6-week check

Question 1

What areas in history are important at 6 weeks?

Answer 1

Parents

• Coping
• Concerns
• Delivery hx, complications
• Screen for baby blues/post-natal depression
• FHx significant diseases
• Sibling development

Child

• Delivery mode, complications
• Urine/faces outputs
• Sleeping
• Irritability
• Birth weight, weight gain
• Feeding
• Allergies

Question 2

Important initial observations on 6-week examination

Answer 2

• Colour - cyanosis, jaundice
• Breathing - resp distress
• Dysmorphic features or deformities
• Eyes (leukocoria & eye movements)
• Development & social (spontaneous smiling, interaction, engagement)
• Limbs moving appropriately
• Rash

Question 3

Growth assessment in 6-week examination

Answer 3

• Head circumference
• Weight
• Abdominal circumference
• Length

Question 4

Abnormalities on growth centile charts

Answer 4

• Crossing centiles
• Any weight loss
• Height and weight are more than 2 centiles different
• Correct for prematurity until 2 yrs

Question 5

Examination of head/face/neck at 6-weeks

Answer 5

Eyes

• Movements - normal is unable to cross midline
• Presence of red reflex (leukocoria)
• Absence = congenital cataracts or retinoblastoma
• Ask parents about responsiveness to visual cues ?visual ax

Ears
- Ask parents about response to auditory cues ?hearing ax

? Cleft palate

Neck muscle tone

Palpate for early closure of fontanelles

Question 6

Examination of limbs at 6-weeks

Answer 6

• Leg length & proportion
• Asymmetry of creases (groin & bum) - DDH
• General symmetry
• Barlow and ortolani tests for DDH
• Femoral pulses - delay or unilateral absence = coarctation of aorta

Question 7

Risk factors for Hip dysplasia (DDH)

Answer 7

• Female
• Breech
• FHx
• Intrauterine packaging disorders and volume reduction, eg/ first pregnancy, multiple pregnancies
• Wrapping the baby with straight legs

Question 8

Neurological examination in a 6 week examination

Answer 8

• Developmental reflexes: moro, rooting, grasp, stepping, suck (should be gone by 3mo), upgoing Babinski
• Assess tone: should be able to hold head up, some head lag still
• Inspect spine

Question 9

Health promotion in 6 week examination

Answer 9

• Immunisations
• Passive smoking
• Breastfeeding
• Car safety