Newborn babies undergo a number of important health checks in the first days of life and will also be given Vitamin K within 24 hours. Please note that the following information is UK specific. Please seek information on checks from your healthcare team. It may give you peace of mind to understand exactly what happens where you are.

What is the Apgar score?

This one was made a bit famous by Bridget Jones’ Diary, but it is not really a competitive thing, as her ‘Smug Married’ friends make it! Apgar tests are used to check a newborn’s health so that any necessary medical treatment can be given as soon as possible. Breathing, heart rate, muscle tone, and response to stimuli are measured at a minute after birth and again at five minutes to ensure that he or she is adjusting to life outside the womb. They’re usually done so quickly and efficiently by midwives that you may not even notice they’re happening. The score will be repeated five minutes later in babies with a low score who need resuscitation.

The five factors that the Apgar store takes into account are scored between 0 and 2, and then these scores are added together. Most babies score between seven and ten. No baby gets ten out of ten at birth. A baby who scores under seven will usually need medical help, as you can see from the table below.

Apgar scoring:

What is measured	0	1	2
Breathing	The baby isn’t breathing.	Slow, irregular or laboured breathing	Effortless, normal breathing
Heart rate	Absent	Less than 100 beats a minute	More than 100 beats a minute
Colour	Blue-grey	Pink but with blue extremities	Pink all over, including extremities
Muscle tone	Floppy or not moving	Moving the extremities a little	Active with spontaneous movements
Response to stimuli	No response to stimuli like gentle pinching	Grimaces in response to stimuli.	Active response to stimuli! Pulling away, and possibly sneezing, coughing or crying.

What about the first physical checks?

These are also extremely important. During his or her first day of life, your baby will receive a thorough medical examination from a doctor or midwife. This is to make sure he or she is healthy, as well as to check for problems or abnormalities. This will cover the heart and lungs, head, mouth, hands, feet, hips, and spine. Her eyes will be checked for any obvious abnormalities, and she will be examined to see whether her tummy feels as it should and if the cord stump looks healthy. Her fingers and toes will be counted, and her feet will be checked for talipes, which can cause one or both feet to turn in or out at the ankles. The genitals and the pulses on the baby's legs will be checked to ensure they’ve formed normally, and the skin will be checked for any birthmarks. You will be asked if your baby has passed meconium (the first baby poo) in the first 24 hours. Some babies have reddish crystals in their urine that are normal but still need to be raised with your doctor or midwife. They can be a sign that your baby is mildly dehydrated, and if this is the case, they can support you with feeding.

How is my newborn’s hearing checked?

Your baby’s hearing will usually be tested before he or she leaves the hospital. An automated oto-acoustic emission (AOAE) screen involves placing a small soft earpiece in your baby’s ear and playing gentle clicking sounds. This does not harm the baby.

If the doctor or midwife detects a problem with your baby, the course of action would depend on the time of discovery and the nature of the defect. We realise any checks performed on newborn babies can be anxiety-inducing. Congenital defects are relatively rare, and most are mild and very treatable. Some won’t need treatment at all.

What is the heel-prick test?

This blood test checks for nine serious but treatable illnesses. These include cystic fibrosis, congenital hypothyroidism, sickle cell disease and several metabolic disorders. These are rare, thankfully, but it’s still very important to check for them as it is important to pick them up as early as possible. For the few babies that test positive, the screening can result in treatments that prevent severe disabilities and even save lives. The heel-prick test carries no known risks.

Phenylketonuria (PKU): this inherited condition affects the ability to process a type of amino acid found in food. Babies with PKU may be treated with a special diet that allows them to live normal lives. Left untreated, PKU can cause irreversible mental disabilities.
Medium-chain acyl-coA dehydrogenase deficiency (MCADD): this condition prevents a baby from metabolising fats properly, which can lead to serious illness and may be linked to cot death. If identified early, it is treatable through medication and diet.
Maple syrup urine disease (MSUD): This is another issue with processing amino acids that can be treated with a low-protein diet. MSUD is an inherited condition, and without treatment, it can lead to severe and life-threatening symptoms such as seizures or falling into a coma.
Isovaleric acidaemia (IVA): This keeps a baby from processing the amino acid leucine and can cause the buildup of harmful substances in the blood. Again, a special diet is required, as well as supplements.
Glutaric aciduria type 1 (GA1) is another amino acid metabolising issue that can cause harmful substances to build up in the blood and urine.
Homocystinuria (pyridoxine unresponsive) (HCU): This means the body can't process the amino acid methionine. Supplements will be required, or if your child doesn’t respond to these, they’ll need a low-methionine diet.
Congenital hypothyroidism (CHT): in this condition, reduced levels of the hormone thyroxine cause impaired growth and brain development. Once it’s discovered, a baby is given thyroxine, which lets them develop normally.
Cystic fibrosis (CF): This inherited condition affects the digestion and lungs and can be managed with a high-energy diet, physiotherapy, and medicines. Babies with cystic fibrosis find it difficult to gain weight and often have chest infections, though they can still go on to live full, healthy lives with the right treatment.
Sickle cell disease: This affects haemoglobin which carries oxygen around the body. It can cause anaemia, severe pain and infections and it is helpful to know about the diagnosis early in a baby’s life.

When will I find out if my baby has something?

You should receive your results within six weeks of birth, by post or phone call. We recommend that you record the results in your baby’s red book, or personal child health record, for you to keep. This book should be taken to all your baby’s health and development reviews and GP visits. Even though the reviews end when your baby is two, you usually need to keep the book until they are four, so find a safe place for it!

Most test results will come back normal, indicating that it is unlikely they have any of the conditions. Very occasionally, a baby tests positive for one of these conditions. This does not necessarily mean they have it, just that they’re more likely to have it. They will be referred to a specialist for further tests.

The cystic fibrosis screening picks up some babies who may be genetic carriers of the condition. These babies may need further testing. Screening for CF does not detect all carriers.

Why does my baby need a Vitamin K injection?

Like the screening test, you can decide whether you want your baby to be given Vitamin K within the first few hours of life or not, but it is highly recommended. Newborns don’t have a very good supply of vitamin K, and it’s essential for blood clotting. Lack of vitamin K in some babies can lead to haemorrhage with potential long term effects. If you don’t want the injection but still want your baby to have the supplement, it can be given orally, but in three doses. The midwife will give one at birth, and then drops are given to you to take home and give when your baby is one week and one month of age. It’s worth remembering that oral supplements may not provide as much protection as the injection, as we’re not sure how much a baby receives. No side effects will happen, whichever form you choose.

How will my baby be checked after birth?

Unii has all the information you need about baby's first checks.