head circumference

Screening Tests for Baby

Now that your little bundle has arrived safely before you go home are some recommended routine screening tests (20) that your baby will require. for some of these tests, we need to obtain your consent.


When your baby is born, your midwife will be observing your baby quite closely. We do this to obtain your baby’s APGAR scores. The APGAR score is your midwife’s way of checking that your baby is adjusting well and does not need assistance in transitioning to new life. APGARs cover five baby observations; each of these scores 0, 1, or 2 (with zero being poor and two being excellent).

  • A – Activity (your baby’s muscle tone)
  • P – Pulse (your baby’s heart rate)
  • G – Grimace (your baby’s reflexes)
  • A – Appearance (your baby’s skin colour)
  • R – Respiration (your baby’s respiratory rate and effort) (21)


Newborn Check

In the first 24 hours of life, we will conduct a brief check of your baby. Straight after birth (after you have had time skin to skin and have given your baby a feed), your baby will be weighed, her length and head circumference measured. We also do a brief check of her reflexes and anatomy.

This includes (20):

  • General appearance – skin appearance and colour, activity, alertness, posture and reflex to stimuli.
  • Growth – weight, length measurement, head circumference and correlation to percentile charts
  • Head, neck, face – shape, size, scalp appearance, fontanelles, sutures, eyes, nose, ears, internal mouth anatomy, jaw.
  • Upper Limbs (shoulders, arms, hands) – structure, number of digits, palm creases, symmetry, length.
  • Chest – heart rate, respiration rate, chest rise and fall, symmetry, breast anatomy.
  • Abdomen – symmetry, shape, size, organ palpation, umbilical cord
  • Genitalia – penis examination (foreskin, size, colour, testicle position), vaginal examination (labia, clitoris, hymen), anal positioning, opening and anatomy.
  • Lower Limbs (hips, legs, feet) – checking for ‘clicky hips’ through rotational manoeuvres, leg lengths and symmetry, feet digit check and observations.
  • Back – spinal symmetry and curvature, skin, buttocks examination
  • Brain (neurological) – muscle reaction, movement, tone, reflexes, cry, behaviour, activity, posture (20). If we find something is not as it should be, then we will recommend a baby specialist (a Paediatrician or Neonatologist) examine your baby.

Healthy Hearing

In most parts of the world, your baby will undergo a healthy hearing screen. This test is performed by a health professional who trained in newborn hearing assessment. This examination usually occurs during your hospital stay. However, sometimes time constraints, early discharge, or birth away from the hospital means that you do this as an outpatient. This test is not invasive and is best performed on a calm baby who arrives for the appointment awake and ready to sleep. Therefore, after a breastfeed usually is ideal.

The length of time the test takes varies for each baby. It is important to remember that if you are concerned about your baby’s hearing, you should speak to your GP (22). During the test, your baby will have some special earphones and cables applied to her head and neck. The sounds played through them trigger electrical impulses in her brain. An attached machine then detects these brainwaves and reports on their normality.

Newborn Screening Test (NNST) or Heel Prick test

In Australia, we offer every family the opportunity to consent for their baby’s blood to be tested with a heel prick test. This screening is done to identify babies who may be at risk for rare but severe conditions of metabolism, such as cystic fibrosis. The reason this test is beneficial is that early detection can be vital for long term treatment and outcomes.

Your midwife will collect this blood sample between 48-72 hours of age. We prick your baby’s heel with a unique tool and drop the blood onto a special paper card. We need to fill all three circles for the test to be valid. Because we are pricking your baby’s skin, she may become upset.

Therefore, it is helpful to feed your baby (if possible) while we are doing this because breastfeeding is a natural pain relief for baby. Sometimes though she will be more distressed because we are holding her foot and she is unable to move it freely. Baby’s blood should freely drop and not require much squeezing or force from the midwife.

Occasionally a baby will need to be pricked twice, and this can be kinder than trying to squeeze blood from a puncture that isn’t bleeding well. Sometimes your baby may require retesting because of a fault occurring with collection or transfer (23). With this test, no news is good news.

Nikki-Lee Rossiter (BMid), Registered Midwife
Photo by Syda Productions used under license from Shutterstock.com