If they’re spending a lot of time on their back they can get a flat head,” says El-Khuffash, who points to the gap between the three-month check and the next one – at nine/11 months.
He adds, however, that at two, four and six months of age, babies visit the GP for their vaccines.
“They’ve an encounter with a healthcare provider. The main purpose is to administer the vaccine, but parents have another opportunity to ask questions.”
At nine to 11 months, the PHN checks baby’s physical, social and behavioural development.
Checks will be similar to the three-month ones, though modified to what would be expected of a child at this developmental stage.
For example, the PHN will look at the baby’s sitting and crawling. Can they sit with/without support? Can they support their weight on their legs?
Does baby poke at objects with their index finger or use their hands to take objects?
When it comes to hearing, does baby listen when spoken to, respond to requests and enjoy games like peek-a-boo?
How is their speech development? Are they babbling, using gestures to communicate or copying different speech sounds?
Does baby respond to people’s expressions and take interest in their own reflection in a mirror?
Next up is the 21 to 24-month developmental check.
Similar areas are looked at but, again, the checks are to ensure baby is doing the more advanced tasks appropriate to this stage.
- Picking up small objects, sorting shapes by size/colour, drinking from a cup, feeding themselves.
- Pointing to a few body parts when asked, following simple commands, understanding simple questions/stories/songs/rhymes.
- Saying more words every month, putting two words to work together, understanding someone- or two-word questions.
El-Khuffash says developmental checks provide a great opportunity to educate parents.
“So much information is thrown at them in the early stages – it’s difficult to absorb. So it’s important they have continuous encounters with health professionals.”
But while there is this recommended time frame for the different developmental checks, El-Khuffash says some tests may not be happening in the community.
Katie Mugan, PHN and lactation consultant (nursingmama.ie), says a big aim with any of the developmental checks is to educate and support, as well as to observe any developmental issues.
“It’s also about educating towards the next stage baby’s approaching, so at three months we educate towards the weaning process.”
When it comes to parental worries, Mugan says: “They always worry about the scales – are baby’s needs being met with what they’re taking in? Sometimes she finds herself educating others besides mum and dad.
“Practices have changed from what our parents would have done. Grandparents can give conflicting advice, so sometimes it’s about educating the whole family.”
Another big area of concern for parents is sleep – what’s normal and what isn’t.
“Parents are subjected to so much information online about babies sleeping all night. If their infant isn’t doing that, it creates huge concern.
“Yet research shows very few babies sleep for these long stretches of time.”
- Mr Afif El-Khuffash presents The Baby Tribe podcast alongside Katie Mugan. Topics relate to newborn- and baby care. A recent episode looked at baby development checks and toddler milestones.